Is the Trained Interpreter Part of Your Healthcare Team?

We’ve come a long way in addressing the needs of our patients who speak little or no English. More medical practices are using interpreters. But is it consistent? Or do we sometimes fall back to the old practice of using a family member, friend or untrained employee? And why does it matter? Research has shown that you need the highly trained interpreter in the medical setting. In 2012 Dr. Mary Lindholm conducted a study with the following results:

Costs of using poorly trained or untrained medical interpreters Cost-saving from using competent, trained interpreters:
• lengthens hospital stays. • shortens hospital stays.
• increases malpractice liability for errors, HIPAA and informed consent violations. • minimizes hospital malpractice liability due to errors, HIPAA and informed consent violations.
• exposes hospital/doctor to civil rights complaints. • protects hospital/physician against civil rights complaints.
• increases patient no-show rates, reduces compliance, results in poorer outcomes. • lowers patient no-show rates, improves compliance, improves outcomes.
• increases risk of harming the patient – patient is more likely to be readmitted. • reduces risk of harming the patient.

A 2017 study by Ryan, Abbato, Greer, et al. confirmed these results. Their study concluded that “the conversation between health care providers and patients is of both diagnostic importance and therapeutic benefit… When professional interpreting services are not engaged, patients receive inferior health care with respect to both decreasing quality and safety. They are less likely to adhere to medical treatmentand are more likely to have poorer health-related outcomes. Errors of clinical consequenceare more likely to be made when an ad hoc or no professional interpreting is provided, exposing patients to increased risk of adverse events, and clinicians to greater medicolegal risk… The engagement of professional interpretersis associated with decreased communication errors of clinical consequence, increased patient and clinician satisfaction…, increased appropriate health care utilization, and improved clinical outcomes. Various studies show that ad hoc interpreters (family, friends, untrained employees) put patient and provider at risk. Many do not know the medical vocabulary in both languages to ensure accuracy and completeness.

  • family members misinterpret 23-52% of questions asked by physicians (Ebden, et al. ‘88);
  • non-medical staff can exclude or distort key clinical information (Launer ’78);
  • the patient is less likely to be told about medication side effects (David & Rhee ’98);
  • children who interpret tend to ignore questions about menstruation, bowel movements, and other bodily functions (Ebden et al.’88)
  • In the mental health setting, ad hoc interpreters distort the affect and mental status of the patient (Marcos, ’79); there is frequent over-identification with providers and patients; they distort by “sanitizing” or omitting patient responses; they distort by answering clinician’s questions without asking the patient.

Not included in these studies is the very important fact that these ad hoc interpreters are NOT insured and may have a conflict of interest. Pay Now Or Pay Later… The competent interpreter could have saved a Florida hospital $78 million dollars in a suit brought by a patient whose family misinterpreted the word “intoxicado” to mean intoxicated instead of poisoned, leading the hospital to test for drug/alcohol overdose and not sepsis. National expert, Dr. Eric Hardt, put it simply: “Trained interpreters pay for themselves.” The Qualified Interpreter What makes an interpreter qualified to be interpreting in the health care setting? The trained interpreter…

  • is knowledgeable in medical terms and procedures in two languages.
  • follows an ethics code including accuracy, neutrality, confidentiality and professionalism.
  • does not give opinions or medical advice.
  • follows HIPAA regulations.
  • is trained to bridge cultural differences to prevent misunderstanding.
  • is insured.

A study by Dr. Glenn Flores showed that the ad hoc interpreter (a family, friend or untrained employee) made 22% more medically significant errors.The less-well trained interpreter made 12% more medically significant errors. The well-trained interpreter made 2% medically significant errors. Not Using A Qualified Interpreter Is A Violation Of Patients’ Civil Rights Requiring a patient to bring “someone” (family or friend), without first offering the trained interpreter violates the 1964 Civil Rights Act Title VI on equal access. Other state and federals regulations since then have re-affirmed this.

This article originally appeared in the Spring 2019 Issue of the Onondaga County Medical Society Bulletin.

By Mary Stronach
Mary Stronach has been an interpreter and translator in Spanish and Italian and an interpreter trainer for many years. Her articles, addressing interpreting and translating issues, have appeared in numerous local and national publications. Through her company, Highlander Communications, she offers written translations in over 200 languages, trainings on how to get the best outcomes when working with refugees and immigrants who speak little or no English, and customized cultural competency trainings. If you have any questions, you may call Mary at 315-796-9284.