The use of interpreters may be mandatory with foreign language speaking patients, but it is self-evident that the translator should not be a family member. This is not only true with Hispanic patients but all non-English, foreign born and reared injured workers. The family members are not impartial/objective individuals. If the orthopedist asks `how severe is the pain’, the patient may reply that it is `extremely severe,’ but the family member may rephrase this to be `somewhat severe’ because the family member has seen the patient engage in tasks that extreme pain would never permit. And, the contrary is also true: the patient indicates that the injury is `sometimes painful’ and the family member who may be invested in tangible (financial) gain will re-interpret this as `always painful.’
In my office, family are more often a distraction for the patient and encourage distortion in obtaining data. They have become embroiled in the patient’s injury to the extent that they feel that their perceptions, needs, interests, fears and frustrations are as important, if not more important, than those of the patient.
But equally important is the issue of embarrassment and humiliation. The patient may be reluctant to acknowledge fears and inadequacies in the presence of their spouse, sibling, child or parent. While one would assume that family comes first in all matters, there are simply many significant areas regarding the impact of injury that the patient will not acknowledge in the presence of family members or friends.
The patient may want to tell me that he is drinking throughout the day, has problems with physical intimacy, feels emasculated by the injury, is fearful of re-injury and is having flashbacks and intrusive recollections of the injury, yet he may be completely unwilling to admit to these to family.
The use of interpreters with excellent experience in physical and emotional trauma who faithfully translate all that a patient is communicating is invaluable. But using an interpreter who is present at other doctor’s appointments, or who doubles as a transportation service, presents the same potential for embarrassment as the family member, and invariably inhibits the patient’s willingness to discuss personal problems.”