Lost in Translation: The Real Challenge of Language Barriers

Let’s get something out of the way right up front:

• This isn’t about politics.

• This isn’t about being “anti-immigration” or “pro-Britain” or any of the other culture war bollocks currently oozing out of Westminster.

• This isn’t ignoring nor excusing any unconscious bias I take with me normally - god knows I try not to contaminate

I’m a GP. I work with people. Real people. And I’m telling you something that every clinician knows but almost none will say out loud:

Consultations with patients who don’t speak English are fucking hard.

Not because the patients are bad.

Not because we’re lazy.

Not because we’re secretly fantasising about some monocultural 1950s utopia where everyone says “please” and nobody needs a translator.

But because language is everything — especially when someone’s scared, sick, and stuck in a system that wasn’t designed for them.

The Setup

If you’ve never done one, a translated consultation goes something like this:

• Patient arrives.

• They speak little or no English.

• You phone a translation service (usually Language Line or something similar).

• You wait. You explain. You get connected to a translator.

• The translator introduces themselves. You introduce yourself again.

• And then you begin.

You have 10–20 minutes to:

• Figure out what’s wrong.

• Get a history.

• Identify red flags.

• Manage expectations.

• Avoid culturally inappropriate missteps.

• Explain investigations, treatments, and risk.

• Answer their questions.

• Document everything.

Except every sentence — every nuance — has to go through someone else.

It’s clinical medicine by relay race — with a fragile baton and no practice run.

What You Lose

Now, I’m no communication guru, but I know this:

A huge chunk of general practice happens in the gaps between words — non-verbal cues, tone, pacing, and interruption.

Things you lose when you work through a phone line and a stranger’s voice.

You say:

“Have you had any chest pain?”

Then you wait.

Then the patient talks.

Then the translator says:

“She says… yes. But also no. But she is scared. And it is maybe from food. But also her uncle had heart surgery once.”

And you’re meant to think: “Brilliant. Let me risk-stratify that in 10 minutes.”

Or worse, you hear a 5 minute rant in what sounds like a blood curse to their deity of choice, a sonnet to their lover, and a firebrand political rally all in one.

Then, the translator says:

“Not really”

And you’re left baffled, with no idea how to unpick what just happened off screen.

The Emotional Drain

Now add a couple more layers.

• The patient is distressed.

• They’re scared, they’ve waited two weeks to be seen.

• They’ve brought a list of six things.

• They’re used to a different healthcare model — private, immediate, prescriptive.

• You’re already 15 minutes behind.

• And the translator has to explain to them that no, they are not getting a scan today.

What you’re left with is a slow-burning, emotionally inert game of fuck-you tennis — where both sides are doing their best to be reasonable, but the rally is endless, and no one’s allowed to win.

Even in face-to-face translation where there more nuance, it’s not just about lost data. It’s about cognitive and emotional drain.

You can’t build rapport. You can’t mirror or de-escalate. You repeat yourself. You over-explain. You nod too much. You worry constantly that you’ve missed the thing that matters.

And patients — who are already more vulnerable to poor outcomes when language barriers exist — don’t always know if they’ve been heard. Which makes them louder. Or quieter. Or distressed.

And then we worry — that we’re being impatient. That we’ll be seen as racist. That we’ve lost the plot of our own empathy.

Because we all know what it looks like when a white British GP sighs during a translated consultation.

And it’s not great.

I’m not a Racist - but…

So here’s the bit I want to say with both hands:

Struggling with translation is not the same as being prejudiced.

But if you’re only ever frustrated with “those patients”? You need to ask why.

Yes, there are sterotypes of certain patients for a reason, there’s sometimes truth in all labelling in the same way that all pain is funny when you don’t think of the damage it causes. If you work in areas where these are more prevalent it’s easy to feel like this is the norm.

There is a key difference between:

• A clinician who’s burned out, overwhelmed, trying their best and didn’t need that extra layer just now.

• A clinician whose frustration always lands on the same kind of patient because of who they are - and that complexity proves it.

One is human. The other is bias with a lanyard.

And that difference matters — because the former needs structural support.

The latter needs a long look in the mirror.

And Yet…

Here’s the punchline:

I still think these consultations are important. Necessary. Worth the effort.

Because healthcare access should not depend on language.

Because being ill in a foreign system is terrifying.

Because care isn’t just about ease — it’s about equity.

And pretending it’s not hard? That’s the dishonesty.

Pretending it doesn’t wear you down? That’s where resentment festers.

So What Do We Do?

Some practical things that help:

• Use structure. Signpost: “I’ll ask a few short questions, then explain the plan.”

• Acknowledge the challenge. “I know this is frustrating — let’s make sure we understand each other.”

• Speak to the translator. “Can you let them know I hear their concern, and I want to help.”

• If you can, always look them in the eye and mirror the sentiment in your body language as it’s translated

• Don’t be afraid to respond with humour, firmness, or even to interject vocally when they are setting up a volley statement when you’re not done.

• Lastly, if you’re spiralling in it - check yourself. “Am I tired — or am I reacting to something deeper?”

Because the cognitive load of interpreted consultations is real.

But so is the difference between tiredness and transference.

If you’re frustrated with the process? Valid.

If you’re frustrated with the people? Dangerous.

It’s always safer to say “we’re struggling here, can I give you some information in your language to read and we take a quick break for me to collect my thoughts” then it is to learn to hate a given people.

Final Word

This job is hard. It’s meant to be.

But there’s a difference between hard and unspeakable. And the only way we stay human — as clinicians, as colleagues — is by naming the stuff no one else wants to say.

These consults are tough.

But tough doesn’t mean optional.

If we believe everyone deserves healthcare, we have to work harder to meet people where they are — not just where we’re comfortable.

And equating equity with “sponging foreigners” makes you less a person yourself.

Bądź zrozumiały

—DW