Errors in medical interpretation: our concerns for public health and a call for caution.

Abstract

To the Editor .— We read with concern Flores et al’s findings on errors in medical interpreting in the January 2003 edition of Pediatrics .1 However, upon closer inspection, we find several flaws in the study’s methods and analyses, which may unnecessarily alarm limited English proficiency (LEP) patients and the clinicians who work with them. Errors are an acknowledged part of medical practice.2 There exists a well-developed literature of the analysis of error in clinical practice in general.2–6 Among the error classification system used by the authors, we hold that omission, addition, substitution, editorialization, and false fluency are highly debatable categories, they lack reproducibility, and neither correlate necessarily with quality of interpretation nor the quality of care provided. There are other striking flaws in the study that lead to misleading conclusions: 1. Methodologically, the study lacks proper controls. At the very least, the encounters under analysis ought to have been compared with encounters between non-LEP patients and clinicians, as well as those between LEP patients and clinicians in the absence of an interpreter. 2. The errors are presented out of context: both interpreters and ad hoc “interpreters” are reported to commit, on average, 31 errors per encounter. This, however, represents only 0.81% of potential word errors (considering that each encounter averaged 3781 words), a far cry from the “alarmingly common” (p. 10) frequency claimed by the authors. 3. Errors committed by clinicians were attributed to interpreters. The authors defend this by stating that “the study focus was on errors of interpretation made by any staff member acting as a medical interpreter during a clinical encounter” (p. 7). However, their final comparison was not between the number of errors made when an interpreter was present vs. number of errors made when an interpreter was not present, but rather between …