The number of individuals with limited English proficiency (LEP) in the United States increased by eighty percent during 1990 and 2010 (LEP Data Brief, 2011). The US Department of Health and Human Services defines LEP individuals as individuals who do not speak English as their primary language and who have a limited ability to speak, read, write, or understand English. Under Title VI, the Civil Rights Act of 1964, the LEP individuals are entitled language assistance when accessing service, benefit, or encounter from any agency receiving federal funding. Between 1990 and 2010, the Southwestern and Southeastern states in the United States saw the highest growth rates of LEP population (LEP Data Brief, 2011). In 2010 Arizona’s LEP population grew by 112.9 percent and Arizona was listed among the top 10 states with the largest LEP (Census Bureau, 2010).
As the number of LEP individuals increase at a rapid rate in our state, it is most likely that there is an increased use of trained/qualified/certified Medical Interpreters by the health care providers in order to establish trust through effective communication with their patients/clients. Below are ten recommendations for medical professionals to consider when working with medical interpreters.
1. Being bilingual is not enough to ensure the quality of a medical interpreter.
Interpreting is a professional skill, developed through training and participation in continuing education courses just like in any other profession. Being able to speak two languages FLUENTLY does not guarantee that professional medical interpreting is taking place.
2. Don’t ask medical interpreters to provide word-for-word interpreting.
Interpreters relay the meaning of the words because a word-for-word interpretation will often lose any meaning whatsoever.
3. Expect medical interpreters to abide by a Code of Ethics.
A trained/qualified/certified medical interpreter will adhere to the National Code of Ethics for Medical Interpreters of which confidentiality, accuracy and impartiality are among the few components. An example of the National Code of Ethics can be found at ncihc.org.
4. Don’t ask interpreters to insert their opinions.
Interpreters make your job easier by being the bridge to communication between the healthcare providers and their patients. Medical interpreters will interpret anything you wish to relay to your patients/client, but they cannot insert their own opinion, act as a messenger, or make any decisions for the patients/clients.
5. Clarify abbreviations and minimize medical jargon.
Medical English is a language unto itself. Hence the use of Medical acronyms (medical jargons) will not make any sense to the limited-English speaker. So please use simple English for the purposes of effective communication.
6. Don’t ask interpreters NOT to interpret something.
Part of the Medical Interpreter’s Code of Ethics says to interpret everything that is said, as it is said. If there are some information you don’t want to share, it is best not to say it in front of a trained/qualified/certified medical interpreter.
7. Address the patient, not the interpreter, and maintain primary eye contact with your patient.
The interpreter’s role is important in helping you develop trust and enhance your relationship with your patients. So please address your patient and maintain eye contact with your patients not the interpreter.
8. Speak at a comfortable pace and pause frequently to allow for the interpretation.
In order to render a complete interpretation, please pause after every one or two sentences. A trained/qualified/certified medical interpreter will let you know when you need to slow down.
9. Don’t ask the patient to bring their own interpreter, don’t ask another patient to interpret for you, don’t use a child as an interpreter, and don’t use friends, family or non-qualified hospital staff as your first line of defense during medical encounters unless it is an emergency.
There are legal obligations that make it imperative that qualified language services are utilized in each clinical encounter with limited English proficient individuals.
10. Document the use of an interpreter. Document when it is not possible to use a qualified/certified interpreter. Be sure to document your attempts and the reason(s) why such an interpreter was not utilized.
Sometimes circumstances may make it impossible to utilize qualified language services. The medical record should reflect when an interpreter was used,
who that interpreter was, and any obstacles in using an interpreter. Find out how to locate a qualified interpreter, and return to using qualified language services as soon as possible.
The above recommendations can get us off to a good start in establishing trust with the LEP patients/clients through effective communication with the help of trained/qualified/certified medical interpreters. Let us strive for a LEP friendly and medical interpreter friendly health care in Arizona.
LEP Data Brief (2011). Migration policy institute: national center on immigrant integration policy.
US Census Bureau, 2010. Language spoken at home by ability to speak English for the population 5 years and over.