Risky business of using student interpreters

Using medical students to interpret languages in clinical settings presents ethical and medicolegal challenges

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Medical students who speak a language other than English are acting as interpreters in healthcare settings, despite having no formal qualifications in interpreting, researchers say.

An Australian study, recently published in the MJA, found more than 70% of medical students could speak at least one language other than English. Of these students, 36% had been asked to interpret during their clinical rotations and 34% had done so.

The researchers gathered data from the medical students enrolled in the graduate medicine program at the University of Melbourne using an anonymous online survey.

“Our findings suggest that Australian medical students who speak another language are often invited to act as interpreters during their clinical placements. Many students accept this invitation and some even volunteer,” the study authors said.

But despite the frequent use of medical students as an interpreting tool, the practice isn’t without risk.

“…The use of ad hoc interpreters (including family, friends and staff) instead of professional interpreters has been associated with greater risk of clinical error,” the study authors said.

Government policy in Victoria (where the study took place), and most other jurisdictions, require patients to have access to professional interpreting services in situations considered to be “high-risk”, such as when gaining informed consent.

Associate Professor Christine Phillips, from the academic unit of primary care at ANU, Canberra, said using a student to interpret in any clinical setting could cause medicolegal risks.

“It is the clinician who has to be able to say they are confident that the patient understood what they signed and (if you decide to let a student interpret) you are therefore vouching for the competence of the student who did the language support,” she told The Medical Republic.

“The student is also in a grey area because (in most cases) the student is registered by AHPRA and may also have to take responsibility in a way that wouldn’t happen with a trained medical interpreter. (The interpreter) only bears the responsibility of being a good interpreter, but won’t bear responsibility for the patient consent,” Professor Phillips said.

The students in the study described a diverse range of experiences from translating a few words right through to interpreting complex interactions which involved gaining informed consent and delivering bad news to patients or family members.

But Professor Phillips said supervising doctors should be looking after their students and protecting them from interpreting in difficult situations.

“In my time as a medical educator, I’ve seen medical students become quite traumatised by what they have interpreted, or they felt guilty because they weren’t able to interpret what they said they could or they feel pressed into interpreting beyond their capabilities,” she said.

Professor Phillips said it was also important for students to know they could deny requests from supervising doctors to interpret if they were uncomfortable in doing so.

“I will often give the students a set of words to use such as: ‘This hospital has an interpreter service that you should contact,’ or if they are in primary care, ‘You can get a free service by calling this number instead of relying on me’,” she said.  

Another issue was whether doctors were using medical students to interpret out of convenience, instead of using the other services available to them.

“If you are doing it for convenience then you need to think about the risks that you are running, including language competence, and the risks you are exposing that student to,” Professor Phillips said.

All GPs in Australia have access to a doctors’ priority line for the free over-the-phone interpreting service distributed by the Department of Social Services.

The service, which is available at all times, claims it can usually find an interpreter in the requested language within minutes.

Although some GPs may be hesitant to use over-the-phone interpreters, Professor Phillips said it was an easy way to mitigate the risk presented by using someone who is untrained in this area.