Case-Based Review

Using a Medical Interpreter with Persons of Limited English Proficiency

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

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Despite the documented benefits of using professional interpreters, they are underutilized. Reasons include underfunded medical interpreting services [10,11], lack of awareness of the risks involved with using an ad hoc interpreter [2,12], providers using their own or another worker’s limited second language skills to communicate rather than using a professional medical interpreter [13,14], perceived delay in obtaining a professional medical interpreter, and judging a medical situation as minor rather than complex [13]. In this article, the roles, importance, and considerations of using a professional medical interpreter are explored.

Case Study

Initial Presentation

A 23-year-old married Somali-speaking female who moved to the United States recently called a local primary care provider’s office to schedule an appointment. When asked the reason for the visit, she said the reason was private. The clinical assistant scheduled her with the next available provider.

When the patient arrived for her clinic appointment, a clinical assistant roomed her and her mother and asked the patient the reason for the visit. The patient remained quiet and her mother replied that she needed to speak with the doctor. When the female medical provider entered, she observed that the patient appeared anxious. When the doctor initiated conversation with the patient, she noted that her English was limited. Her mother tried to explain the reason for the visit saying her daughter was having severe pain. She then pointed towards her daughter’s lower abdomen. The clinician noted the limited English abilities of the patient and mother and used the interpreter line to request a Somali interpreter and placed the first available interpreter available on speaker.

How can patients who need an interpreter be identified?

If a person does not speak any English, then an interpreter is necessary; however, sometimes whether a person from a non-English speaking background would benefit from an interpreter is unclear. If a patient is answering only in nods or yes/no responses or answering questions inconsistently, further evaluation should be done. Asking open-ended questions and/or having the patient repeat what is his or her understanding of the conversation will help determine if the person may benefit from an interpreter [12] ( Table 1 ).

Health care systems can facilitate identifying patients in need of an interpreter by routinely collecting information on LEP status. The patient should be asked during registration if her or she speaks English and has a preferred language, and the answers should be recorded in the medical record [3]. If an interpreter is used during the hospital stay, it should be recorded to alert future providers to the need of an interpreter [15]. Patients may speak a dialect of a common language and this also should be noted, as an interpreter with a similar dialect to the patient should ideally be requested when necessary [16]. Furthermore, health care systems can measure rate of screening for language need at registration and rate of interpreter use during hospital stay to assess language need and adequacy of provision of interpreters to LEP patients [15].

It should be noted that patients may be wary about the presence of an interpreter. In one study involving pediatric oncologists and Spanish-speaking parents, the former reported concern regarding the accuracy of interpretation and the latter were concerned about missing out on important information even with the use of professional medical interpreters [17]. The concern for accuracy of interpreting was shared in a study by Chinese and Vietnamese Americans with LEP [18] as well as in a Swedish study involving Arabic-speaking persons. In the latter study, Arabic-speaking patients also felt uncomfortable speaking about bodily issues in the presence of interpreters [19]. In a study of Latina patients, there were concerns about confidentiality with interpreters [20].