Lost in Translation
Fawne Cady
University of Maryland University College
Turnitin Originality Score: 7%
Turnitin Originality Score: 7%

Abstract
Managers who take time to become familiar with the basic cultural beliefs of a patient foster an environment of mutual respect and consideration. Cross cultural communication can enhance patient-provider relationships and improve quality of care outcomes. Cultural unfamiliarity hinders autonomy of the patient and threatens an optimum level of care health care professionals are sworn to strive towards. Language barriers and mediated conversations hinder communication and foster an environment filled with confusion and apprehension. This essay reviews a scenario featuring a health care team’s disregard for communication barriers and its impact on an Iranian man diagnosed with cancer. Recommendations are offered on traditional American College of Healthcare Executives (ACHE) approaches to cross cultural medicine as they apply to this scenario. The ultimate objective is for health care providers and administrators to be aware of the possible impacts elicited by the lack of attention to language barriers and to provide approaches to combat these obstructions of quality health care. Keywords: cross-cultural medicine, cultural miscommunication, cultural awareness

Lost in Translation Hospitals in the United States are not restricted to serving a single language population or culture. Many medical professionals consider cultural barriers a hindrance and do not make time to familiarize themselves with other cultures before providing care. This unawareness results in ethical dilemmas that question autonomy of the patient and does not promote beneficence. First, this essay examines violations of basic ethical principles as related to Mr. Tabrtizi. Next, the writer addresses the impact of cross-cultural communication barriers presented in the scenario, and provides sound approaches to resolve. Finally, the paper provides the best solution for a manager to utilize in order to handle Mr. Tabrtizi’s case with a high level of cultural competence.
The Ethical Impact of Cross-Cultural Communication Barriers Peterson-Iyer (2008) presents an ethical dilemma featuring Farhad Tabrtizi, a 69-year-old immigrant from Iran. Mr. Tabrtizi was treated in an American hospital by health care professionals who displayed little regard for cultural sensitivity. The physician’s diagnosis of cancer was lost in translation and Mr. Tabrtizi’s treatment options were not clearly translated by his English speaking son.
Dilemma
Due to a language barrier, the provider does not provide Mr. Tabrtizi with accurate or thorough treatment information. Due to inaccurate translations, the patient is never fully informed of his treatment options, nor is he told he has cancer. The provider is unaware of Mr. Tabrtizi’s lack of knowledge due to his inability to understand Farsi. The collaboration of the above issues cause confusion and inhibits the patient’s ability to make informed decisions about his treatment. Additionally, Mr. Tabrtizi is not able to clearly communicate information necessary to provide adequate treatment such as pain level or previous medical history. His inability to effectively communicate information limits treatment options and hinders outcomes.
Ethical provisions violated: 1. “Work to provide a process that ensures autonomy and self-determination of patients or others served” (ACHE, 2011). 2. “Provide prospective patients and others with adequate and accurate information, enabling them to make enlightened decisions regarding services” (ACHE, 2011).
ACHE-Based Approach: Hire a Translation Service Based on his documented experience treating cancer patients in Sri Lanka, Dr. Dayasiri (2011) recommends adding a professional translator to the treatment team. An accurate translation from patient to provider/provider to patient affords the patient with an independence to make his own treatment decisions. Additionally, medical professionals receive appropriate information via translation necessary to make informed decisions and provide quality treatment.
Strength
Dr. Dayasiri has developed extensive research treating cancer patients in Sri Lanka. His findings reflect translators as “indispensable in relaying symptoms, providing an accurate patient history, communicating instructions about medications, and discussing diagnoses and treatment options” (Dayasiri, 2011, page 773). Translators enable the provider to relay important treatment diagnosis and options. This is important because the patient is unable to make informed decisions about his care unless he is privileged to and fully understands all information related to his medical condition. In addition to their knowledge about the language, he notes translators are also often aware of indirect cultural indicators such as body language and other cultural nuances that may aid in treatment (Dayasiri, 2011).
Weakness
There are two notable pitfalls to hiring a professional interpreter. Dr. Dayasiri (2011) notes while interpreters may serve a health care team extensively, they are expensive and not always readily available. Also—a medical professional still does not know for certain the patient is receiving all applicable information necessary to achieve informed consent or to make informed decisions about his treatment options. A question of true autonomy still lingers.
ACHE-Based Approach: Depend on Family Member to Translate Family members, like Mr. Tabrtizi’s son, often serve as translators when a language barrier exists. This no-cost option may be appealing to managers, but it is not without risks.
Strength
Family members are the most economic route to addressing cross-cultural communication barriers since they come at no financial cost. In many cultures, medical decisions are not strictly made by the patient, but collectively—as a family (Kai, Beavan, & Faull, 2011). In this dilemma, the patient-centered approach also includes Mr. Tabrtizi’s family.
Weakness
While Mr. Tabrtizi’s son appeared to translate the physician’s diagnosis and recommendations, the diagnosis of cancer and his options for treatment were not clearly communicated. It is possible his son’s initial emotional state may have hindered his ability to accurately translate the information. Kai, Beavan, & Faull (2011) reveal family members may withhold diagnosis to encourage the patient to fight the illness or to prevent their final days from being peaceful.
When a patient is unable to convey his thoughts and feelings on his own, he must depend on his family to speak for him. This dependence transfers ownership of many decisions related to his own care from him to his family member(s). Health care is no longer patient-centered; autonomy is threatened.
Final Thoughts/Best Solution
In Mr. Tabrtizi’s case, a professional translator is the best solution. A health care manager must advocate for her patient(s). The ultimate solution to any ethical dilemma should be based upon safeguarding patient rights, ensuring autonomy, and fostering an environment of prime medical care. Language barriers arise in hospitals because many non-English speaking immigrants call America home and depend on health care professionals to treat their ailments. Disregarding this barrier does not provide the patient or provider with adequate information. The only way for a health care administrator to resolve this dilemma is by taking a patient-centered approach. The ACHE (2014) stresses the importance of a patient-centered approach to care. A professional translator removes emotional factors, advises the patient of his rights, and encourages autonomous care.

References
American College of Healthcare Executives (2014). About ACHE: ACHE code of ethics. Retrieved from http://www.ache.org/abt_ache/code.cfm
Dayasiri, M. C. (2010). Ethics of cancer palliative care in Sri Lanka. A cross- cultural perspective. Australasian Medical Journal, 2(12), 772-776. Retrieved from http://eds.a.ebscohost.com.ezproxy.umuc.edu/ doi:10.4066/AMJ.2010.436
Kai, J., Beavan, J., & Faull, C. (2011). Challenges of mediated communication, disclosure and patient autonomy in cross-cultural cancer care. British Journal of Cancer, 105(7), 918-924. doi:10.1038/bjc.2011.318
Peterson-Iyer, K. (February, 2008). Markula center for applied ethics. Cancer: A Failure to Communicate. Retrieved from http://www.scu.edu/ethics/practicing/focusareas/cases.cfmfam