Medical students as ad hoc interpreters and trauma by proxy

We must educate and provide resources to medical students and institutions.

REMARK

“I’ve been feeling bad since I got COVID. My chest pain is unbearable. It hurts so bad. I wish I had come earlier but I don’t have health insurance. Please, tell me it’ll be ok. Please.”* I said these words in a sad tone, in pain and with a hint of desperation. That’s the job of an interpreter: relaying everything that is said by a patient. I embodied the feelings of the patient so that the team understood her pain.

Interpretation is its own work of art – a theater where the interpreter receives the lines live and expects to perform them immediately. Before you can process this, you start receiving more lines and continue playing. Except the lines you receive are real words spoken by real patients who are going through deep disease processes. Sometimes you interpret sickness, pain, and grief, while other times you interpret happiness.

When you channel grief and worry, you are also unknowingly enduring vicarious or secondary trauma. The secondary trauma is accentuated by the practice of interpreting by speaking in the first person.1 Vicarious trauma—known interchangeably as secondary trauma—occurs in clinicians, interpreters, and medical students who absorb the traumatic experiences, words, and feelings of their patients.2 Vicarious trauma can be painful and transformative. Symptoms of secondary trauma include reimagining of the traumatic event, intrusive thoughts, irritability, and generalized anxiety, among other post-traumatic stress disorder (PTSD)-like symptoms.1 Lack of experience and increased exposure to patient stories make medical students more vulnerable to secondary traumatic stress.1

As a medical student without professional training as an interpreter, I act as an ad-hoc interpreter. Often in a healthcare setting, this can be for a family member, physician assistant, nursing staff, and medical students. I started interpreting for my mother when I was about 9 years old. It was then that she injured her shoulder and had several doctor‘s appointments and an operation. Being an ad hoc interpreter and language broker is very common for Latino immigrant children.3 For most of us, interpreting for our loved ones has been what exposed us to the medical field. Some of us have had great experiences, and others have been fueled by injustice. We hoped that our culture, language, and stories would lead to better health care outcomes for our Latinx community.

However, many of us have found ourselves regressing to ad hoc interpreters during our clinical rotations. Several studies have shown that medical students also experience vicarious trauma in wards.1 We may feel grief, anger, shock or sadness during rotations, especially when we lose a patient. What happens to medical students who fulfill both roles? And why is it so important? From what I’ve seen, the majority of my fellow bilingual medical students and ad hoc interpreters come from communities underrepresented in medicine (URiM). We already know that URiM students face structural barriers and racism. Many are the first in their families to go to medical school. What if URiM medical students also bear emotional trauma vicariously as interpreters?

Personally, it was through my own therapy that I gained some insight and was able to process the vicarious emotional trauma I experienced in the wards. It was through my own therapy that I was able to recognize that my role as an ad hoc interpreter was also triggering my previous trauma as an ad hoc child interpreter for my mother during her doctor’s appointments.

It is imperative that physicians, healthcare workers and other professionals recognize the vicarious trauma that medical students can experience during ad hoc interpreting and therefore choose to use professional interpreters instead.4 Healthcare teams can allow medical students to speak to their patients in their native language. However, medical schools and institutions should have clear guidelines, language assessments, and support for students choosing to interpret for LEP patients.5 It is also important that medical students who act as ad hoc interpreters receive therapy services and workshops on vicarious trauma, and are educated on how to set boundaries with their teams. The work, above all, should focus on the institutions to provide these resources and emphasize their importance for the well-being of doctors in training.

*Patient quote has been changed to protect patient privacy.

Ms Mendoza is a medical student in the Medical Education Program for the Latin American Community (PRIME-LC) at the University of California, Irvine (UCI) School of Medicine. She is co-founder and co-chair of the child and adolescent psychiatry interest group at UCI and an. advocate for diversity in mental health. She is currently working on a qualitative research project with Violeta Osegueda PGY-1 at UCLA/VA Psychiatry on this very important topic.

References

1. Crumpei I, Dafinoiu I. Secondary traumatic stress in medical students. Procedia Soc Behav Sci. 2012;46:1465-1469.

2. McCann IL, Pearlman LA. Vicarious Trauma: A Framework for Understanding the Psychological Effects of Working with Victims. J Traumatic stress. 1990;3:131-149.

3. Kam JA, Lazarevic V. The stressful (and not-so-stressful) nature of language brokering: identifying when brokering functions as a cultural stressor for Latino immigrant children in early adolescence. J Youth Teenagers. 2014;43(12):1994-2011.

4. Paradise RK, Hatch M, Quessa A, et al. Reduce reliance on ad hoc interpreters in a health system with a safety net. Jt Comm J Qual Patient Saf. 2019;45(6):397-405

5. Vela MB, Fritz C, Press VG, Girotti J. Experiences and Perspectives of Medical Students on Interpretation for LEP Patients at Two US Medical Schools. J Ethnic-Racial Disparities in Health. 2016;3(2):245-249.

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