A Vietnamese-speaking family arrives for a well visit and their clinician is English-speaking. Since the family understands some English, the family and provider move forward with the appointment.
During the visit, some aspects of the conversation were misunderstood or completely missed. The family completes the visit and schedules a three-month follow up appointment. Because of the language gap, the family did not schedule necessary, pre-follow up testing because they thought all testing was to be done during the next visit.
According to Teresa Amado, senior interpreter with Boston Children’s Interpreter Services, this is a common scenario — and one that shines a critical light on the need for a medical interpreter during appointments.
“When there’s good communication between the two parties there’s a better chance of compliance and follow up,” says Amado. “There is also less chance of misunderstandings that may bring the patient back to the hospital.”
Defining the language landscape
According to the US Census Bureau, there are more than 350 reported languages spoken in US homes and more than 25 million Americans have limited English proficiency (LEP) — a term referring to any person age 5 and older who speaks English less than “very well.”
Patients with limited English proficiency are:
- least likely to receive preventive care
- less likely to have access to regular care, or be satisfied with their care
- more likely to have adverse effects from drug complications
- poor understanding of diagnoses
- low health literacy
- greater risk of being misunderstood by their physicians
- decrease patient satisfaction
For these reasons, the presence of a professional medical interpreter is not only critical to clinical accuracy — an interpreter will help decrease the potential for adverse outcomes, and improve patient comprehension and overall care.
“The benefit of working with an interpreter is that the patient and family will understand everything that is being asked, said and done during the visit instead of just some of it,” Amado adds. “Also, the provider is able to get a better medical history because the patient and family are better able to answer questions and get their questions answered.”
A medical interpreter may also serve as a cultural broker or liaison — someone who anticipates and recognizes misunderstandings that arise from the differing cultural assumptions and expectations, and responds to such issues appropriately.
“As a cultural broker, our role is to help providers and families understand each other’s culture, and in certain circumstances, serve as a patient advocate,” she says.
Professional medical interpreters have an equally powerful role in the care of international patients. “Boston Children’s cares for more than 2,000 international children each year, and many international families may not be as familiar with the American culture,” Amado adds. “So, an interpreter may have to play a bigger role.”
8 tips to work with a medical interpreter
Amado, who speaks fluent Portuguese and Cape Verdean and has worked with thousands of families and health care providers throughout her 15-year career, offers the following tips to successfully work with a medical interpreter:
- Do not use children, family members and untrained bilingual hospital employees as interpreters.
- Meet with the interpreter before an appointment and give the interpreter a brief background before the encounter.
- Allow for extra appointment time.
- Look and speak directly to the patient and family — not the interpreter.
- Use first person statements.
- Speak clearly and use short sentences.
- Avoid jargon, idioms and jokes.
- Refrain from saying anything that you don’t wish to be interpreted during the encounter.
Avoid ad hoc interpreters
The American Academy of Family Physicians says it is best to avoid nonprofessional interpreters because of the following pitfalls:
- no guarantee of confidentiality
- family members may have personal agendas
- interpreter may provide unsolicited advice
- nonprofessional interpreters are associated with a higher risk of longer hospital stays and readmission
- physician may lose control of the interview because of tangential conversations
- scope of inquiry may be limited when using a family member or friend because of embarrassment about intimate or sexual issues
- unfamiliarity with medical terminology may lead to misunderstanding and errors in interpretation
Amado notes that when working with patients and families, the goal of a medical interpreter is twofold: assist and support clinical staff and facilitate effective communication with patients and their families. “Using and interpreter is key to achieve open and clear communication between providers and families.”
- American Academy of Family Physicians
- National Council on Interpreting in Health Care
- Commonwealth of Massachusetts: Best practice recommendations for hospital-based interpreter services
Learn more about Interpreter Services at Boston Children’s Hospital.
About our expert:
Teresa Amado, senior Interpreter (Portuguese & Cape Verdean), Interpreter Services, Boston Children’s Hospital