Hospitals and large health care systems often have an interpreter services department that offers coverage in the most commonly encountered languages. Massachusetts General Hospital, for example, has staff interpreters who speak Spanish, French, and Italian, as well as Arabic, Chinese (two dialects), French Creole, Khmer, Portuguese, Russian, and Vietnamese.
For smaller practices, it may not be practical to have staff interpreters. “To have in-house interpreters, you have to have a good number of patients who speak [a particular language] to warrant having someone on your payroll who needs to be busy all the time,” Fernandez says. “If you only have this issue once in a while, it’s probably worth it to contact a language service over the telephone or video.”
Arocha also touts the benefits of remote interpreting for situations when in-person services are not available. “Remote interpreting [provides] 24/7 access in over 150 languages,” she says, “something that no city, no hospital, is ever going to get, even if they’re in a metropolitan area. There will be a day and a time and a language for which they can’t provide face-to-face services.”
Fernandez cautions that remote interpreting services can be expensive. Arocha says the average rate is around $2 per minute. However, even if a 15-minute call adds up to a $30 bill, “you will take a lot longer not having a professional interpreter there to assist.” There could also be a cost to your patient’s health and well-being if you are unable to provide appropriate care.
Flores encourages clinicians to explore more creative mechanisms to improve language access when traditional interpreter services are unavailable or cost-prohibitive. One clinic in Ohio, for example, “had the creative strategy of training Romance-language majors from the local college as interpreters” and having them volunteer at the clinic. Another option would be to work with local community-based groups that may have bilingual members; these individuals could be trained to provide interpreter services.
Working Together
What you should avoid is falling back on the misconception that anyone who can speak the language is better than no interpreter at all. “There’s now good evidence that the so-called ad hoc interpreters—family, friends, children, people pulled from the waiting room, people actually pulled from the streets—that’s a suboptimal situation and probably endangers patients more,” Flores says. “We know, for example, that they’re more likely to make not only errors but errors of clinical consequence.”
In one of the many studies that Flores has published on this topic (Pediatrics. 2003;111[1]:6-14), a total of 396 interpreter errors were identified in 13 pediatric clinical encounters. Of these, 63% were determined to have clinical consequences, such as the omission of questions about drug allergies and the omission of key information from the medical history.
Ad hoc interpreters—particularly family members—are also prone to editorializing or interjecting their own opinions into the encounter. This is something a professional interpreter is trained not to do. Interpreters do more than translate words from one language to another; they must understand what they are interpreting and provide a context if the patient or provider is confused. But they do not take sides in an encounter.
So how can clinicians guarantee that they are working with a properly trained medical interpreter? Arocha says the bare minimum of training that medical interpreters should have is 40 hours. There is already a trend in the growth of one-year college-based programs across the United States, and since spoken-language interpreters have tended to follow the path of sign-language interpreters, she anticipates the eventual development of Associate’s-degree or even Bachelor’s-degree programs.
“It’s a really highly specialized field,” Arocha points out. “People don’t realize that a medical interpreter needs to have a pretty deep knowledge of medical terminology.” Interpreters who are placed in large medical centers or hospitals, for example, may have to interpret during a primary care session with a patient, then switch to a clinical trial, then move on to a specific department, such as oncology.
“Interpreters really have to be incredibly versatile to be able to accurately interpret,” Arocha says. “That’s important for patient safety.”
In October 2009, the field of medical interpretation got a boost from the launch of the first national certification examination, which will result in a “Certified Medical Interpreter” credential. The Spanish-language exam was the first available; additional languages will be added this year.
“It’s important for health care providers to know about that,” Arocha says. “If they’re ever going to hire an interpreter, they should ask if the person is a certified medical interpreter. If not, they should say, ‘Well, go get certified and come back.’”