Do you always understand what your doctor is saying?

Many of us find it hard enough to sift through doctor’s medical jargon to comprehend exactly what they are trying to say about our health and we speak English.

Imagine the frustration and confusion you would experience if you were one of the almost 47 million people, or 18%, of the U.S. population who speak a language other than English at home. Furthermore, for families living in language-isolated households, where no one over age fourteen speaks English well, those percentages are even higher, making them more vulnerable to inadequate health care services. For instance, among Hispanics the percentage is 30%. Thai, Chinese, Korean, and Vietnamese families, range between 26-42%. While Laotian, Cambodian, and Hmong families, far exceed 50%. In addition, fifteen states reported more than 100% growth in their LEP (Limited English Proficiency) populations between 1990 and 2000.

An individual’s limited English proficiency often results in the provision of care based on inaccurate or incomplete information.  Moreover, it increases the cost of care.  Language barriers are the primary reason why non-English speaking populations disproportionately underutilize cost-effective preventive care.  Consequently, providing qualified interpreters can ensure improved preventive care, save money by avoiding unnecessary test and reduce costly emergency room visits. Implementing the services of an interpreter may not seem so expensive when you consider having to run costly tests numerous times because the doctor did not know it was done in another facility.

Another major dilemma is the use of untrained interpreters and bilingual individuals. Many people erroneously equate bilingualism with the ability to interpret and translate; however, an untrained bilingual individual is no substitute for a trained language professional. A mere bilingual person cannot possibly be familiar with technical medical terminology and so increases the probability of error. The use of such individuals is risky and can represent serious legal, clinical and financial ramifications for health care providers.

The following study is a perfect example of how using an untrained interpreter can critically affect the quality of health care services. The study, conducted at a hospital outpatient clinic, audio-recorded thirteen encounters involving a Spanish interpreter. The study revealed an astonishing “three hundred ninety-six interpreter errors”, with a mean of 31 per encounter. The most widespread error type was omission (52%), followed by false fluency (16%), substitution (13%), editorialization (10%), and addition (8%). Sixty-three percent of all errors had potential clinical consequences, with an average of 19 per encounter. Errors committed by ad hoc interpreters were significantly more likely to be errors of potential clinical consequence than those committed by hospital interpreters, showing a statistic of 77% vs. 53 %” (Pediatrics Vol. 111 No. 1 January 2003, pp. 6-14.)  It is necessary to mention, that in this study the term “professional interpreter” includes any individuals paid for providing interpretation, regardless of whether they underwent specialized training and testing.

To illustrate further the dire consequences of care without linguistic access, here are some actual incidents caused by lack of language assistance.

1. In Chicago area hospital, Rosa Campos, a Mexican native and non-English speaker, was scheduled for a routine prenatal checkup. Because there was no Spanish speaker found in the hospital, she had no choice but to ask her nephew to interpret for her. Nobody considered that it could violate her privacy and confidentiality. When a doctor started asking questions about her private matters, she was too embarrassed to discuss it through her nephew and remained silent. Considering this particular example and many others, it should not be permitted to use family members and minors as interpreters.

1. A patient underwent a battery of expensive tests for angina after an emergency room physician misunderstood his complaints of “ungina” – Russian for sore throat.
2. A pregnant woman lost her baby when her doctor, using an untrained interpreter, failed to communicate adequately that she needed an immediate Caesarian section, and the woman returned home.  Her child was ultimately stillborn.

Thus, in the end the safest bet is to use the services of a qualified medical interpreter.  As these and countless other scenarios similar to those previously mentioned continue to occur across the nation, health care providers cannot afford not to use interpreters.