Getting The Most From Language Interpreters

By Author: Harris Symonds
Total Articles: 121
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Communicating with patients who have limited English proficiency requires more than simply “finding someone who speaks their language.”

More than 31 million foreign-born people live in the United States. Eighteen percent report speaking a language other than English at home, and almost half say they speak English “less than very well.” Under Title VI of the Civil Rights Act of 1964 and Executive Order 13166, patients with limited English proficiency (LEP) have the right to a trained interpreter. Any practice receiving federal funding aside from Medicare part B must comply. Failure to use interpreters for LEP patients has led to higher hospital admission rates, increased use of testing, poorer patient comprehension of diagnosis and treatment, and misdiagnosis and improper treatment. This article provides some general guidelines to help maximize communication with LEP patients when using interpreters of all skill levels.

What is a “trained language interpreter”?

Trained language interpreters have formal education in interpreting and abide by a professional code of ethics that includes confidentiality, ...
... impartiality, accuracy and completeness. Good medical interpreters are not only fluent; they are also familiar with medical terminology and have experience in health care. Although there are several accredited training programs for medical interpreters, there is no national certification. In fact, only Washington offers state testing and certification. Fortunately, most companies that offer interpretation services have developed procedures to “qualify” their interpreters and can provide verification of their training and certification.

Well-trained interpreters convert the meaning of all messages from one language to another without unnecessary additions, deletions or changes in meaning and without injecting their own opinions. They act as message clarifiers when there is a possible misunderstanding and are always careful to ensure that neither party is left out of the discussion. Interpreters can also act as cultural clarifiers when traditional health beliefs or practices lack equivalent terms. Well-trained interpreters will communicate both verbally and nonverbally, in such a way that their presence is barely noticed by either party. Trained interpreters are costly but can save time and resources in the long run by decreasing the number of callbacks, misdiagnoses and unnecessary tests, and increasing patient comprehension, compliance and satisfaction.

Although the success of an encounter with an LEP patient is strongly dependent on an interpreter’s training, family physicians can do several important things to facilitate the process. For example, if you have a choice or feel that a patient would prefer it, ask for an interpreter of the same gender as the patient. Some patients feel more comfortable having someone of the same sex interpret for them, particularly when discussing personal issues.

KEY POINTS

According to the Civil Rights Act of 1964 and Executive Order 13166, patients with limited English proficiency have the right to a trained interpreter.
Well-trained interpreters abide by a code of ethics and interpret without unnecessary additions, deletions or changes in meaning, and without injecting their own opinions.
Friends or family members may unconsciously screen what they hear and provide only a summarized interpretation to the other party.

Guidelines for using trained on-site interpreters

Other points to keep in mind when working with an on-site interpreter include the following:
Confidentiality. Prior to the office visit, give any necessary background information to the interpreter. Remind the interpreter that everything you and the patient say needs to be interpreted and that all information must be kept confidential. When you enter the exam room, introduce yourself and the interpreter to the patient. Have the interpreter explain to the patient that all information will be kept confidential.

Addressing the patient. If you can, position the interpreter so that he or she is sitting beside the patient, facing you. Maintain eye contact with the patient (if culturally appropriate) and be careful to address the patient, not the interpreter. For example, look at the patient and ask, “Have you had any fever?” instead of asking the interpreter, “Has she had any fever?” Before entering the exam room, ask the interpreter to speak in first person when speaking for either you or your patient (e.g.,“I think you have an ear infection”). Statements in the third person (i.e., “The doctor thinks you have an ear infection.”) can create a barrier between you and your patient. When both sides talk directly to each other, the interpreter has the opportunity to melt into the background and unobtrusively become the voice of each party.

Time constraints. Because English is relatively direct compared with other languages, interpretation might take longer than you expect. Consequently, you should allow for extra time. When interacting with LEP patients, keep your sentences brief and pause often to allow time for interpreting. Avoid highly technical medical jargon and idiomatic expressions that may be difficult for the interpreter to convey and the patient to comprehend. Use diagrams and pictures to facilitate comprehension. Listen without interrupting and make it a point to confirm that the patient understands by asking him or her to repeat important instructions back to you. Pause at several points during the conversation to ask whether the patient has any questions. Many cultures see questioning physicians as a sign of disrespect and may be hesitant to respond initially. Finally, if you have any concerns or questions about the interpretation, don’t hesitate to ask the interpreter.

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