The need for health care interpreters

February 5, 2014, Audrey Singer and Camille Galdes. A new U.S. citizen waves
a U.S. national flag in front of a display of flags.

According to the 2010 Census, roughly 574,560 people in Minnesota speak a language other than English at home; or 10.6% of the population in Minnesota, compared to the 20.5% of the total US population. Over half of these individuals report that they speak English less than “very well.” These individuals are considered to have limited English proficiency (LEP). That is, they are not able to speak, read, write, or understand the English language at a level that permits them to interact effectively. 

Due to this deficit in communication between patients and providers in a medical setting there are many issues that arise; they are at risk due to their ability to access care and communicate with their providers, to name the two most important.

It is well established that language barriers contribute to health disparities for LEP patients. These patients have less access to a usual source of care, and lower rates of physician visits and preventive services. Even when they do have access to care, LEP patients often have poorer adherence to treatment and follow-up for chronic illnesses, decreased comprehension of their diagnoses and treatment after emergency department (ED) visits, decreased satisfaction with care, and increased medication complications. In contrast, language concordance between patients and physicians increases patient satisfaction, patient-reported health status, and adherence with medication and follow-up visits.

Given that over 100 languages are commonly spoken in the United States (US Census), it is often not possible to provide language concordant health care. In some clinics around Minnesota, providers my experience 20+ different languages in one day alone; and many interpreter services agencies offer 40-50 of the most common languages, where hospitals and clinic are forced to fill in the gaps with  "web or telephone" communication with up to 104 languages in any given day.  

Although some LEP patients are fortunate enough to be seen in settings where physician and office staff speak their primary language, this language concordance can readily disappear once these patients present for laboratory testing, emergency care, or are admitted to the hospital. Therefore, the majority of providers must use other means to communicate with their LEP patients and, if they receive federal financial assistance, they are required to do so by Title VI of the Civil Rights Act of 1964. Most often this means is a third person, an interpreter, who can range from a highly trained professional medical interpreter to any available bilingual person (NCIHC 2001).

The National Interpreter Organizations such as, the National Council on Interpreting in Health Care (NCIHC), and many professional interpreters agree and recommend the use of professional interpreters to augment the use of bilingual clinicians and staff, in order to improve the quality of care delivered and to decrease health disparities. A recent general review of literature concludes that the quality of medical care is improved by either use of professional interpreters or via direct provision of care by bilingual health care providers. 

Through careful evaluation of this literature it is clear that professionally trained interpreters decrease communication errors, increase patient comprehension, equalize health care utilization, improve clinical outcomes, and increase satisfaction with communication and clinical services for limited English proficient patients. Health care providers need to recognize that language barriers place LEP patients at a disadvantage that can be overcome by providing better linguistic access. Without access to professional interpreters, this large and growing population will continue to suffer differentials in both health and access to quality health care.