The pain, suffering, costs, wasted resources, and even deaths that result from medical errors are almost always the result of a breakdown in communication. As medical teams see more Limited English Proficient (LEP) patients, it’s crucial that everyone in every conversation completely understands everyone else. The best way to ensure this is to use a qualified medical interpreter.
Why Use a Professional Interpreter Instead of Family or Friends?
Often, a family member who speaks the patient’s language is right at hand, so why not use them? There are potential entanglements and liabilities in a situation where a family member is the conduit for medical information.
Family Pitfalls—The patient may be reluctant to disclose certain personal details through a family member. Those close to the patient may also inject their own biases into the
interpretation they deliver to you, or accidentally skip details a trained interpreter would render. Though it’s rare, a family member may even use their influence in the relationship to prevent the patient from choosing a treatment option they oppose. Having a neutral, trained party provide interpretation is the best option.
Knowledge—Medical interpreters have received training so that they are knowledgeable when it comes to medical terms and procedures, as well as HIPPA requirements. This way, you’ll know these things are being interpreted to the patient accurately.
Cultural Nuance—Professional interpreters are trained to notice and account for differences in speech and body language in the speakers’ cultures, and can alert the other party to anything that may need clarification due to cultural context. Family members may dismiss these nuances in their rendition or may not think they are important.
In short, when a family member is used as an interpreter, the risk of a medical error grows. They should only be relied on in emergencies where there is no time for an alternative.
Best Practices for Working with an Interpreter
Once we’ve adopted the practice of using a professional interpreter, how can we work with them and with patients to make communication as clear as possible?
Choose Certified Interpreters—Depending on the language in need, a few organizations (such as The National Board of Certification for Medical Interpreters) certify that interpreters have the appropriate skills and knowledge for medical settings. Because interpreting is currently unregulated in the U.S., make sure the interpreter’s credentials are through a nationally recognized organization. Use such an interpreter whenever possible.
Use Onsite Interpreters When Possible—Though Covid-19 is preventing this in most cases, keep in mind for the post-pandemic future that in-person interpreting delivers the best results. It not only allows the interpreter to catch cues that may not reach them via phone or video, but onsite interpreters are local interpreters. Understanding the geographic area and the variations in local speech can give them valuable insights that help you deliver better care.
Have the interpreter sit next to and slightly behind the patient when space and circumstances allow. This makes it easier to maintain eye contact with the patient and allows the provider to build a relationship with the LEP.
Allow Extra Time—If you are in a non-emergent setting, allow extra time with the patient.
Interpreted conversations may take a little longer. Also, keep in mind the health literacy of LEP patients may be different from those who have lived their entire lives in the United States. Take your time, because nothing causes errors like a need to rush.
When requesting an interpreter, give as much detail as possible regarding the appointment. Include names of specific diseases or procedures that will be discussed during the appointment. This will allow the interpreter to prepare for the appointment. In some cases, such as when discussing a complex procedure or treatment plan, you may even want to schedule 10 or 15 minutes for extra briefing time with the interpreter so they have a full understanding of the specifics.
Use Basic Interpreting Best Practices—In every conversation involving an interpreter, you should maintain eye contact with the LEP, speak to them just as you would speak to an English speaker, and avoid using the third person. In other words, you would say, “Mrs. Lopez, your test results…” instead of “Tell her that her test results…”. Using the third person causes confusion as the interpreter is trained to interpret in the first person. Speaking directly to the LEP also helps the provider to develop a rapport with the patient.
It’s also important to keep statements short—a sentence or two at most—and leave pauses for the interpreter. Though it can be a challenge in medical settings, it’s also crucial to eliminate jargon and other technical terms whenever possible.
Ask the Patient To Repeat— Using the teach-back technique to assess the patient’s understanding is a great tool to use when working with LEP persons. When giving instructions for care, politely ask the patient to repeat them back to you.
Use Phone or Video Wisely—In emergent situations or when a language has fewer resources in your area, you may not be able to use an onsite interpreter. We’ve prepared an article on the best ways to work with remote interpreters, but in a medical setting the most important difference is that some languages may not have certified interpreters. In this case, you’ll need to be more careful with your explanations, and more careful about making sure the patient is fully understanding your questions.
Don’t Forget the Importance of Translation
Making sure the patient clearly understands the written word (such as care instructions) is as crucial as it is in conversations. Consider having common documents translated by a professional so the patient will not have to rely on others to read them.
Remember that each interpreter and translator is a highly trained expert, and they are eager to help you succeed. With the right approach, you’ll keep everyone properly informed and completely safe.