The Word That Has No Word
You are interpreting in a prenatal visit for a 29-year-old Somali-speaking patient who has lived in the U.S. for two years. The obstetrician explains that a screening test came back indicating an increased risk for a chromosomal condition and recommends diagnostic testing. The doctor uses terms like "false positive," "amniocentesis," and "termination option." The patient nods and says little. You know that in her community, disability and pregnancy loss can carry strong stigma, and that "termination" may be a deeply sensitive topic discussed only with certain family members. There is no equivalent single word in her dialect for "false positive," and she has not asked any questions. The doctor says, "Great, she seems to get it - let's schedule."
1. The doctor assumes the patient understands because she nodded. What should you do?
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Nodding is not evidence of comprehension, and silence can reflect deference, stigma, or simply not knowing what to ask. I should not let the encounter end on that assumption.
- Tell the clinician what I observed neutrally: she nodded but asked no questions; some of these concepts are hard to convey and may be sensitive in her community. Suggest a teach-back.
- Interpret a teach-back: ask her, in her language, to explain in her own words what the test is for and what the results might mean. Interpret her answer faithfully - including gaps or confusion.
- Handle the "no equivalent word" problem by interpreting meaning, not words: explain "false positive" as "the test can say there is a problem when there may not be one," then check understanding.
- Do not certify comprehension myself or reassure the doctor that she "gets it."
My value here is catching a false impression before a decision is scheduled on it.
2. How do you interpret sensitive terms like "termination option" and "chromosomal condition" responsibly?
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I interpret the clinician's meaning accurately and completely, using the patient's language and register, without softening, omitting, or adding my own judgment.
- Accuracy over literalness: convey what "termination option" means (the choice to end the pregnancy) in clear, respectful terms she will understand, since a literal cognate may not carry the meaning.
- Use the patient's preferred terms where possible and check comprehension; if a concept is stigmatized, I still convey it - withholding it would deny her information she is entitled to.
- Do not editorialize ("This is just in case" or "You don't need to worry") and do not let my own cultural discomfort change the message.
- Flag ambiguity to the clinician if I'm unsure a concept translated clearly, so they can rephrase.
- Maintain confidentiality and neutrality about the topic; her reproductive choices are hers.
The principle: faithfulness includes conveying difficult, stigmatized content, and doing so in a way the patient can actually understand.
3. The patient later asks you, quietly, "What would you do?" How do you respond?
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I do not give medical or personal advice; that would exceed my role and could substitute my judgment for hers or the clinician's.
- Interpret her question to the clinician so the doctor can respond, or explain (in her language) that I'm the interpreter and can't advise, but I can help her ask the doctor anything.
- Redirect to the decision-support she needs: offer to interpret her questions about the test's accuracy, what the results would mean, and her options - and to connect her with the clinician or a genetic counselor.
- Acknowledge respectfully that the decision is hers and sensitive; I don't dismiss her concern.
- Do not share my personal views, even if pressed.
Boundary: I facilitate communication and access; I don't make or influence the medical/ethical decision. If she needs emotional or decision support beyond the clinician, I can help route her to appropriate resources per policy.