We Had No Language in Common and She Was Consenting to Surgery

Quick answer: Consent obtained through a family member is not reliable consent. Children interpreting for parents will soften bad news, omit risks and answer on their behalf — usually with the best intentions. For anything beyond a check-up, a proper interpreter is needed.

The call

Her daughter phoned to book, and mentioned in passing that she would be interpreting.

The patient was 68, originally from Ethiopia, in Beit Shemesh for eleven years, speaking Amharic and a small amount of functional Hebrew. She had pain and, from the daughter's description, several teeth that needed removing.

The daughter's offer was generous and it was the wrong arrangement, and explaining why without causing offence is a skill worth having.

What we found

At the first appointment we established what we could: three grossly decayed lower teeth, one with an abscess, generalised periodontitis, and probably four extractions plus a partial denture.

That is a treatment plan involving surgery, anaesthetic, risk, cost and alternatives. It is not something to convey through a relative.

Why family interpreting fails, and it is worth being specific because the objection sounds like bureaucratic fussiness:

• Relatives soften. A daughter translating "you will probably lose four teeth" reliably delivers something gentler. It is protective and it is not what was said.
• Relatives answer for the patient. Asked whether she had chest pain, the daughter answered without turning to her mother. That happened three times in ten minutes.
• Risks get omitted. Numbness, bleeding, dry socket — a family member conveying these to a frightened parent frequently skips them, and those are precisely the things consent depends on.
• The patient stops being the person in the room. She had begun addressing her answers to her daughter rather than to us, which is the visible sign that the consultation has been handed over.
• Confidentiality disappears. Some things are not said in front of a child, at any age.
• Children should not be interpreters at all. A grandchild was offered for a later appointment. That is not acceptable for medical information at any age.

None of this is a criticism of the daughter, who was doing something helpful and was told so.

What we did

Arranged a professional interpreter for the consent appointment. Kupot in Israel provide interpreting services, and there are national telephone interpreting lines for health settings in Amharic, Russian, Arabic and other languages. Telephone interpreting is adequate and considerably better than nothing when an in-person interpreter is not available.

A longer appointment. Everything takes roughly twice as long through an interpreter, and booking a standard slot guarantees a rushed and inadequate discussion.

Technique that makes interpreted consultations work:

• Speak to the patient, looking at her, not at the interpreter.
• Short sentences, one idea at a time, pausing.
• No idiom, no jokes, no "we'll pop that out" — figurative language does not survive translation.
• Teach-back: ask her to explain in her own words what was going to happen, through the interpreter. That is the only reliable check that consent is real.
• Photographs and a model, which cross languages entirely.

Written consent in Amharic, obtained through the interpreting service, not a Hebrew form signed on trust.

The daughter stayed in the room, at her mother's request, as a support rather than as the interpreter. That is the right role for a family member and it was made explicit.

Post-operative instructions written in Amharic, and gone through with the interpreter before she left. Aftercare instructions the patient cannot read are not instructions.

The outcome

Four extractions over two visits, a partial denture at three months.

At the review, through the interpreter, she raised two questions she had not asked at any earlier appointment — one about her medication and one about whether the remaining teeth would also be lost. Neither had come up in the sessions where her daughter was interpreting.

That is the argument for the whole arrangement, in one observation.

What to do if this happens to you

1. Ask the practice to arrange an interpreter rather than bringing one. Kupot provide this and telephone services exist.
2. Do not use children, at any age, for medical interpreting.
3. Ask for a longer appointment. Interpreted consultations take twice as long.
4. Ask for written consent and aftercare in your own language.
5. Expect teach-back. Being asked to explain it back is a sign it is being done properly.
6. Bring family as support, which is valuable, rather than as the interpreter.

Need an appointment in another language? Tell Ramat Beit Shemesh Urgent Dental Care when you book and we will arrange interpreting. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh

This is a composite clinical story. It reflects a presentation we see regularly in Beit Shemesh and Ramat Beit Shemesh; the name and details are illustrative and are not those of a real patient.