Opinion | In medicine, a simple misunderstanding can kill

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“How many times do I take the medication a day?”

“Once.”

When you read that short interaction, I bet what you took away from it is that the person speaking is meant to take one pill a day. But what if I told you that in Spanish, once means 11 — and the patient misunderstood and ingested 11 pills when they were only supposed to take one? Obviously, that would be incredibly damaging to the patient’s health, and all because of an interpretive issue involving one simple four-letter word. Four letters can make the difference between life and death.

This isn’t a theoretical situation. It is a true story. At an L.A. County hospital, this exact misunderstanding occurred, and it resulted in the patient’s death. Health care’s purpose is to save and improve lives, not end or endanger them. Yet because of language barriers within the system, many patients are harmed due to miscommunication between them and their providers. During the COVID-19 pandemic, this issue became especially visible. A study conducted by the University of Minnesota found that patients who were not proficient in English were twice as likely to be hospitalized as those who were native English speakers.

The Twin Cities has a growing immigrant population, and in 2020, more than 8% of residents were reportedly not proficient in English. However, our health care system has failed to adapt to the changing needs of this population, resulting in inequalities in both access to care and quality of treatment — particularly for Somali, Hmong and Latino communities. While interpreter services are available, they are extremely flawed. They are understaffed, mistrusted and often undertrained, requiring as little as 10 hours of training with little to no oversight. With pay averaging around $30 an hour, recruiting and retaining qualified interpreters has proven to be an ongoing challenge.

Dr. Needle-Suarez shared the story of a patient who went in for what she believed was a routine Pap smear. Because she was not fluent in English, she unknowingly signed consent forms for a hysterectomy instead. Fortunately, the error was caught in time, but this is not always the case. Incidents like these damage trust in the health care system and harm the relationships between patients and providers — relationships that are essential to effective care.

In pediatric intensive care, these challenges are even more complex. Parents must consent to care on behalf of their children, adding another layer of responsibility and risk. Needle-Suarez explained that many families prefer to rely on English-speaking relatives rather than professional interpreters, because they trust them more. However, hospital policies often discourage this practice due to concerns about ethics and privacy.

While these concerns are valid, families’ mistrust of interpreter services is not unfounded. Needle-Suarez has even witnessed cases in which interpreters discouraged families from asking questions. At the same time, relying solely on family members — especially in complex medical situations — is not a sufficient solution either. So what is the solution?

The reality is that there is no perfect fix. The system is flawed. However, that does not mean we cannot improve outcomes and reduce harm. Needle-Suarez proposes approaching this issue through the lens of harm reduction. Harm reduction acknowledges that some level of harm may be inevitable and focuses instead on minimizing it as much as possible.

One critical step is creating a health care system in which patients feel respected and heard. As Needle-Suarez noted, “People are meant to feel like outsiders because systems are set up in English.” Health care workers are trained within this framework, which leads to communication issues that extend beyond language alone. She explained that “doctors don’t have good radar for when something isn’t being interpreted appropriately,” and that polite nodding is often mistaken for understanding when it is actually a response to power dynamics. These assumptions leave patients feeling devalued and misunderstood.

Finally, she argued that we must stop enforcing a false binary between using professional interpreters and using family members. “We need to create a spot in the system for both,” she said. Family members bring insight into a patient’s values, culture and history, while interpreters provide technical and medical expertise. Both have limitations, but together they can address gaps in communication more effectively than either could alone.

Ultimately, this is a systemic issue that requires systemic solutions. We need increased funding for interpreter services, standardized qualifications and training programs, and policy enforcement that protects patients’ agency and rights to involve their own support systems alongside professional interpreters. Access to health care is a human right, so let’s make it accessible.