The purpose of this study is to describe issues in use of interpreters when Brazilian residents have an access to the medical care services in Japan. Focus groups were undertaken with three groups of eighteen Brazilian residents in Shizuoka prefecture. Data analysis drew upon the principles of summarizing content analysis.
The participants' proficiency in Japanese language varied; six were intermediate level, eight were basic level, and four were unable to communicate in Japanese. Ten of them used interpreters at medical care services. Those interpreters were usually ad hoc, untrained individual such as members of the family, friends, or outsourced personnel. Summarizing content analysis revealed three themes as follows: When using ad hoc interpreter; The interpreter may omit, add, or substitute some words/phrases therefore the interpretation may be inaccurate. The interpreter may not understand the medical terms because those terms are not used daily. Absence of trained medical interpreters at medical facilities; It is tedious to find an interpreter. The patient cannot provide sufficient information to a physician, nor can he/she understand what a physician explain, nor know the effect/side effect of the medicine. Measures to improve the communication between Brazilian patients and physicians; The presence of a hospital interpreter would be essential. Written notes are highly appreciated.
Communication barriers between a physician and a patient can be seen regardless of the presence of an interpreter. It is important to tell the interpreter to interpret a word/phrase uttered by both a patient and a physician accurately and to explain to him/her of the importance of privacy protection in advance. It is also suggested that a physician needs to avoid to use the technical terms, explain in words which could easily be understood by a patient or give notes to a patient so that there will be a better communication between a physician and a patient.

Objective  This study aimed to identify the types, frequency, and clinical significance of altered interpreta-tion in clinical settings.Methods  Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese doctors, and hospital-provided interpreters were digitally recorded and transcribed. Segments of consecutively interpreted utterances were coded as “altered,” in which the interpreter changed the meaning of the source utterance, or “unaltered (accurate),” and the types and frequency of occurrence were analyzed. Altered interpretations were categorized as clinically negative or positive and classified into four categories: omission, addition, substitution, or voluntary intervention. Incidents resulting from alterations were investigated. Reliability was assessed by examining the correlation between random independently coded samples.Results  In total, 111 encounters were analyzed. The mean segments per encounter was 67.9 (range 14-186), and the mean frequency (standard deviation) of altered interpretations per 100 segments was 46.7 (14.3) for accurate interpretations; 46.1 (17.9) for negative or not significant alterations, including 27.2 (10.3) for omissions, 6.0 (5.0) for additions, 10.4 (6.9) for substitutions, and 2.5 (2.7) for voluntary interventions; 0.0 (0.2) for alterations potentially leading to an incident; and 26.2 (11.9) for positive alterations, including 1.8 (2.6) for positive omissions, 7.7 (4.7) for positive additions, 7.8 (6.3) for positive substitutions, and 8.8 (5.2) for positive voluntary interventions. The frequency of negative alterations was weakly negatively correlated with number of segments per minute (r＝−0.339). Conclusion  Trained healthcare interpreters with fewer clinically significant altered interpretations were effective. Professional medical providers should recognize the importance of positive alterations by healthcare interpreters and collaborate with them to provide safe medical care for foreign patients. To facilitate the provision of appropriate medical care to a growing foreign population with diverse cultural and linguistic needs, undergraduate medical education should teach aspiring medical professionals how to collaborate with healthcare interpreters and foreign patients.