Those interviewed for this article advised that physicians should avail themselves of trained medical interpreters whenever possible. These professionals are trained to translate providers’ and patients’ communications verbatim—without editing—and are conversant with medical terminology.
However, such resources may not be available in rural hospitals. Such is the case for William D. Atchley, Jr., MD, medical director of the Hospitalist Service at Sentara Careplex Hospital in Hampton, Va., who recently used a cafeteria staff person to translate while he examined and admitted a Mexico-born patient with rhabdomyolysis that resulted from heat exhaustion. Dr. Atchley, an SHM Board member, has also used family members as translators. He notes, though, that “trying to get an understanding of what is going on can be difficult at times because the one family member who may act as a translator may not have as good a command of English [as a trained medical interpreter]. You are always fearful that something could get lost in translation.”
Even large institutions that have medical interpreters on staff may not have 24-hour coverage. In that case, telephone interpreters through AT&T’s Language Line service can be another option (www.languageline.com). Physicians can also work with ad-hoc interpreters, defined as family members or friends who act as interpreters, but are not professionally trained, says Dr. Fernandez.
“It can pay off to first take a few minutes to explain to these interpreters that you want them to repeat everything they hear as much word for word as they can,” she explains. “Tell them that you will give them time to participate in the conversation—as a family member—later on. First, you want them to play this narrow role as interpreter, and later you will let them add information as the family member because their contribution is also valuable.”
Young people, including teenage children, should not be used to interpret unless the situation is immediately life-threatening. “There has been a lot of research,” says Dr. Fernandez, “showing that [using children as interpreters] distorts family roles and makes the children uncomfortable.”
For example, says Dr. Grainger-Monsen, it would be completely inappropriate for a child to translate while a physician asks his mother about her past sexual history or vaginal bleeding.
The Time It Takes
At San Francisco General Hospital, where Dr. Fernandez is an attending physician, there are 140 languages spoken each month. She says the variety of patient backgrounds presents a challenge even for someone like herself, who has conducted extensive research on barriers to minority healthcare. She admits that she sometimes experiences an “internal groan” when she notices that the next patient in her busy clinic day is someone who speaks a language that she doesn’t. Like many of the hospitalists interviewed for this article, Dr. Fernandez notes that because using medical interpreters is time-consuming, she experiences initial resistance to the process.
A 2004 Canadian study examined the relationship between length of stay and LEP in the ambulatory care setting. It found that LEP patients stayed in the hospital longer for conditions, such as unstable coronary syndromes and chest pain, stroke, diabetes, and elective hip replacement.3
Issues about cultural competency are “fairly complex,” notes Alpesh Amin, MD, MBA, FACP, executive director Hospitalist Program and vice chair for clinical affairs, Department of Medicine at the University of California, Irvine, and SHM Board member. Sorting through issues surrounding patients’ beliefs toward healthcare, as well as their family values and dynamics, “takes time to resolve, and if I really want to understand your personal beliefs, I’ve got to be willing to sit down and talk about it. But, I’m not going to get paid for that time. This is not a reimbursable expense for the physician.”