doc w/ Pen

journalist + medical student + artist

Getting an accurate interpretation

Hormigueo (tingling). Escayalo (plaster cast). Expediente (patient’s file). Presión arterial (blood pressure).

Two weeks ago, I didn’t know any of this Spanish medical terminology. Sure, I’m fluent in Spanish, but these words — as well as a few dozen (er, a few hundred) others — simply never came up in regular conversation. I’m hoping that will change soon, as I have applied to be a volunteer Spanish translator at an urban clinic in Chicago.* Which means, of course, that I will need to know quite a bit of Spanish medical terminology to successfully do my job.

I never took this position lightly. But the more I think about it, and the more I learn about interpreting, the more I understand that “professional” interpreters can make the difference between a successful and an unsuccessful clinican-patient encounter, and between helping a patient making an informed versus an uninformed medical decision. I can help make that difference. I want to help make that difference.

When it comes to demand for Spanish interpreting, the need is only going to grow. According to a 2008 report from the U.S. Census Bureau, the Hispanic population is expected to grow from its level of 15 percent in 2008 to 30 percent in 2050. The percent of non-Hispanic whites is expected to fall from 66 percent to 46 percent — meaning whites are expected to no longer be in the majority, although they will still be the largest minority. And my home state, Illinois, is one of the centers of the Hispanic population. A 2006 U.S. Census Bureau document ranked Illinois as number 5 in the nation in terms of size of Hispanic population (1.89 million). Cook County, IL, my home county, was also ranked number 4 in the nation in terms of Hispanic population size, with 1.2 million Hispanic people.

Along with that increasing number of Hispanic people comes an increasing number of “Limited English Proficient” (LEP) patients in the medical context. These are people whose primary language is not English (Spanish, in this case), and who have difficulty reading, writing, speaking, and understanding English. According to a number of scientific studies, this language barrier can cause many health care problems, as summarized in an article published in Health, Research and Educational Trust in 2006 (“Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency?”):

  • less access to routine care
  • fewer physician visits
  • lower rates of preventive care
  • less follow-up for chronic illness
  • poorer understanding of Emergency Room visits (i.e., diagnosis and treatment)
  • less satisfaction with care
  • more medication complications

When it comes to Spanish, the problem is often not the lack of a translator. The problem is more frequently with the quality of the translation. Very often, “ad hoc” interpreters — people who are untrained, such as family members, receptionists, or other people in the waiting room — are used, which results in inaccurate and sometimes disastrous consequences. Sometimes, it is that the interpreters who are used are simply poorly trained. Because unlike courtroom reporting, there are no  national standards, or even guidelines, for health care interpreting at this time. The National Council on Interpreting in Health Care, an organization dedicated to promoting professional and culturally conscious interpreting, is working to develop a set of training standards (which are set to be done at the end of 2010). The idea is to eventually have national certification for interpreters.

Right now, though, we are far from that. And it is affecting patient care, sometimes dramatically. One study, published in 2007 in The Society of General Internal Medicine (“Are Good Intentions Enough?: Informed Consent Without Trained Interpreters”), found that Latina patients who were at a prenatal clinic being given the choice of whether to have amniocentesis were unable to truly give their informed consent to the procedure. In some cases, their interpreters did not fully explain what the medical practitioner was saying, either because of a lack of fluency in Spanish or a lack of medical understanding in general. In other cases, the procedure was not presented as being “optional,” but as “simply the next step in the clinical process.” In addition, it was often not communicated that there were any alternatives to amniocentesis (while a woman could have an ultrasound instead, although this test is not as definitive).

In short, the complicated nature of translating medical terminology, risks, benefits, potential complications, alternatives, etc. is something that requires more than being bilingual or “good” at speaking Spanish. It requires training and a fluency in medical terminology, in addition to privacy practices and other issues related to health care.

At the clinic where I want to volunteer, there is an orientation/training seminar where volunteers are tested on medical terminology to ensure they meet at least a minimum of requirements. In addition, I have spent hours (and I mean HOURS) studying literally hundreds of flashcards with words copied from my new best friend, the Spanish Medical Dictionary. I may not have to pass a set of national standards at this point, but I have my own standards. And I have set the bar high. Because I am serious about this job — it’s an important one, and it’s even more important to do it right.

 

*I’m still waiting to hear back regarding my application; apparently they are currently reviewing my references.

Health in the Headlines: Life span vs. Health span

Good news, if you’re a roundworm: researchers at Stanford reported last month that blocking the expression of a particular protein can extend a worm’s life span up to 30 percent.

That is good news . . . right?

It depends on whom you ask. Clearly, the Stanford researchers, as well as other researchers who have studied caloric restriction (another method purported to promote long life) think so. But there is another camp of scientists dedicated to improving not so much life span, but health span.

So what does “health span” mean? According to the Macmillan Dictionary’s online “Buzzword” feature, “health span” is “the period in a person’s life during which they are generally healthy and free from serious or chronic illness.” So the focus is on living better, as opposed to living forever.

Sounds simple enough, doesn’t it? But this concept is really a very complex one which scientists are only beginning to grapple with, understand, and research. Ironing out some of the complexities, and getting more scientists, policy makers, and regular people to think this way, though, is key to making sure that “aging gracefully” is not just a catch-phrase.

One major problem in the world of aging research is a disconnect between the viewpoints of clinicians and “basic” science researchers on this very topic. In an article published in the Journal of Gerontology in 2009, authors Drs. James Kirkland and Charlotte Peterson write that “Geriatricians and others providing health care for the elderly have long recognized that disability, frailty, and age-related disease onset are the critical end points that need to be addressed in older populations.” Hence, many clinicians are on the “health span” wagon. However, Kirkland and Peterson also claim that “Most investigators in the basic science of aging use survival curves and maximum life span as key end points for studies of effects of interventions, rather than health span or function.” Hence many basic science researchers are on the “life span” wagon. And when researchers and clinicians are on two different wagons, little if any progress will be made in terms of going from the scientific “bench” to the bedside with new treatments.

What needs to happen, writes Marc Tatar, a biologist at Brown University, is first clarification of the health span concept. While Tatar explores a more scientific definition of health span than the one I previous listed, his comments relate to our more simple definition as well. For example, how do you define “healthy”? What is the threshold between healthy and unhealthy, in terms of time and quality of life? And even if you use baseline performance as a judge, that baseline performance declines over time — how do you factor that in? These issues need to be resolved before any progress can be made, Tatar says.

Once some of that ambiguity is resolved, the next step is to develop a better animal model for studying health span, Tatar says. That will allow researchers to take results and translate them to human models. For example, researchers should look at how best to study osteoporosis — clearly a factor in human health span — in mice, flies, or worms (three of the best animals for studying aging issues).

Kirkland and Peterson agree that better animal modeling is needed, although they focus on the concept of frailty: “Frailty usually describes a condition in which a critical number of impairments occur in parallel, becoming evident after a threshold is reached, and if a stress such as an infection or injury is applied.” They say that indicators of “frailty syndrome” include weakness, fatigue, weight loss, impaired balance, decreased physical activity, slowed motor performance, social withdrawal, mild cognitive dysfunction, and increased vulnerability to physiological stress.

According to Kirkland and Peterson, screening for frailty in humans is being developed and validated, and could be adapted for use in animals. Testing animals for frailty — after giving them an anti-aging compound, for example — could help show whether the added longevity compromised health span, and therefore whether the compound was potentially appropriate for trials in humans.

Living longer, obviously, can be a good thing. But only if that extended life is a healthy one. That’s what the study of health span is about. And while the idea is catching on, it has some catching up to do.