Published on in CHOP News
Why do we need a qualified medical interpreter?
According to a United States Census Bureau report published in 2014, 50 percent of the nearly 41 million foreign-born people aged 5 and older reported to speak English less “than very well.” That is approximately 20.5 million people!
This trend is expected to continue increasing in the coming years. Many of these individuals have limited English proficiency, which represents a challenge for the healthcare sector in providing safe, high-quality medical care. This challenge involves overcoming language and cultural barriers when obtaining critical medical information.
Medical interpreters are key to overcoming obstacles when providing medical care for limited English proficient (LEP) families.
Federal laws and regulations governing language access
Federal law requires providing medical interpreters to LEP families. A series of laws at the federal level were designed to protect LEP families’ rights to access programs that receive federal funding and to receive medical information in their preferred language. In order to do so, these laws seek to ensure that language access services are offered. Language services must be provided by qualified medical interpreters either in-person, by phone or by video.
Federal laws and regulations governing language access include:
- Title VI of the 1964 Civil Rights Act
- Executive Order 13166 of the Department of Justice
- DHHS Office for Civil rights Policy Guidance
- Office of Minority Health CLAS Standards
- Americans with Disabilities Act — Title 42, Chapter 126
- Patient-centered Communication Standards, Joint Commission
How medical interpreters can help keep patients safe
Above all else, medical interpreters keep patients safe. Research has shown that language barriers have a big impact on healthcare. Not being able to understand critical medical information in someone’s own language could lead to serious adverse outcomes, more complications, more visits to the ER and re-admissions, non-compliance with the medical treatment, even death. One word can change the whole meaning of a conversation.
There have been numerous unfortunate cases. The most publicized case occurred in the 80s in Florida when an unconscious 18-year-old male was brought to the ER. The patient’s LEP family tried to explain that they believed the patient had a severe case of food poisoning, or as said in Spanish this means “intoxicado.” They were desperate to communicate with the doctor and without an interpreter around, one of the family members attempted to explain in broken English by saying, “intoxiCAted, armBURger.”
The doctor assumed that an unconscious, but otherwise healthy teenager had probably had a drug overdose, as he incorrectly interpreted that the family was saying as “intoxicated.” The diagnosis was made and the patient was treated as if he had overdose. Thirty hours after admission, the doctors decided they should place an order for a neurology consult as one of the patient’s eyes was deviated.
As it turned out, there was no overdose; the patient had a stroke. Communication barriers led to a misdiagnosis and the delay of appropriate medical care resulted in a quadriplegic patient. The family sued the doctor and the hospital and received a $71 million settlement.
Perhaps the presence of a qualified medical interpreter could have changed the outcome for the patient, who is living the rest of his life in a wheelchair; and for the doctor, whose career was tarnished over this one mistake. A qualified interpreter does not repeat what was said word for word (verbatim,) but understands the message of what was said and delivers the message with the same meaning and spirit, as he or she understood it.
Culture and communication
Culture can pose a barrier to communication. Our culture shapes the way we see and understand the world. The interpreter is aware of the differences between their culture and that of the United States. A patient may smile, nod and say “yes,” meaning they are giving you their attention. However, this does not necessarily mean they understand what you said. Additionally, patients may avoid contradicting a doctor, as it could be considered disrespectful.
During the patient-provider conversation, the interpreter is able to identify potential issues with communication based on the culture of the patient and alert the medical team of these issues. In the case of questionable comprehension, an interpreter might suggest verifying that the patient understood the information.
So, the next time you are debating requesting a qualified medical interpreter, please remember:
- It is required by law for patient safety.
- One word can change the meaning of critical medical information.
- Your interpreter can help you to overcome cultural barriers to healthcare.
Please do not hesitate to contact the Language Services Department at Children’s Hospital of Philadelphia (CHOP) for all your language access needs.
Gambino, C.; Acosta, Y.; Grieco, E. (June 2014) English-Speaking Ability of the Foreign-Born Population in the United States: 2012. Read more.
Price-Wise, G. (2011) An Intoxicating Error: Language, Culture, and Medical Tragedy. Read more.