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By: Chelsea On: May 17, 2018 In: Interpreting, Medical Comments: 0
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For those people living in the US with Limited English Proficiency (LEP), even simple day-to-day tasks that native English speakers take for granted can prove difficult. From ordering food at the butcher counter to making deposits at the local bank, modern life in our English speaking culture is a constant challenge. According to the US Census Bureau, as of 2017 more than 20 percent of the US population (61.8 million people) speaks a language other than English at home.[1] The resulting language barrier can be frustrating, if not life threatening, when it comes to healthcare. Imagine getting hurt or falling ill in a foreign country and trying to communicate your symptoms to a doctor who doesn’t share your language. Imagine filling out intake forms, trying to read warning labels, or following prescription regimens all written in a language you don’t speak. As you can see, obtaining medical care can quickly become overwhelming.

The truth of this becomes apparent as we take a closer look at recently reported doctor-patient outcomes when a language barrier is present. According to an article published by Harvard Medical School, recent studies “indicate that patients with limited English proficiency receive less preventive care, are less likely to adhere to medication regimens, and are more likely to leave the hospital against medical advice.”[2] The reason for this? Hospitals and medical care facilities are simply not properly equipped to handle the number of patients that require language assistance. Research conducted in 1996 revealed that an alarming 74% of Spanish-speaking patients went without an interpreter when admitted to the ER.[3] Although this data is more than two decades old, there is little evidence to suggest the situation has significantly improved. For example, at St. Luke’s Hospital in Lehigh Valley, Texas there are only ten full-time interpreters on staff serving more than 40,000 Spanish-speaking patients. Meanwhile, at Parkland Hospital in Dallas County, Texas, although there are 85 available interpreters (the largest number of on-staff interpreters at any US hospital), nearly half of the hospital’s patients require language assistance. That equates to 1,000 visits a day where an interpreter is needed.[4]

There are numerous reported instances that demonstrate the dire consequences that can occur when a patient is not provided with an interpreter. In 2013, for instance, the Huffington Post reported that a Spanish-speaking woman in California had a devastating miscommunication with her doctor: The doctor informed his patient that she was three months pregnant, and she was thrilled. However, the patient had a limited understanding of English, her doctor did not speak Spanish, and no interpreter was provided. After misunderstanding her doctor’s question about wishing to keep the baby, the patient believed she had been given a prescription for prenatal care; unfortunately, she had instead taken medication to induce an abortion. A 2010 study conducted by the University of California, Berkeley School of Public Health on the relationship between language barriers and medical malpractice highlights other recent cases where a language barrier, combined with a lack of proper interpretation, resulted in negligence and, in five cases, death.[5]

A dangerous approach often taken by health care workers when confronted with patients who do not speak English is to enlist family members as interpreters. Several cases in the UC Berkeley School of Public Health study report the use of a child, sibling, or parent as an interpreter, since he or she could speak the languages of both the patient and the doctor — but this approach can backfire drastically. First, a bilingual family member is unlikely to be conversant in the medical terminology needed to properly interpret a patient history or diagnosis. Second, family members cannot be impartial. They may lie or omit information in order to avoid dealing with painful circumstances or to protect their loved ones from difficult truths. The use of family members who are children for medical interpreting, as occurred in several cases highlighted in the study, is particularly risky. In some cases, the children who were acting as interpreters were also the patients. A child receiving medical treatment is already likely to be scared and overwhelmed. Adding the burden of asking that child to act as a medical interpreter is only going to make the situation worse for the patient.

A major hurdle to overcoming this language barrier in the medical field involves a lack of proper training for doctors and other medical professionals when confronted with non-English speaking patients. As reported by UC Berkeley, in more than one case described in the study, conflicting records show that healthcare workers were not even certain what language the patient spoke.

This problem was more common with Asian patients because many providers tend to aggregate the diverse Asian languages and cultures as “Asian” or “Chinese.” Providers were confused about the distinctions between Cantonese, Mandarin, other Chinese dialects and Vietnamese; and the nationalities, races, and cultures of patients from Hong Kong, Taiwan, Vietnam and Macau. Even if the patient was correctly identified as Chinese, providers failed to consider the possibility of further barriers manifested in different language dialects – Mandarin, Cantonese or other Chinese dialects. None of the cases noted any provider asking the patient for clarification of their primary language.[6]

Effective training needs to be administered during medical school in order to ensure that professionals know what steps to take when dealing with LEP patients, including how to identify the language being spoken. The current state of LEP patient education was recorded by a Harvard Medical School survey in which 70 percent of fourth-year students admitted that they felt inadequately prepared to care for LEP patients, while one third of residents nationally confessed to using a child under the age of twelve to interpret. More than half of those surveyed also reported dismissive attitudes among attending physicians and fellow students when it came to caring for patients with limited English.[7] In fact, only 23 percent of teaching hospitals offer training courses on how to work with an interpreter and in most cases this training is fully optional.[8] It is this lack of proper training that often results in the use of ad hoc interpreters, whether they are family members present during exams and emergency situations, or fellow staff members who are not trained in professional medical interpreting, but have a conversational grasp of the patient’s language.

In order to reduce the number of instances where non-English speaking patients fail to receive the care they need, it is vital that hospitals and other healthcare facilities provide proper interpretation services. As a study published by Health Services Research reports, the “use of professional interpreters is associated with improved clinical care more than is use of ad hoc interpreters, and professional interpreters appear to raise the quality of clinical care for LEP patients to approach or equal that for patients without language barriers.”[9] Additionally, professional interpreting not only improves the quality and outcome of patient care, but also results in financial gains for patients and doctors alike. When a patient does not understand their primary care provider’s instructions for at-home treatment, they may fail to take the proper steps to treat their illness, resulting in return visits. When a doctor does not understand their patient’s symptoms they prescribe ineffective medication or schedule unnecessary tests. Every time a patient must return to their physician or take another test, it puts an additional financial burden on that patient. And, since the passing of the Health Care Law in October 2012, this financial burden is also shared by the healthcare facilities since the law requires them to pay the costs for those patients readmitted within thirty days. Misdiagnoses and subsequent return visits also take up valuable time for both the patient and the physician. When a doctor is able to communicate clearly with their patient and vice-versa, it increases the chances of an accurate diagnosis and proper treatment the first time around. This in turn alleviates the possibility of malpractice and subsequent lawsuits.

Lastly, hospitals and healthcare facilities need to provide professional interpreting for non-English speaking and LEP patients because it is the law. Both federal and state laws provide coverage for patients who require language assistance. Title VI of the Civil Rights Act of 1964 and the Affordable Care Act (ACA) both state that any provider who receives federal funds (including from Medicare, Medicaid, and other federal health programs) must provide interpreters for LEP patients. Additionally, as of 2016, Section 1557 of the ACA states that “providers must use qualified medical interpreters when treating LEP patients” and also grants those patients the right to “sue providers for language access violations.”[10] Any violation of the above stated federal laws are considered civil rights violations and so are not covered by medical malpractice insurance. It is therefore imperative that providers know and understand these federal laws in order to ensure compliance and avoid any malpractice lawsuits. There are also language access laws in effect in all 50 states, meaning healthcare professionals must additionally familiarize themselves with their state’s specific laws if they want to avoid future lawsuits.[11]

The best way to guarantee non-English speaking and LEP patients are provided with the interpretation services they require is to have a professional medical interpreter present during the visit. What is meant by “professional medical interpreter”? Unlike someone who simply speaks both English and the language of the patient, a professional medical interpreter is someone who has been trained in interpreting for the medical industry. They have in-depth knowledge of both the necessary medical terminology as well as the culture of the language they are interpreting. Unqualified interpreters (i.e. staff who speak the patient’s language or friends and family members of the patient) will face difficulties when it comes to providing accurate interpretations since they will either fail to understand key medical terms and concepts, or they will be unable to bridge the cultural divide.

What sets professional medical interpreters apart is that in addition to having knowledge of medical terminology, they can also properly handle issues of cultural taboos. For example, in a 2012 article the Voice of America news site reported that when interpreting for many African nations, medical interpreters must often resort to euphemisms when speaking about sexual health — including body parts — due to African cultural taboos.[12] The process of communicating necessary medical information while respecting cultural norms is a delicate one and it requires a trained professional. It is for this reason that a medical provider’s best approach to overcoming the language barrier is to enlist the aid of a professional Language Service Company (LSC). For any hospital or health care provider, locating and hiring experienced interpreters can be an arduous and time-consuming endeavor. When you work with a language service company, like Accredited Language Services, the difficult work of screening and scheduling interpreters is done for you. At Accredited Language, all of our medical interpreters are fully vetted and adhere to strict medical regulatory compliance. We also offer a range of different interpreting services to meet your specific needs including on-site and remote interpreting.

When faced with a language barrier, the preferred form of interpreting is in-person interpretation. When interpreters are physically present during a medical examination, they are able to provide the most accurate translations. It also often sets the patient more at ease when someone who speaks their language is in the room with them. However, this option is often not the most cost effective and is not always feasible due to language requirements and in emergency situations. For instance, on-site interpretation works great when you know a Spanish-speaking patient has an upcoming appointment. In this scenario, you simply contact your trusted LSC and they can schedule an interpreter to be on location at the requested time. But if an LEP patient arrives unannounced with an emergency situation or they speak an uncommon language, on-site interpretation is no longer the best option, as it can take several hours for an unscheduled interpreter to arrive onsite and, if the language is especially uncommon, there may not even be anyone in the area who can interpret.

Another great interpreting option, which provides more flexibility, immediacy, and affordability, is remote interpretation. Current technology offers two forms of remote interpretation: telephonic (over-the-phone) interpreting and video remote interpreting (VRI). Telephonic interpreting works much the same way as a conference call. All three participants – the medical provider, the patient, and the interpreter – will be on the line. Generally, the medical professional will speak first in English. The interpreter will then repeat back what the provider said in the patient’s language. After the patient supplies their response in their native language, the interpreter will relay that information back to the medical professional in English. Telephonic interpreting works well in emergency situations and when the language that the patient speaks is not widely spoken. However, because telephonic interpreting is a purely auditory experience, it is not considered the most reliable approach to medical interpreting.

Non-verbal gestures and expressions account for more than 90 percent of human communication and studies have shown that “body language is as accurate a reflection of our thoughts as the words we use.”[13] For this reason, video interpreting is a much more effective means of remote interpretation. As with over-the-phone interpretation, VRI allows interpreters to communicate simultaneously with medical professionals and their patients located anywhere in the United States. VRI, however, has the added benefit of enhanced communication. Interpreters not only hear what patients are saying, but can also observe their body language and physical gestures, improving interpretation accuracy.

Communication is key to delivering effective health care. It is therefore vital that medical professionals provide non-English speaking and LEP patients with qualified interpreting services through the use of a Language Service Company. Not only will doing so improve medical outcomes, but it also saves time and money, and reduces the potential for malpractice lawsuits.

Whether you decide to seek on-site interpretation in the form of in-person interpreters, or utilize the benefits of remote interpreting, Accredited Language Services can help. Contact us today for a free consultation to learn more about how we can address all your medical interpreting needs.

 

Notes

[1] “American Community Survey (ACS).” United States Census Bureau. Accessed March 15, 2018. http://www.census.gov/programs-surveys/acs/.

[2] Williams, Erika. “Learning the Language of Patient Care.” HMS. February 7, 2011. Accessed March 15, 2018. https://hms.harvard.edu/news/learning-language-patient-care-2-7-11.

[3] Baker, David W., Ruth M. Parker, and Mark V. Williams. “Use and Effectiveness of Interpreters in an Emergency Department.” JAMA. March 13, 1996. Accessed March 6, 2018. https://jamanetwork.com/journals/jama/article-abstract/398141?redirect=true.

[4] Huang, Binghui. “No comprende? Hospitals are hiring more interpreters to change that.” Lehigh Valley Business Cycle. November 30, 2017. Accessed March 15, 2018. http://www.mcall.com/business/healthcare/mc-nws-health-translators-hospitals-20171115-story.html.

[5] Quan, Kelvin, and Jessica Lynch. “The High Cost of Language Barriers in Medical Malpractice.” 2010. Accessed March 15, 2018. http://www.pacificinterpreters.com/docs/resources/high-costs-of-language-barriers-in-malpractice_nhelp.pdf.

[6] Quan, Kelvin, and Jessica Lynch. “The High Cost of Language Barriers in Medical Malpractice.” 2010. Accessed March 15, 2018. http://www.pacificinterpreters.com/docs/resources/high-costs-of-language-barriers-in-malpractice_nhelp.pdf.

[7] Kenison, Tiffany C. “Through the Veil of Language: Exploring the Hidden Curriculum for the Care of Patients With Limited English Proficiency.” Academic Medicine, vol. 92, no. 1, Jan. 2017, pp. 92–100.

[8] Williams, Erika. “Learning the Language of Patient Care.” HMS. February 7, 2011. Accessed March 15, 2018. https://hms.harvard.edu/news/learning-language-patient-care-2-7-11.

[9] Karliner, Leah S., Elizabeth A. Jacobs, Alice Hm Chen, and Sunita Mutha. “Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature.” Health Services Research. April 2007. Accessed March 6, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955368/.

[10] “Legal Risk & Compliance.” InDemand Interpreting. Accessed March 26, 2018. https://www.indemandinterpreting.com/wp-content/uploads/2017/03/InDemand-Interpreting-Trends-risk-1.pdf.

[11] Perkins, Jane, Mara Youdelman, and National Health Law Program. “Summary of State Law Requirements Addressing Langauge Needs in Health Care.” January 2008. Accessed April 18, 2018. http://www.healthlaw.org/issues/health-disparities/summary-of-state-law-requirements-addressing-language-needs-in-health-care#.WuHz_pcpDcs.

[12] VOA. “Translators Face Cultural Dilemma.” VOA. April 30, 2012. Accessed March 26, 2018. https://www.voanews.com/a/translators-face-cultural-dilemma-149487765/369955.html.

[13] Brady, Ann J. “When There Are No Words: Interpreting Patients’ and Families’ Subtle Messages.” ONA. January 23, 2018. Accessed March 26, 2018. https://www.oncologynurseadvisor.com/oncology-nursing/when-there-are-no-words-interpreting-subtle-messages/article/738955/2/.

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