We need to expand our definition of healthcare team when it comes to patients with limited English proficiency.
I was reminded of this after reading a March 17 article on Multibriefs.com, “Multilingual healthcare providers for a multilingual nation.” Author Jon Jilani makes a convincing and important argument for the use of competent, trained medical interpreters when providing care to non-English-speaking patients.
The article spoke to the likelihood of poor health outcomes when using ad hoc interpreters, such as family members or untrained staff, and the recent availability of national certification processes to ensure competency of spoken language interpreters.
As a former sign language interpreter for the Deaf and a practicing physician assistant, this issue is near and dear to me. Sign language interpreters have been professionally organized and had a national certification process to ensure competency for decades. This is largely due to the existence of the Americans with Disabilities Act and the highly organized self-advocacy of the Deaf Community.
In addition to the national certification exam, which ensures basic fluency in American Sign Language and the ability to function effectively as an interpreter, there is a required specialized certification for sign language interpreters who wish to work in the legal setting. This is because the legal system has a language all its own and people’s lives are at stake.
And yet for years there has been no specialized certification for interpreters who work in the medical system, which has a language all its own and where people’s lives are also at stake. Specialized medical interpreter training and certification for spoken and sign language interpreters is underutilized and long overdue.
The article’s title invokes the image of multilingual healthcare providers who are able to communicate directly with their patients without the aid of a professional interpreter. However, Jilani fails to mention the danger of healthcare professionals taking a basic language course or two and thinking they are able to communicate effectively with patients in their native language.
I cringe when I see health professions schools or online courses offering “basic medical Spanish.”
Health professionals need to understand that a basic language course will only provide you with conversational skills, which will no doubt aid in rapport-building with your patient. It will not, however, provide you with the skills necessary to be fluent and conversant to the point that you will be able to effectively interview, educate and obtain consent from your patient.
You still need a qualified interpreter to ensure that you are communicating clearly and effectively with your patient. Professional interpreters are either native to the patient’s language (they grew up speaking or signing it in the home) or they spent years studying the language and perfecting their fluency.
While it can be a challenge to ensure the availability of qualified interpreters for both planned and emergent medical visits, the law (Title VI of the Civil Rights Act) and our moral imperative to “first do no harm” require it. And although an on-site interpreter may be preferable in terms of patient comfort and rapport, the availability of interpretation services through video and phone conferencing aids in both the screening process (the company should be verifying their interpreters’ skills and fluency) and 24/7 access to the service.
In today’s healthcare climate, where team-based practice is improving patient outcomes, we need to add qualified medical interpreters as a critical member of the healthcare team.
Lisa Walker is clinical associate professor and director of the Master of Physician Assistant Studies Program at the MGH Institute of Health Professions School of Health and Rehabilitation Sciences in Boston.