Case-Based Review

Using a Medical Interpreter with Persons of Limited English Proficiency

Journal of Clinical Outcomes Management. 2016 December;23(12)

Author(s):

References

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From the Department of Medicine, Mayo Clinic, Rochester, MN .

Abstract

Objective: To provide an overview of important aspects of interpreting for medical visits for persons with limited English proficiency (LEP).
Methods: Literature review.
Results: When working with persons of LEP, providing a professional medical interpreter will facilitate optimal communication. Interpreters may work in different roles including as a conduit, cultural broker, clarifier, and advocate. In-person and remote (videoconferencing or telephonic) interpreting are available and one may be preferred depending on the medical visit. Clinicians should recognize that patients may have a preference for the interpreter’s gender and dialect and accommodations should be made if possible. Prior to the visit, the provider may want to clarify the goals of the medical encounter with the interpreter as some topics may be viewed differently in certain cultures. When using an interpreter, the provider should maintain eye contact with and direct speech to the patient rather than to the interpreter. The provider should speak clearly, avoid complex terminology, and pause appropriately to allow interpretation. Additionally, providers should assess patient understanding of what has been discussed. After the medical visit, providers should consider discussing with the interpreter any issues with communication or cultural factors noted to have affected the visit.
Conclusion: Providers should utilize a professional medical interpreter for visits with persons with LEP. Appropriate communication techniques, including talking in first and second tenses and maintaining eye contact with the patient rather than the interpreter, are important for a successful visit. Realizing patients may have interpreter preferences is also important to facilitate patient-centered-care.

Key words: language barriers; quality of care; physician-patient communication; interpreter services.

The United States is a diverse country that includes many persons whose first language is not English. According to the U.S. Census Bureau, more than 63 million persons age 5 and above (about 51 million adults) reported speaking a language other than English at home. Also, about 25.7 million of the population age 5 and up (around 10.6 million adults) noted speaking English less than “very well” [1]. Protecting people from discrimination based on the language they speak is highlighted in Title VI of the Civil Rights Act of 1964 (which focuses on those receiving federal funding). President Clinton, furthermore, in 2000 signed Executive Order 13166, which encouraged federal agencies to provide appropriate access of their services to those with limited English proficiency (LEP) [2,3].

The benefits of using professional interpreters is well-documented. In addition to increased satisfaction with communication when professional medical interpreters are used [4], they also make fewer clinically significant interpretation errors compared to ad hoc interpreters (ie, untrained individuals such as bilingual staff member, family member, or friend who are asked to interpret) [5–7]. LEP patients who do not have a professional interpreter have less understanding of their medical issues, have less satisfaction of their medical care, and may have more tests ordered and be hospitalized more often compared to those who do utilize professional medical interpreters [8]. In addition to improved satisfaction and understanding of medical diagnoses, hospitalized persons requiring interpreters who utilized a professional medical interpreter on admission and discharge were noted to have a shorter length of stay than persons who required an interpreter and did not receive one [9].