“Habla Espanol?”: Improving Communication between Care Providers and Patients with Low English Proficiency

I walk into the room and when I ask the patient what brought her to the hospital I receive a confused look followed by a hopeful, “Habla espanol?”

“Si,” I answer and the woman smiles and begins to relate the problem that brought her to the hospital. Although I understand most of it, I realize there are words I did not understand. I wonder if I should ask for an interpreter. Fortunately my hospital has well-trained, available interpreters but I hate to bother them if I feel I am understanding the key points. Still, I wonder, is my Spanish good enough and might I have missed an important detail? Two articles in the October issue of Academic Medicine address the use of interpreters and proficiency in languages other than English. Lion and colleagues tested pediatric residents and compared their tested proficiency with their self-perceived proficiency. They found that 70% of residents who felt they had conversational Spanish skills were not proficient and 46% who thought they were proficient tested in the non-proficient range. Those who thought they were proficient generally did not use interpreters. Thompson and colleagues surveyed pediatric residents about training they had received in utilization of interpreters and found that 54% had never received education on interpreter use. 77% of respondents reported that they had never received feedback on their use of interpreters.

As I have had the opportunity to watch our interpreters assist with patients, I have noticed that when I have an interpreter I can concentrate more on the patient care decisions and less on my language comprehension. I often understand the conversation between the interpreter and the patient but realize that the interpreter is able to convey complex issues, such as consent for procedures, far better than I could. I can still talk directly to the patient in her language but I can use the interpreter as a check to make sure that information has been communicated accurately. I realize that communications is more than  the transfer of information between people. There is also the important relationship building, the subtle nonverbal cues we give that build trust and convey compassion and caring. These things are hard to do through an interpreter and I am sure that tests of proficiency are not able to measure this. There are also the logistical issues of interpreter availability, the effects of delays upon patient quality of care, and the costs associated with training and supporting interpreter services. For hospitals and clinics that have few patients with low English proficiency, the low utilization may not justify around-the-clock interpreters; other options, like telephone interpreter services, may make more sense. When deciding whether or not to utilize an interpreter, a health care provider should probably take into account a variety of factors about the patient, the provider, and the situation. Considering the findings from Lion and Thompson’s studies, we all may want to assess our own individual second language capabilities and provide education and feedback to residents about their use of interpreters as part of our routine assessment of communications.

I realize that for many of us the opportunity to communicate with a patient in her native language is an important skill that we may have developed with significant effort and that needs to be practiced regularly to be maintained just like other skills. I notice an increasing number of health care providers with second language skills, and I think this is generally a wonderful improvement in the culture of communications at our health sciences centers. Maintenance of these skills is  important because interpreters may not be available at all times, and because the language skills allow for rapport to be developed between the provider and patient.  However, I do not believe that calling for an interpreter should shut off the option of providers using the second language in the presence of the interpreter. Interpreters can be part of the provider team who can observe an interaction and jump in and out to assist when they feel that clarification is needed. They can also help the providers to improve in their use of the second language with feedback. These roles need to be recognized as important and legitimate by administrators of interpreter services.

I applaud Lion and Thompson for enlarging our understanding of this important part of communications and encourage all of us to strive to improve our communications skills, whether with interpreters or through our own proficient use of a second language.

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  1. Kemi Tomobi
    September 25, 2013 at 8:07 PM

    I am fortunate that my middle school encouraged cultural competency.  I therefore valued it at an early age, and am thus sensitive to doctors and academic leaders who need more cultural competency to reach out to patients and trainees alike. 

    My middle school had a Translator club that we could join so that if any new students came to the school that spoke a foreign language as a first language and had different cultural practices the appropriate middle school student with the language AND cultural experience would help them feel welcome.  I am not sure if this practice is something that more medical schools can encourage.  You can learn all the language you want, but if you are not culturally competent through the relationship and communication skills you have with the patient, the patient’s care will not be as good, and thus you perpetuate the disparities that needs to be reduced.


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