Professional medical interpreters are trained to facilitate communication of a spoken language in a medical setting [2,10]. Certification is offered by the National Board of Certification for Medical Interpreters and the Certification Commission for Healthcare Interpreters. In order to be certified certain requirements must be met which include a minimum of 40 hours of health care interpreter training (which includes medical terminology as well as roles and ethics involved in medical interpreting) as well as demonstrated oral proficiency in English as well as another chosen language (such as Spanish) [10].
In certain circumstances, patients may feel more comfortable disclosing personal details with a professional medical interpreter rather than in the presence of an ad hoc interpreter. For example, more details of traumatic events and psychological symptoms were spoken of in the presence of a professional, rather than an ad hoc, interpreter in medical interviews of asylum seekers requiring an interpreter in Switzerland. In the presence of ad hoc interpreters, more physical symptoms were disclosed rather than psychological [6].
Furthermore, in visits concerning sexuality or abuse issues, using family members as interpreters may violate privacy concerns of the patient [2,27]. Additionally, in certain cultures where respect for elders is very important, parents who use children as interpreters may feel that the structure of the family changes when he or she interprets on behalf of the parent [18]. Also, what children consider as embarrassing may not be interpreted to either the parent or to the care provider [8]. Furthermore, one should note there are ethical issues of using non-adult children as interpreters in situations involving confidentiality and privacy—by doing so, there may be resulting harmful effects on non-adult children [27,28].
Patients may at times decline the use of a professional medical interpreter and prefer to have a family member interpret; this preference should be documented in the patient’s medical chart [10]. Caution should be had using an ad hoc interpreter when obtaining informed consent [12].
What professional interpreting services are available to the clinician?
For the most part, access to interpreters via a telephone service is widely available [10]. The cost of providing interpreters in-person and/or remotely varies depending on the health care site [29–31] In general, considerations of using professional medical interpreters, whether remotely or in-person, involves accessibility and cost. There are certain sites that have explored having a shared network of interpreters available via the telephone and videoconference to reduce the cost of providing interpreters for individual hospitals [32]. While the costs of providing a person with LEP with interpretation varies depending on the health care site, the costs of not providing a professional medical interpreter should be considered as well, which include greater malpractice risk and potential medical errors [32]. In addition, the use of employees as interpreters takes time away from their respective jobs, which results in staff time lost [31].
In-person interpreting may be preferred for certain medical visits, as an in-person interpreter can interpret both verbal and nonverbal communication [16]. When emotional support is anticipated, in-person interpreting is usually preferred by providers [24]. There may be improved cultural competence when using an in-person interpreter, which may be important for certain visits such as those involving end-of life care discussions [4]. One concern may involve the comfort level of the patient if he or she personally knows the interpreter; this can occur in smaller ethnic communities [12]. Telephonic interpreting may be preferred in certain medical situations where confidentiality is desired [16].