BMJ  2007;334:490 (10 March), doi:10.1136/bmj.39143.032801.1F

Letters

Translation services

Let's talk about critical consciousness

Jones is correct that many people with limited English who seek NHS care are vulnerable, sick, and disempowered and have good reasons why they cannot immediately or easily learn English.¹ Adams is also correct that providing a free translation service creates a perverse incentive for people to resist the social integration that could improve their health and wellbeing.² But translating what is said is often the least problematic task faced by the professional interpreter, whose multiple (and inherently conflicting) roles also include those of advocate, cultural adviser, negotiator, broker of trust, professional friend, teacher, taxi service, and citizens advice bureau.³⁴⁵ Translation without careful attention to the patient's health literacy, receptiveness, and personal priorities (for right of residence, housing, and so on) may erode rather than enhance doctor-patient communication.⁴⁵

Before we all lock horns over "paying for translation," let us shift the debate to more fruitful territory. I propose we start with three principles: (a) people most in need of healthcare are least likely to seek it or receive it; (b) citizen engagement is essential if society is to enjoy maximum health and productivity; and (c) education has a critical role in creating engagement and liberating society's most vulnerable members from oppression. Perhaps it is time to stop using NHS interpreters as bilingual parrots in medical consultations and instead develop them as community educators. My team is currently testing such an approach in a randomised trial (www.newhamuniversityhospital.co.uk/poseidon/).

University College London, London N19 5LW

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Competing interests: None declared.

References

1. Jones D. Should the NHS curb spending on translation services? BMJ 2007;334:399. (24 February.)[Free Full Text]
2. Adams K. Should the NHS curb spending on translation services? BMJ 2007;334:398. (24 February.)[Free Full Text]
3. Greenhalgh T, Robb N, Scambler G. Communicative and strategic action in interpreted consultations in primary health care: a Habermasian perspective. Soc Sci Med 2006;63:1170-87.[ISI][Medline]
4. Robb N, Greenhalgh T. "You have to cover up the words of the doctor": the mediation of trust in interpreted consultations in primary care. J Health Organ Manag 2006;20:434-55.[CrossRef][Medline]
5. Angelelli C. Medical interpreting and cross-cultural communication. Cambridge: Cambridge University Press, 2005.

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