While I was growing up, I would frequently accompany my Farsi-speaking grandparents to their medical appointments. During those appointments, I often found myself struggling to find the right words to describe their symptoms. My Farsi vocabulary had quite a few gaps as it pertained to medical terminology, and I would frequently not be able to articulate certain ideas. I noticed that my grandparents were unable to have a close relationship with their physician because they never felt like they were able to understand him, and vice versa. They probably experienced many symptoms that they were too shy to have their grandchild hear about, let alone explain, to a physician. In retrospect, I may have unintentionally acted as a barrier to proper care.
There are thousands of languages spoken throughout the world, and a portion of these languages are spoken by thousands of individuals who have migrated and now reside in the United States. Any country’s health care system is difficult to navigate when one’s primary language is not the same as the national language. As a native English-speaking individual, it is easy to converse freely with one’s physician in the United States. Even for more frequently spoken languages in the United States, like Spanish, it is usually easy to find a medical interpreter to help facilitate communication during office visits. However, the task of bridging the communication gap is much more difficult if fluent speaker are sparse, as was the case for my grandparents.
Over the past several years, health care laws have changed significantly. Some of the changes that have occurred have positively impacted regulations on medical interpretation. Prior legislation only required an interpreter to be competent in a particular language, but no formal documentation was required. In May 2016, the Department of Health and Human Services finalized amendments of the Affordable Care Act that increased health care access to non-native English speakers. The amendment required that patients with limited English-speaking ability be provided with access to certified medical interpreters and prohibited uncertified family members, friends and office personnel from serving as medical interpreters.
Even though the law was created with positive intentions, its requirement for patient access to a certified interpreter are often ignored in many clinical settings. Family members, friends, and unqualified office staff often mediate conversations between patient and physician commonly due to convenience. Ultimately, this can have a negative impact on the quality of care a physician is able to provide. We, as current and future health care providers, should actively participate in providing our patients with proper support and access to an interpreter. Even if we are under time constraints, we should make every effort to arrange that an interpreter be present during a patient encounter as it is our duty as physicians to be able to fully communicate with our patients.
In an ideal world, a patient would always be able to find a physician who is fluent in his native language. Because the relationship between patient and physician is often a key, overlooked part of health care, it is essential that patients have access to a person who will be able to fully understand his words and serve as a bridge between the communication barrier. In many cases, doctors who are familiar with a particular culture and able to converse with patients who share that culture tend to provide more culturally-sensitive care. Understanding a patient’s background equips a provider with the tools necessary to consider and craft a care plan that a patient will agree to follow.
Identifying physicians who share a similar background and who speak a particular language can be accomplished through a general online directory. Another approach involves either requesting a physical list from one’s insurance provider or searching for the company’s online directory. However, it is important to note that it can be difficult to find a provider who speaks the same language; many people may be fail to find one locally. Individuals who live in rural areas are even less likely to be afforded this right.
If a physician who speaks a desired language cannot be found, access to interpreters can help facilitate visits. Many health care networks are capable of providing access to hundreds of different languages through a telephone system or in-person network of interpreters. However, arranging for an interpreter to be physically present during a scheduled appointment is complex and often requires a formal request followed by careful coordination with the patient, interpreter, and the physician’s office to ensure a mutually acceptable appointment time.
Finding an interpreter who speaks a particular language in a designated locale and placing a request far enough in advance to ensure an interpreter’s presence can be incredibly challenging especially in acute settings. Lately, there has been a trend of offering interpretation services via different online or telephone interpreting institutions. This is a flexible option for urgent care facilities, emergency departments and other locations that provide same-day appointments. Even though coordination between interpreter, physician and patient can be difficult, there are a number of translating options available.
There are certain actions a provider can take to improve the ability to connect with a patient communicating via an interpreter. The physician should always maintain eye contact and speak directly to the patient instead of the translator, and they should be cognizant of remaining focused on the patient even though it is easy to become distracted by the presence of an interpreter. Additionally, the provider should consider tone and body language as means to enhance communication and trust. As future physicians, our goal should be to foster relationships and facilitate an inclusive atmosphere for all patients.