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Article: Getting By: Underuse of Interpreters by Resident Physicians

Wednesday, December 17, 2008

  • Lisa C. Diamond, MD, MPH, Yael Schenker, MD, Leslie Curry, PhD, MPH Elizabeth H. Bradley, PhD, and Alicia Fernandez, MD
  • Journal of General Internal Medicine

Lost in Translation - Many Hospital Physicians Not Using Interpreters
Published: December 23, 2008

New Haven, Conn. - Many physicians fail to use readily available interpreters with their non-English speaking patients, opting for "getting by" with their own limited foreign language skills or using a patient's friend or family member, according to research conducted in part by the Yale School of Public Health.

Increasing the use of interpreters by hospital physicians will require "substantial" changes in hospital practice, the study finds. Failure to use a qualified professional interpreter in medical situations can lead to breaches in patient confidentiality and can compromise quality patient care.

"The study shows that there will be no easy fix, but clearly this is an important and widespread problem," said Elizabeth Bradley, professor of public health who co-authored the study with Yale research scientist Leslie Curry. "When we think about quality medical care, effective communication in the right language has to be part of it, but the results show that this is challenging in many settings."

According to the 2000 U.S. Census, the number of Americans with limited English proficiency grew by 53 percent between 1990 and 2000 to more than 22 million. These numbers are particularly concentrated in California, where 20 percent of residents speak limited English. Research has shown that language barriers in patient care can lead to decreased access to preventive services, poor understanding of instructions for medications, longer hospital stays and an increased risk of medical errors and misdiagnoses.

"We found that it has become acceptable for a physician to rely on his or her own limited language skills, hand gestures or on the convenience of a patient's family member instead of calling a professional interpreter, even when one is available," said Lisa Diamond, M.D., lead author of the study, who conducted the research as a Robert Wood Johnson Foundation Clinical Scholar at the Yale School of Medicine. "Residents found it difficult to change their practice, despite misgivings about the quality of care provided."

The researchers conducted in-depth interviews with internal medicine resident physicians from two urban teaching hospitals-one on each coast-that are considered to have excellent interpreter services. An interview guide was used to explore the decision-making around interpreter use. Although previous research has suggested time constraints and lack of availability as reasons physicians under-use interpreters, data from this study found that the reasons are far more complex. Other reasons included the perception of "getting by" without major clinical consequences, lack of awareness of the limitations of using family members as interpreters and the lack of professional consequences for this practice.

Details of the research appear in the December online edition of the Journal of General Internal Medicine. Researchers from the University of California, San Francisco, also participated in the study.

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