What do the GMC and NHS say?

The GMC does not specifically comment on using relatives as interpreters, but in its Decision making and consent guidance states that, "you should use an interpreter or translation service if they have difficulty understanding spoken English."

It also says you should, "accommodate a patient’s wishes if they would like anyone else - a relative, partner, friend, carer or advocate - to be involved in discussions and/or help them make decisions" about their care.

NHS England does address this specific issue. In Guidance for commissioners: Interpreting and Translation Services in Primary Care (2018), it states:

6. Patients should always be offered a registered interpreter. Reliance on family, friends or unqualified interpreters is strongly discouraged and would not be considered good practice.

7. If a patient expressly desires a family member or friend to act as their 'interpreter', the patient should give informed consent in their own language, sought from them independently of the family member/ friend. The consent must be noted in the patient's record.

Our advice

Although this guidance is aimed at primary care, and is not applicable to the private sector, it is good practice to use a suitably qualified and independent interpreter rather than a relative.

Without an independent interpreter, there is no assurance of quality and accurate translation of complex medical terminology. Through no fault of their own, relatives may filter or omit key points to save the patient distress or to steer them into making a decision the relative feels is best for them.

There's also a confidentiality issue when using relatives, and not checking via an independent interpreter what information the patient would want their family member to know. The patient may subsequently feel uncomfortable asking questions via their relative, especially for conditions of a sensitive nature.

Finally, you should be aware of the safeguarding aspects of minors (like younger relatives of the patient) being used as interpreters - for example, exposure to inappropriate information, or missing school.

It's worth considering that if you faced an adverse outcome or complaint, could you justify why you relied on the relative being a translator if there was time to arrange an alternative, professional option for an elective case?

This question would be particularly pertinent for a patient at high risk of a complications, when the need for meaningful dialogue would be even greater to satisfy the requirements for appropriate consent.