July 16, 2024

Communication and the Use of Interpreter Services

By Shari L. Hendrickson

Communication is key to providing quality health care services to patients, including those who have limited English proficiency. For patients needing language interpretation and translation services, we recommend the use of a certified interpreter when communicating. This includes patient education, care planning, and obtaining informed consent, as it is vital to ensure improved clarity of the information being presented. The use of an interpreter may reduce health care disparities among different cultures while increasing trust and confidence in the health care team. Compliance is advised regarding federal and state laws (e.g., Title VI of the Civil Rights Act of 1964) that mandate the use of interpretive services in health care.

Why certified?

Communication between patient and physician or advanced practitioner is often made more complex by the lack of knowledge regarding each other's culture. We recommend the use of certified interpreters due to the training their certification requires, which should include knowledge of medical terminology, health care systems, accuracy of the language being interpreted, and training in the obligation of confidentiality.

We recommend exclusive use of certified interpreters and translators and advise against the use of staff, minor children, or other family members as routine interpreters. This is to prevent the risk of inaccurate translation, commissions, and potential conflicts of interests that may arise from personal or emotional connections. In a health care emergency, such use may be justified until a certified interpreter can be secured-and all measures to secure a certified interpreter should be exhausted. The emergent need and actions taken to secure a certified interpreter should be detailed and documented in the medical record.

Patient refusal

If the patient refuses the use of a trained medical interpreter, the physician should document the patient's decision. One way to document the decision is with a waiver that explains the risk of refusing a medical interpreter. With a trained medical interpreter present, the physician should review the waiver with the patient and have the patient sign the waiver once the contents are understood. The signed waiver should be kept in the patient's medical record.

Practice makes perfect

It is important for physicians to recognize and address potential cross-cultural communication barriers with their patients. Medical interpreters help improve patient-physician communication and may provide insight into common communication barriers that may lead to poor quality or life- threatening medical errors.

To increase competence in the use of interpreter services, consider simulation as a training tool. Simulation may provide an opportunity to identify ways to improve style, health literacy, and medical terminology, as well as how to gauge the pace of communication.

Medical records

Certified medical translators can provide the translation of a patient's medical records. To ensure that all information is correct, such individuals are required to be proficient in the technical and medical terms for the language they are translating. These individuals should be certified to perform such services. Staff, minor children, or other family members should not translate medical records. Mistakes during translation may lead to medical errors.

Interpreter services and telehealth

The recent increase in telehealth services presents unique challenges to the delivery of care. Access to interpreter services must be reviewed prior to confirming a patient's candidacy for telehealth care. Criterion must be developed, and patients should be evaluated for their ability to access required technology, for their appreciation for both the benefits and challenges of telehealth services, and for their consent for service. Criteria must also be in place regarding the physician's ability to obtain timely interpretive language services for all aspects of the telehealth visit.

Use of a certified language interpreter

Below are procedures to consider when communicating through a certified language interpreter:

1. During the interaction, look at and speak directly to the patient, not the interpreter.
2. Provide guidelines for the interpreter to keep communication open and facilitate an understanding of the goals and purposes of the interview or counseling session. When possible, meet with the interpreter or familiarize yourself with interpretative companies' processes before meeting with the patient.
3. To increase competence in the use of interpreter services, consider simulation as a training tool.
4. Encourage the interpreter to meet with the patient before the interview to discover the patient's language literacy and attitudes toward health care. This information can aid the interpreter when explaining process and setting expectations and can aid in gaining insight into the patient's overall communication needs.
5. Speak in short units of speech. Avoid long, complex discussions of several topics in a single visit or interview.
6. Avoid technical terminology, abbreviations, and medical jargon.
7. Avoid abstractions, idiomatic expressions, slang, similes, and metaphors.
8. Encourage the interpreter to translate in the patient's own words as much as possible rather than paraphrasing.
9. Encourage the interpreter to refrain from omitting information or from inserting his or her own ideas or interpretations.
10. To check on the patient's understanding and the accuracy of the translation, ask the patient to repeat instructions, or whatever has been communicated, in his or her own words, with the interpreter facilitating.
11. To facilitate timely access to all health care and services, offer language assistance to individuals who have limited English proficiency or other communication needs, at no cost to them.
12. Inform all individuals of the availability of language assistance services. Do this clearly and in their preferred language, verbally and in writing.
13. Ensure the competence of individuals providing language assistance, recognizing the importance of certification, and acknowledge that the use of untrained individuals or minors as interpreters should be avoided.
14. Provide health literate appropriate print resources, multimedia materials, and postings on social media, websites, and elsewhere.
15. Listen to the patient and watch his or her nonverbal communication. Often, much can be learned regarding the patient's response by observing facial expressions, voice intonations, and body movements.
16. Exercise patience. An interpreted interview takes longer. Careful interpretation often requires the use of long explanatory phrases.
17. If using telehealth care for patients who require a certified interpreter, ensure that patients meet the criterion for telehealth care.

For more information and guidance on the use of interpreters in your practice, including a sample waiver you can adapt for your setting, visit phyins.com.

Shari L. Hendrickson is a senior clinical risk consultant with Physicians Insurance.

This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.