Interview with… Ulrike Nichols, PhD, MITI

Ulrike Nichols is a colleague and a speaker at our upcoming MedTranslate 2025 conference in Mulhouse on “Bias in healthcare/bias in translation and interpreting: uncovering one’s blind spot” (you can check out the session description here)

Hi Ulrike, can you tell us a bit about yourself, your career, etc.?

Hello. I am originally from Germany and started my career in the humanities. I got a degree in German and English literature and language and worked in the US at the University of Michigan for 8 years. When I moved to the UK in 2006, I changed gears, got my Diploma in Translation from the CIOL and became a translator. With time, a lot of reading and attending workshops and courses, I became a medical translator.

Your session topic for the upcoming MedTranslate 2025 conference in Mulhouse has generated significant interest. What initially drew you to explore the intersection of bias in healthcare and our work as medical translators and interpreters?

In 2024 I attended a conference on mental health and a psychiatrist from Sheffield, Dr. Chris Douglas, gave a talk on unconscious bias in healthcare. That made me think of the double-burden of when doctor and patient don’t speak the same language or when translators do not fully grasp cultural context that might be embedded in a text. That tickled me and I wanted to know more 😊

In your session description, you mention that bias isn’t always wilful or conscious. Can you share an example of how unconscious bias might manifest specifically in medical translation or interpreting scenarios?

Bias is inherently human as we “learned” to distrust unfamiliar things to protect ourselves from potential danger but also to organise our complex world by simplifying it a little. So, nobody is beyond stereotyping and developing bias and doctors/translators/interpreters are not more or less biased than the general public. In interpreting scenarios, some studies have shown that too much of an emotional bond between interpreter and patient (possibly because the interpreter is not a professional but e.g. a family member) might result in omitting information – be it the patient not telling the doctor everything because of the third person in the room, or the interpreter “sparing” the patient by omitting potentially upsetting content. Hence, the urgent call everywhere to invest in professional interpreters to improve patient outcomes. (That said, any interpreter is better than none, also a studied fact.)

You note that both healthcare providers and receivers exhibit bias. How does this bidirectional nature of bias complicate our role as medical language professionals?

I think, awareness is key, and it raises the bar for medical language professionals to stay professional and really try to convey meaning and facilitate the dialogue between doctor and patient. Dislike between doctor and patient is not the same as bias and the interpreter might actually be the vessel to navigate animosities and improve the situation.

What are some of the “blind spots” you’ll be addressing in your talk that medical translators and interpreters might not even realize they have?

The blind spots arise from unconscious bias, things we cannot know because we never learned or were made aware. If a doctor has never or rarely seen dark or black skin, they will have a harder time diagnosing skin cancer on such skin. Only when they become aware that that could be an issue are they able to address it.

How can medical interpreters and translators develop greater self-awareness about their own potential biases while maintaining professional objectivity?

Hopefully through a talk like mine? By questioning oneself, learning about it, staying informed about inclusive language and following debates and the public discourse on bias. We cannot really change who we are but we can strive to recognise where we fall short.

When a medical translator or interpreter recognizes bias in a healthcare setting, what ethical obligations do we have? Where’s the line between neutrality and advocacy?

A starting point for people thinking about the ethics might be the Code of Professional Ethics that was put together by the International Association of Conference Interpreters. They state “The exercise of the profession shall be based on principles of independence, impartiality and responsibility.»
Our role is to facilitate communication, not to be an active part of it . That said, the call for impartiality does not mean that we should not be careful in our choice of words or reiterate stigmata or potentially discriminatory language. Are we speaking for someone or to someone?
Bias in healthcare can result in different treatments for different groups of patients when the symptoms are the same. This is something interpreters and translators would not necessarily recognise as they do not have the comparison but only see a particular case at a particular moment. So, I’d be very careful to say that we recognise “bias” when we experience patronising behaviour or animosities. Yet, inclusive language and awareness for both speakers (doctor AND patient) can help to avoid the pitfall of discrimination. Avoiding well- meaning euphemisms or expressions is also helpful in this regard. The NIH has a good list of terms for inclusive language, which is a great starting point.

How can medical language professionals balance cultural sensitivity with the need to challenge harmful biases they encounter?

Given that it is hard to really identify “bias” with treatment consequences in a particular situation, it might be tricky to challenge it. Potentially, bias might also be understood belatedly when seeing a case in a larger context.
However, for cultural sensitivity and potentially better communication, I think the 4-sides-model (or 4-ears model as it is called in German) by Friedemann Schulz von Thun is still very useful. Thun says that every message can be heard/interpreted in 4 different ways: as a self-revelation of the speaker, as factual information, as an appeal to the listener and as a statement about the relationship between speaker and listener. If we manage to reflect both on what we hear and on how we have just heard it (did we react emotionally or rationally etc.), we might be able to step aside from ourselves a little bit and hence be more measured in our response. The model goes further and was developed over many years but as a starting point, it might be quite useful to sharpen our self-awareness. Maybe we heard a side of a statement with an emphasis that had not been the most important one. Keeping that in mind we might manage to communicate better, listen more thoroughly, and understand each other better. Maybe that could even help mediate bias, our own and possible that of others.

For medical translators and interpreters who want to continue learning about this topic after your session, what resources would you recommend?

Learning about the psychological concept of bias (conscious and unconscious), you could start with a collection of articles in Frontiers in Psychology that were put together under the heading “The psychological process of stereotyping” (see here >>)
Megan Falk’s recent article in the ATA Chronicle is an excellent piece to understand ableism and translation.
I mentioned Friedemann Schulz von Thun’s communication model already. I would also recommend literature on bias and AI, there have been a number of studies on gender in AI translations and how the models are still training the algorithms with deeply biased data. It’s disturbing AND fascinating.

What’s the one key message you hope every medical translator and interpreter takes away from your MedTranslate 2025 presentation?

Bias is a result of our need for stereotyping to categorize, simplify, and process our complex world. We need to sharpen our awareness and (possibly) our choice of language to prevent that bias results in discrimination. There are numerous resources to help us in our professional conduct and we should strive to be inclusive and aware so that we facilitate communication, understanding and in the best case, better outcomes in healthcare.

Thank you very much Ulrike – see you in Mulhouse in a couple weeks!

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Visit Ulrike’s website

Ulrike is a speaker at our upcoming MedTranslate 2025 international conference for medical translators! Visit the conference website: medtransconf.com

About MedTranslate international medical translation conference: MedTranslate 2025 announcement