Bilingual Health-Care Staff Are Not Interpreters

In health-care settings across Canada, bilingual staff are frequently asked to interpret for patients with limited English proficiency. This may seem like a practical solution, but the reality is more complex and potentially harmful for both patients and staff.

As a certified medical interpreter, I’ve seen first-hand how often informal interpreting arrangements happen in health-care settings. Even when professional interpreters like me are available, we are sometimes turned away, and bilingual staff — often nurses or unit clerks — are pulled in to interpret instead.

These staff are rarely given a choice, much less formal consent or adequate support. When time is short and the needs are pressing, asking a nearby bilingual clerk to relay vital information might seem like a practical solution.

But when we cut corners like this, critical nuances are missed — and that can have serious consequences.

It is increasingly common in Canada for patients to speak a first language other than English or French, Canada’s two official languages. According to Statistics Canada’s 2021 census, more than half a million people in Canada speak predominantly Mandarin at home, and another half a million speak Punjabi at home; 393,430 Canadians speak Yue (Cantonese), 317,365 speak Spanish, 285,915 speak Arabic, and 275,040 speak Tagalog.

Being a bilingual health professional does not mean you are qualified to interpret medical information. Medical interpreting is a specialized profession. Medical interpreters have training in medical terminology, accuracy, confidentiality and cultural nuance, among other skills. The work also requires impartiality — something that is nearly impossible to maintain when the work of interpreting is added on top of a health-care worker’s existing role.

When nurses, clerks or other staff are asked to interpret, they’re placed in a dual role that directly conflicts with their primary responsibilities. Even when the interpreting nurse is familiar with the patient — such as a charging nurse overseeing their care — that familiarity can make things worse, not better.

Instead of neutrally conveying what the patient is saying, they may insert their own opinions, summarize or offer a clinical interpretation rather than an accurate translation. This undermines patient-centred communication and shifts the focus away from the patient’s voice. The pressure to support colleagues, manage time or maintain team dynamics only further compromises neutrality.

Cultural proximity adds another layer of complexity. Many bilingual staff share cultural backgrounds with the patients they are asked to interpret for. While this might initially appear beneficial, it can lead to unconscious bias or emotional entanglement. Professional interpreters are trained to recognize and manage this, but bilingual staff typically are not.

The burden falls particularly hard on immigrant women, who make up a significant portion of Canada’s health-care support workforce. They are often expected to interpret without language assessment, without training and without pay. Over time, this leads to emotional exhaustion and burnout.

This is not just anecdotal. A 2017 study titled “Risk and Protective Factors Impacting Burnout in Bilingual, Latina/o Clinicians” found that bilingual clinicians suffered higher levels of emotional fatigue and depersonalization. Many reported being routinely asked to take on extra duties like translating documents, interpreting clinical conversations or educating colleagues about a patient’s culture.

None of this was officially part of their job description, and it was rarely acknowledged or compensated.

The risks of informal interpretation will only grow over time

This problem isn’t new, but it is becoming more urgent. As Canada ramps up recruitment of internationally trained health-care professionals, many of whom are multilingual, the risk of informal interpreting will only grow. Canada is not hiring these workers to act as interpreters, but in the absence of clear policies and accountability, it’s likely they will still be asked to interpret, just as many already are.

Language interpretation work in health care should be delivered by trained, qualified professionals, whether on site, by phone or through video remote platforms. Research has repeatedly shown that this is not just best practice, but essential. Reports such as 2005’s “Pay Now or Pay Later: Providing Interpreter Services in Health Care” and 2021’s “Investing in Language Access to Optimize Health System Performance” have demonstrated that the use of professional interpreters reduces medical errors, prevents costly complications and improves patient outcomes.

Yet across Canada, access to trained interpreters remains inconsistent. We lack a government-level policy that mandates or enforces the proper use of language services in health care.

Other countries have already set a higher standard. In Australia and the United States, legislation requires health-care providers to use qualified interpreters when language barriers are present.

Failing to do so can constitute a breach of the legal duty of care. Canada needs to follow this example with clear policy, proper funding and real accountability.

We also need to invest in the long-term sustainability of professional interpreting. That means creating pathways for interpreter training, offering fair compensation and recognizing this work as a vital part of the health-care system.

Without these supports, we will continue to face a shortage of qualified interpreters, leaving the burden to fall on bilingual staff who are not trained or positioned to take on this responsibility.

Language access is not an optional service. It’s a core element of safe, equitable and effective health care. We must stop treating interpretation as a favour or an afterthought and start treating it as a standard of care.

Patients deserve clear communication. Health-care providers deserve support. And bilingual staff deserve clear professional boundaries that don’t require them to bring skills from their home lives to work. We owe it to everyone to build a health-care system that gets this right.