 |
Types of Interpreters Used and Quality of Provider-Patient Communication
From the American Medical Association’s Office guide to communicating with limited English proficient patients.
| Type of Interpreter | Average availability | Professionalism (knows ethics of interpretation) | Comfort to Patient | Interpreting quality | Circumstances where interpreter type is appropriate* |
| Trained onsite Interpreter | Varied | High | Moderate-high | High | All |
| Trained telephonic interpreter | High | Moderate-high | Moderate | High | All |
| Bilingual health care practitioner | Varied | Moderate-high | High | Moderate-high | All |
| Trained bilingual staff | Low-moderate | Moderate-high | Moderate | Moderate-high | Moderate-high risk circumstances (depends on level of training) |
| Untrained bilingual staff | Varied | Low | Low-moderate | Low | Low-risk circumstances** |
| Bilingual family member or friend | Moderate-high | Low | Varied | Low | Low-risk circumstances** |
* Examples of possible circumstances:
- Low: Nonmedical communications such as scheduling follow-up or making appointments for referrals; some low-risk medical encounters, such as medication refills, annual influenza vaccination, otitis media recheck.
- Moderate: Routine follow-up for chronic disease, patient triage.
- High: Consent discussions, diagnostic evaluations for new problems, end-of-life discussions.
** Experts in medical communication consider this an option of last resort.
a) Trained onsite interpreter
Competency in medical interpretation requires more than fluency in a language or even knowledge of medical terms in that language. Trained medical interpreters are individuals who have received professional instruction in medical concepts and terminology, interpretation skills and process, communication skills, ethics, confidentiality and cultural issues.
While there is a national code of ethics and the National Standards of Practice for Interpreters in Health Care, training standards are still in the process of being developed. No specific certification requirements currently exist for use by all training organizations.
Many health care organizations and some insurers will provide access to onsite medical interpreters. If you do not have access to these resources in your clinical setting, you can access community-based, trained medical interpreters through:
- Local language agencies
- Community colleges
- Social service programs such as legal aid, welfare assistance programs, immigration programs, migrant health clinics and English as a Second Language programs
Onsite interpreters are preferred for encounters that rely on nonverbal communication (e.g., facial expression, body language), such as when delivering bad news. They may also work best when obtaining informed consent. In these situations, it is important to ensure effective communication and nonverbal cues are appropriately considered to assess whether informed consent truly takes place.
b) Trained telephonic interpreter
Trained telephonic interpreters provide offsite multilingual interpretation to the patient and physician by telephone. Companies providing these services can furnish wireless remote headsets for use in areas not wired for telephones or dual-handset equipment that avoids the need to pass the telephone back and forth. (The speaker option available on many phones can also be used for this purpose, if it has good sound quality.) Telephonic interpretation usually works best when a specific telephone in the office is designated for interpretation or when one is placed in every examination room.
Trained telephonic interpreters are particularly useful for practices with a multilingual patient base, at which it would be difficult to have multiple onsite interpreters. They are most effective for administrative and routine encounters, when nonverbal communication plays a limited role. Some considerations when choosing telephonic interpreting are cost, miscommunication due to patient dialect and possible discomfort with the use of a telephonic versus an onsite interpreter.
The National Health Law Program provides resources for researching interpretation services across the country, such as the Language Services Resource Guide for Health Care Providers (October 2006).4
c) Bilingual health care practitioner
Being bilingual or being a bilingual medical practitioner does not ensure competency in medical interpretation. Practitioners in this role should complete an interpreter training program to optimize their effectiveness and the quality of care they deliver.
d) Trained bilingual staff
If bilingual staff members are trained to serve as interpreters (as described earlier in section a), and have been tested to demonstrate competency, they can effectively fulfill the role of interpreter. However, because bilingual staff are also responsible for performing their primary roles, their availability for interpretation may be limited.
e) Ad hoc interpreters (bilingual family members or friends, untrained bilingual staff)
Experts in medical communication believe that family members, friends and untrained staff should only be used as a last resort, when none of the other preferred methods are available.
Research indicates that when family members, friends, strangers or other untrained individuals serve as interpreters (known collectively as ad hoc interpreters), significantly more interpretation errors of clinical consequence occur. Studies also show that the use of ad hoc interpreters is associated with a high risk of interpretation errors, omissions, distortions and redundancy. Ad hoc interpreters are unlikely to have adequate training in medical terminology and confidentiality, and sometimes may have priorities that conflict with patients and may inhibit or preclude essential discussions on sensitive issues such as domestic violence, substance abuse, psychiatric illness and sexually transmitted diseases.
