Using a Medical Interpreter with Persons of Limited English Proficiency

The provider should face the patient and direct conversation to him or her rather than to the interpreter. Third-person statements should not be used, such as “tell her,” as this directs the conversation to the interpreter rather than to the patient [10]. By using the first and second person (when addressing the patient) and making eye contact, the relationship between the provider and patient is emphasized [14,40].

Choosing the right word is important to have meaningful communication. Interpreters advise that providers should understand that medical concepts may be unfamiliar to patients with LEP. Providers should use simpler words rather than medical terminology to discuss medical issues [42]. In general, straightforward word choice is recommended [16]. Providers are advised to not use acronyms or idioms. It is important to note that humor may be difficult to convey as well [10].

Clinicians are advised to speak clearly and not quickly and to use shorter sentences with appropriate pauses to allow time for the interpreter to interpret (if consecutive rather than simultaneous interpreting style is being used) [2,41,43,44]. In addition to limiting speech to one to two sentences at a time, asking one question at a time is important for optimal communication [43]. To improve information gathering, patients may respond better to open-ended questions [42], which is an aspect of patient-centered communication, as directive questioning often leads to shorter answers [43].

Furthermore, the provider should be aware that persons with LEP may know some English, so statements that one would not say to an English-speaking patient should not be said in the room with a person with LEP [10].

Encouraging the interpreter to clarify certain concepts, if necessary, may provide for improved information exchange [21] as well as encouraging the patient to ask questions during the medical visit may help elucidate potential areas of confusion [22,40,44]. Summarizing important concepts [40] and limiting the number of concepts discussed may increase patient understanding [10]. Additionally, asking the patient to repeat what was discussed in his or her words [10], rather than directly asking if he or she understands, will allow for more meaningful assessment of patient understanding [43].

Finally, recognition that interpreters may experience distress after certain visits, such as an oncologic medical encounters, is important and debriefing may be desired by the interpreter [22,45]. Also, discussing any communication concerns may be helpful [40,42] in addition to discussing certain cultural beliefs that impacted the visit may be educational for the provider [45].

Case Continued

After the female translator arrived, the physician asked the patient if she felt comfortable with her mother in the room for this medical visit. After the patient confirmed that she wanted her mother present, the physician tried to further clarify the reason for the medical visit. Her mother, appearing very concerned, began speaking quickly to the interpreter without stopping for interpretation. When the mother did stop speaking, the interpreter, rather than informing the provider what was spoken of by the mother, dialoged with the mother and the back and forth conversation continued.