Use of Medical Interpreters: Facilitating Talk but Delaying Actions: Benefit vs. Annoyance

In the United States the use of medical interpreters is becoming more common in view of the influx or non-English speaking patients and state laws such as in California. But while the interpreter is valuable in obtaining the patient’s history, the patient’s concerns and may help to facilitate the physical examination and the concluding discussion, there is a time factor operating. It may take time to obtain the appropriate interpreter. It takes more time for the interpreter to translate the physician’s words, takes time to make sure the patient understands, takes time to listen to a response and then translate the response into the language understood by the physician. And a physician who has only 15 minutes for an office visit or a hospital resident physician who is simultaneously following a number of patients and/or has various surgeries scheduled throughout the day may find that the time for the use of an interpreter and the process of translation is too time consuming. The value of the interpreter, to that physician, may be simply to get the basic facts and to explain to the patient for informed consent. But beyond that the physician may be comfortable with asking “half-answered “ questions as a memorized couple word expressions and be satisfied with a partially understood patient response and never calling for an interpreter. But is this really fair for the patient who may want to talk more than a brief word or two, expecting to be able to provide the doctor with a full detail of the patient’s concerns and questions?


To help define the problem, here is the result of a study as an abstract regarding the use of interpreters by resident physicians from an article by L.C. Diamond, et al in the Journal of General Internal Medicine, Volume 24, No. 2, February 2009 titled “Getting By: Underuse of Interpreters by Resident Physicians”

Abstract
Background Language barriers complicate physician–patient communication and adversely affect healthcare quality. Research suggests that physicians underuse interpreters despite evidence of benefits and even when services are readily available. The reasons underlying the underuse of interpreters are poorly understood.
Objective To understand the decision-making process of resident physicians when communicating with patients with limited English proficiency (LEP).
Design Qualitative study using in-depth interviews.
Participants Internal medicine resident physicians (n = 20) from two urban teaching hospitals with excellent interpreter services.
Approach An interview guide was used to explore decision making about interpreter use.
Results Four recurrent themes emerged: 1) Resident physicians recognized that they underused professional interpreters, and described this phenomenon as “getting by;” 2) Resident physicians made decisions about interpreter use by weighing the perceived value of communication in clinical decision making against their own time constraints; 3) The decision to call an interpreter could be preempted by the convenience of using family members or the resident physician’s use of his/her own second language skills; 4) Resident physicians normalized the underuse of professional interpreters, despite recognition that patients with LEP are not receiving equal care.
Conclusions Although previous research has identified time constraints and lack of availability of interpreters as reasons for their underuse, our data suggest that the reasons are far more complex. Residents at the study institutions with interpreters readily available found it easier to “get by” without an interpreter, despite misgivings about negative implications for quality of care. Findings suggest that increasing interpreter use will require interventions targeted at both individual physicians and the practice environment.

A physician’s personal experience with this issue is presented in a New York Times article.


All patients deserve beneficent attention and care by physicians despite the handicap of the inability for both to communicate in a common language. In the United States, interpreters are becoming more available to help in this communication and in some states are required by law. But the medical system is complex, not easily changed and tends to produce time limiting necessities but also physician behavioral issues that all lead to impaired doctor-patient communication and potential for errors or inadequacies of care. So what is the answer? Is it medical interpreters or something else? ..Maurice.

Graphic: Illustration by me using ArtRage and Picasa3.