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The role of the interpreter is to convert a source language input into its equivalence in the target language. The interpreter themselves must be able to convey the same message accurately and completely, while maintaining the flow of the conversation between physician and patient in real-time. There are also cultural and linguistic interfaces, where certain conditions or words may not be directly converted to the target language. A true interpreter uses competencies beyond dual language proficiency to avoid literal interpretations when it paints an incomplete patient experience. 

July 2020

Talking Heads

Linguistics 101




My Spanish ain't perfect. [Heck, clearly my English isn't either.] I learned Spanish at home and up to the third grade in school. My parents' formal education did not exceed 3rd/4th grade-level in their respective, native countries. I thought in bits of Salvadoran- and Mexican-accented vocabulary, then my brain switched lexicons and English became dominant. My L1 (Spanish) and L2 (English) are not equivalents, and there's significant attrition over time. This is why I own at least ten Spanish dictionaries. I am also perfectly okay when Axana corrects me, so that I do not sound like the foul-mouthed, acute & tilde accent-avoiding, code-switching, excessive discordant hand-gesturing savage that I am outside of professional settings. 


Self-awareness of language limitations is important for healthcare personnel who want to interpret. The best way to assess your ability to speak Spanish in a clinical setting is by getting certified. If taking a language assessment exam seems unnecessary, then use a certified interpreter. Spanish monolingual patients are not practice sessions for your Medical Spanish, especially when they are unable to assess if the intended interpretation is correct or may not  point out noticed mistakes out of respect. Your patients' quality of care may be put at risk in your honest attempts of linguistic competence. Regardless, you can still flex your growing Spanish skills at the beginning of patient encounters, but as soon as clinical topics are ready to be discussed, have the interpreter do the heavy work


I am thankful for professional interpreter services AND those whose L1 Spanish was academically formal (or even just less crass than mine) and culturally competent. If you're one of those two, DO NOT ever stop correcting your less fluent peers when they mess up in Spanish. 

They should never hold it personally against you. This is not personal attack on them as a person when calling out their Spanish limitations. A good colleague will welcome corrections for their own progress. In the end we are all working toward the same goal: providing the best care for our patients using the most appropriate method.


There is research that show physicians are likely to overestimate their fluency in Medical Spanish, more so following Spanish courses. "False fluency" is a real problem in healthcare. Know your limitations, and play to your strengths. Learning a new language is a big challenge. Doubt anyone who claims mastery after taking a ten-week crash course or even a three-month medical trip to Mexico.  


Patients are more important than possible misunderstanding between two adult colleagues. Cultural, linguistics and psychosocial factors are not optional in healthcare, where "fluency" in each must be challenged and improved continuously throughout our careers



L1 - Native language, first learned. 

L2 -  Language learned later that is not the native or first language. 

Dominant - in terms of language does not always equate to L1; language most comfortable with. 

Phonological transfer - bilinguals often pronounce the sounds in one language  with sounds native to their other language. 

"Bilingual Advantage" - controversial neurolinguistics, 

relating mostly to executive functions and maintaining cognitive reserves.


Interpreter Services are also available 24/7 over the phone or even through iPad for video.


When in doubt...

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–Table from:

Regenstein M, Andres E, Wynia MK. Appropriate Use of Non–English-Language Skills in Clinical Care. JAMA.2013;309(2):145–146. doi:10.1001/jama.2012.116984

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