Language Justice and the Importance of Using Professional Medical Interpreters
/| Tips and Tricks for Using Medical Interpreters | ||
|---|---|---|
| Speak directly to the patient | ||
| Have the interpreter sit behind or to the side of the patient | ||
| Speak in short sentences | ||
| Only ask one question at a time | ||
| Avoid medical jargon, acronyms, humor | ||
| Allow extra time for the interview |
A young female presents to the emergency department with abdominal pain. She is Spanish speaking and accompanied by a man. It is a Monday evening and the emergency department is very busy. The patients to be seen are piling up. The man with her speaks some English and rather than wait for an interpreter, the provider uses him as an ad hoc interpreter to obtains some limited history. The provider is reassured by her benign exam, orders some labs, and moves on to the next patient. The patient meanwhile is scared, confused, and probably frustrated that she is not given the opportunity to communicate for herself.
Her pregnancy test is positive and a professional medical interpreter is eventually used. The patient is interviewed by herself and the provider learns that she was raped about 1 month ago. Social work and police are then involved. It is verified that the man with her is her cousin, but what if he had actually been her assailant? Through the interpreter it is also learned that the patient is in this new country without her mother and sisters. She misses them terribly and she hates school because everything is in English. She cannot understand and no one can understand her.
No intrauterine pregnancy is seen on bedside ultrasound. She has a gynecology consult and the plan is to have close outpatient follow up for repeat beta-hCG in 48 hours which she does. Without use of a professional interpreter, crucial history would have been missed, her interactions with her providers would have likely further contributed to her isolation, and she could have been lost to follow up due to not understanding the discharge instructions. Professional interpreters are valuable assets when interacting with patients with limited English proficiency (LEP) and this article will address how to effectively use a medical interpreter, their importance in pursuing language justice, and some dangers of not using a professional interpreter.
An interpreter is someone who interprets the spoken word during live situations. A translator on the other hand translates written word. An interpreter additionally can serve as a cultural liaison, patient advocate, and can help to clarify certain interactions. It is actually required by law to use interpreter services for all patients with LEP under Title VI of the Civil Rights Act (1). Furthermore, medical interpreters are essential to language justice, the idea that all patients have the right to communicate in their preferred language, to understand, and to be understood (2, 3). It has been shown that LEP patients have outcomes and experiences that are not equal to English speaking patients. Falling to use a medical interpreter leads to patient dissatisfaction, medical errors, poor adherence, and even malpractice exposure (1, 4, 5, 6). In fact, there was a $71 million malpractice payout due to the misunderstanding of the word “intoxicado.” A young Cuban-American presented to the emergency department with altered mental status. Family and friends reported that he was “intoxicado” and the doctor in the case took this to mean that his altered mental status was due to drug or alcohol intoxication and further workup was not pursued. The family was trying to communicate that he may have eaten a bad hamburger. Two days later while still altered and in the ICU, he was found to have a large intracranial hemorrhage. He ended up quadriplegic (3, 7). Another study showed lower hospital readmissions and reduced hospital stays when professional interpreters were used (8).
In order to be crusaders for language justice, it is important to use professional interpreters and use them correctly. The interpreter should be like an unnoticeable channel for the conversation so speak directly to the patient, have the interpreter sit a little behind or to the side of the patient, and do not use the 3rd person when referring to the patient. It is best to speak in short sentences and avoid medical jargon, idioms, and acronyms. Jokes should also be avoided as humor often does not translate well and often leads to further confusion. Only ask one question at a time, be patient, and allow extra time for the interview. Always have the interpreter return for discharge instructions to make sure further instructions and recommendations are clearly understood and that the patient’s concerns have been adequately addressed (1).
Ad hoc interpreters such as family and friends should not be used to interpret. They are not professionally trained, may not understand medical terminology, and you do not know how effectively your message and the patient’s concerns are being communicated. Furthermore, this is not HIPPA compliant, the patient loses confidentiality, and the ad hoc interpreter may have their own agenda. Also, this may create embarrassing situations when dealing with issues of a sexual or intimate nature. Children should especially not be used as ad hoc interpreters for these reasons, they likely are not mature enough to understand the adult nature of some situations, and they may be emotionally affected by the situation (1, 9). It may save you time to use a friend or family member, but there is a lot that could go wrong, and this practice should be avoided.
We need to provide the same care to all patients regardless of their preferred language that is spoken. Professional medical interpreters are essential to this. They will improve the patient experience and lead to fewer adverse events. It is overall better patient care and helps address health disparities.
Post by Eileen Hall, MD
Dr. Hall is a member of the UC EM Class of 2021 and Attending Physician in the Cincinnati area.
Editing by Whitney Bryant, MD MPH
Dr. Bryant is an Associate Professor of Emergency Medicine and the head of the MD/MPH program at the University of Cincinnati
References:
Juckett, Gregory, and Kendra Unger. Appropriate Use of Medical Interpreters. Am Fam Physician. 2014 Oct 1;90(7):476-480.
Taira BR, Orue A. Language assistance for limited English proficiency patients in a public ED: determining the unmet need. BMC Health Serv Res. 2019;19(1):56.
Taira, Breena. Achieving Language Justice in the Emergency Room. FemInEM, 17 Feb. 2020, feminem.org/2020/02/17/achieving-language-justice-in-the-emergency-room/.
Bagchi AD, Dale S, Verbitsky-Savitz N, Andrecheck S, Zavotsky K, Eisenstein R. Examining effectiveness of medical interpreters in emergency departments for Spanish-speaking patients with limited English proficiency: results of a randomized controlled trial. Ann Emerg Med. 2011;57(3):248–256.e1-4.
Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255–299.
Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–754.
Price-Wise, Gail. Intoxicating Error: Mistranslation, Medical Malpractice, and Prejudice. Bookbaby, 2015.
Lindholm M, Hargraves JL, Ferguson WJ, Reed G. Professional language interpretation and inpatient length of stay and readmission rates. J Gen Intern Med. 2012;27(10):1294–1299.
Flores G, Abreu M, Barone CP, Bachur R, Lin H. Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters. Ann Emerg Med. 2012;60(5):545–553.
