Quality Healthcare: Reduce Risk and Increase Patient Safety through Language Access


 When a Deaf, hard of hearing (HOH), or limited English proficient (LEP) patient has a medical appointment, providers are legally obligated to make arrangements for a qualified interpreter. Some providers believe if a patient is accompanied by a family member or friend to a medical visit, these individuals can also serve as interpreters. This may seem to be a reasonable accommodation because the friend or family member knows the patient well, may be familiar with their medical condition or can communicate with the patient. However, relying on family and friends to interpret can pose major risks for healthcare organizations as well as the patients. Learn more here about the business case for providing language access.

Medical Interpretation Requires Qualified and Certified Medical Experience

Interpreting in any language takes several years of study, practice and experience, particularly in medical environments, to become certified medical interpreters. Conversational fluency, while valuable in personal relationships, is not sufficient to interpret in clinical settings. Using medically qualified, professional interpreters reduces opportunities for miscommunication between providers and their patients. 

Often times a clinician may think the facial expression or body language of a Deaf, LEP or HOH patient means a level of agreement or understanding, however that may not be the case. For example, in ASL, a nod is not just a nod of approval, confirmation or agreeance, but it can also be a nod of comprehension that the individual is following the conversation, but not necessarily agreeing or answering in the affirmative. In addition, ASL is its own unique language with its own structure and grammar, an interpreter will often restructure a question. This restructuring may prompt the Deaf or HOH patient to answer yes or no, but not in the way a provider is anticipating.

For example, if a provider asks: “Is this the first time you’ve broken your foot?” The question could be interpreted to say: “Have you broken your foot before?” If the question is phrased in this way, the patient would respond: “No.”

If a clinician tried to work around an interpreter, they could suspect the “no” or shaking of the head meant the patient had broken their foot before when, in fact, they had not.

The precarious nature of the above scenario is often compounded by medical providers who know some ASL. Often times, medical providers who have completed a few courses in ASL feel that they will remember enough to provide medical care without an interpreter. However, this can be very damaging to the patient’s ability to communicate and fully engage in their healthcare. Finger spelling and gestures may communicate basic and rudimentary information, but it is far from suitable for a medical encounter.

Key Takeaways that Minimize Patient Safety Risks

When a patient or support person offers to interpret rather than use a professional interpreter, medical providers and professional interpreters should encourage family members and friends to be of support to the patient and leave the interpreting to a medically qualified professional.

When anyone, including providers, interpreters, family and friends, attempt to fulfill the interpreter and support role, the quality of the patient encounter will surely suffer. A support person may not be able to fully engage in his or her role, patients may not have total confidence that they are able to fully participate in their healthcare and clinicians who attempt to interpret may misunderstand patients or entirely miss critical information.

Additionally, a patient may not feel comfortable telling family or friends not to interpret for them, which is why it’s even more important for medical providers to serve as an advocate and insist that patients use professional, medical interpreters. There may be relationship dynamic between the patient and the accompanying family or friend that will prevent the patient from being completely honest. This invariably causes a liability issue for the hospital and an ethical dilemma for all parties involved. Finally, minor children who are asked to interpret may not be able to adequately interpret because of their own language exposure, therefore, they may omit information or misinterpret entirely.

It’s also important to keep in mind three federal laws, Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act and the Affordable Care Act (ACA), requiring providers who receive federal funds to provide oral interpreters and written translated materials to LEP and Deaf and HOH patients. Section 1557 of the ACA requires providers to use “qualified, medical interpreters” when treating LEP and Deaf and HOH patients.

For the sake of efficiency and ease, it may seem like using family and/or friends or even a medical provider who speaks the patient’s language is the best use of resources and time, but it isn’t. It is always beneficial to regularly review language access plans and to ensure that all medical providers know how to request an interpreter.

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