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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Tuesday, April 01, 2003
    When the Interpreter Is a Child

    The state of California is pondering a bill that would prevent children from interpreting for their parents to doctors or lawyers. You can read more about the bill here.

    Children are often inappropriately used as interpreters for their non-English speaking parents in medical, legal or social service settings, said a San Francisco lawmaker who introduced a bill Tuesday to ban that practice.

    "I think that all of us who come from an immigrant background have had an experience of having to translate for our parents," said Assemblyman Leland Yee, who immigrated to the United States from China when he was 3.

    Asking a child to translate information about medical or legal problems can hurt the parent-child relationship, traumatize the child and can result in a less-than-accurate interpretation of health advice, said Yee, a Democrat.

    His bill would ban state agencies and organizations that use state money from using children as translators. Those groups could instead turn to professional or volunteer interpreting services, community groups or ask older family members to translate, Yee said.

    Now in theory I think this is a really good idea. Have you ever tried to take a sexual history from a patient using a child (or, indeed, any family member) as an interpreter? It destroys patient privacy. There's also no way to know that the child will be able to understand the terms the doctor is using, even if the problem is couched in layman's language. Unfortunately in a state like California, where there are literally dozens of languages spoken, there is no way to ensure that a non-family member will be available to interpret. We're not just talking about Spanish here - I have patients who speak Russian, Armenian, Hindi, Chinese, Korean, Tagalog... there's no way we can cover all those bases.

    But people bring their family as translators because it's convenient and it's free. Often children are the only people available to the patient who are even partially bilingual. And doctors don't have the time or funds to find translators for patients in multiple languages:

    Medical providers warned the bill could cause access problems for Medi-Cal patients in rural areas because doctors won't be reimbursed for the expense of hiring an interpreter.

    Interpreting services cost about $1 per minute, said Heather Campbell a lobbyist for the California Medical Association. If a doctor has a 15-minute visit with a patient, Medi-Cal pays $22 for reimbursement, she said.

    After paying for the interpreter, the doctor would be paid $7 for that patient's visit, Campbell said.

    "It will probably stop physicians from taking patients who bring in a child as an interpreter," she said.

    We shall see. I definitely think more interpreters should be available as a resource for doctors and patients - it could only improve communication between them - but if the bill passes and does, in fact, restrict access to health care for Medicaid and other patients by discouraging doctors from accepting them, it won't have done any good.



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