According to the United States Census Bureau, an estimated 8.3% of the United States population, representing over 25 million people, speaks English less than “very well.” In certain areas of the country, including southern Florida and the Southwest, the proportions are significantly higher.
As you practice medicine, you’ll likely encounter patients who speak languages other than English. In these scenarios, communication can prove challenging. Here’s some advice for how to communicate with patients with language barriers, including best practices when working with medical interpreters.
How to Communicate With Patients With Language Barriers
Effective communication is essential to the practice of medicine. Patients must convey histories and personal values to their physicians, while physicians must, in turn, provide complex medical information to their patients. Anything that disrupts this line of communication, including language barriers, can potentially jeopardize patient care.
Physicians are extraordinarily busy on a day-to-day basis, and using interpreters can slow down a busy clinic. However, when seeing a patient whose primary language is one in which you aren’t fluent, you should always obtain the services of an interpreter. Not only is patient care at stake, but not doing so may also violate a patient’s rights. According to the United States Department of Health and Human Services, “Title VI of the Civil Rights Act of 1964 requires recipients of Federal financial assistance to take reasonable steps to make their programs, services, and activities accessible by eligible persons with limited English proficiency.” In practice, these regulations require hospitals and hospital-based clinics to provide patients with limited English proficiency the ability to use interpreter services.
Patients will often bring family members or friends who are fluent in their primary language to their appointments. While it may be tempting to use these individuals as interpreters to save time, resist the urge. Not only are patients’ loved ones generally not trained to deliver medical information, but they may also be biased in how they present the information you wish to convey. Crucial details may be lost in the process.
Instead, to limit opportunities for misunderstanding, seek an interpreter who is medically trained. Large medical institutions generally employ a variety of interpreters who can provide in-person translation services. Many medical clinics and hospitals also subscribe to telephone- and web-based interpreter services, which generally offer a larger variety of language services at the cost of a more cumbersome interview process. Medical colleagues fluent in the patient’s primary language may also be an option, depending on their availability.
5 Tips for Working With Interpreters
Working with medical interpreters is your best choice for communicating with patients with language barriers — but it’s not without its challenges. Here are five recommendations for doing it effectively.
1. Identify Patients Who Need an Interpreter in Advance
Patients who are fluent in languages other than English deserve high-quality care. Providing that care requires an interpreter’s services, which will inevitably extend the length of the patient visit. To avoid backing up your clinic, try to identify patients who will require interpreter services in advance and allot extra time for their visits. This preparation will allow you to coordinate your interpreter services prior to your patient’s visit, saving you time and keeping your clinic running smoothly.
2. Speak Directly to the Patient, Not the Interpreter
During the visit, you may find yourself tempted to speak directly to the interpreter, who will be fluent in your primary language, rather than to your patient. Avoid this tendency at all costs. Every patient visit should be focused on the patient themselves, and patients shouldn’t be treated differently just because they speak a different language. When seeing a patient with limited English proficiency, be sure to speak directly to them.
3. Ask the Interpreter to Sit Next to or Behind Your Patient
If you’re working with an in-person interpreter, ask them to sit next to or behind your patient. This seating arrangement will help facilitate a conversation with your patient. Not only should you speak directly to your patient, as noted above, but you should also be seated in front of your patient and maintain direct eye contact for the duration of the interview. In other words, treat all of your patients, regardless of the languages they speak, the same.
4. Speak in Short Sentences and Ask One Question at a Time
When interviewing your patient, speak in short segments to allow interpreters to fully convey your message in a manner that isn’t overwhelming and allows patients to ask questions as you proceed. Additionally, when soliciting information from patients, ask one question at a time to allow them to answer completely. While it may be tempting to talk for long, uninterrupted stretches to save time, this may backfire and result in information lost in translation.
5. Respect Cultural Differences
Taking care of patients from different cultures is incredibly rewarding. That said, it can be challenging, and you should strive to respect cultural differences in all of your patient interactions. Support your patients’ wishes, incorporate their values into their care plan and respect their autonomy at all times. As Dr. Ogie Ezeoke highlights in a prior article on After Rounds, “When caring for patients from different cultures, it’s best to listen, acknowledge, validate and support. Be an advocate and a cheerleader for your patients.”
You’ll inevitably find yourself using the services of a medical interpreter in your practice. Be sure to master the tips above to optimize your ability to communicate with patients who aren’t fluent in English.