Working with a professional interpreter is critical to the medical care of patients who don’t speak English. Professional interpreters have medical interpreting experience and training and adherence to a code of ethics that keeps them unbiased and transparent in their communication. Using professional interpreters also satisfies the legal requirements of Section 1557 of the ACA and Title III of the ADA for Deaf patients. Effective communication provided by professional interpreters also supports patient outcomes by facilitating an accurate medical diagnosis, treatment, and care plan while also being a protected legal right of patients.
However, patients may often have family or friends with them at their appointments to offer support or provide insight. For LEP, Deaf and Hard of Hearing patients, family or friends may also try to bridge the language barrier even while an interpreter is present. At first glance, this may seem like a great option - the friend and/or family know the patient, speaks the patient’s language and English and has the patient’s best interest at heart. However, this often becomes a precarious situation. The best of intentions cannot replace the training, experience, and professionalism afforded by an interpreter. Most often, the interpreter is called and begins interpreting and, as the appointment unfolds, clinicians ask questions and the family and/or friend may start answering for the patient in English. And then they also start to interpret for the patient. Most often the interpretation is summarized so that the conversation can keep moving between the clinician and support person. As the family or friend starts to interpret, they become emotionally invested and biased - two qualities that professional interpreters are trained to keep out of their work.
Interpreters are responsible for navigating these communication dynamics. An effective strategy is to pause the appointment and ask for the communication preferences of everyone present. You may hear an interpreter say, “This is the interpreter speaking, I want to support the best communication approach, let me ask the patient if they would like me to interpret.” By asking the patient their preference, interpreters are empowering the patients to share the preferred means of communication that will allow them to fully engage in their own healthcare. While the room may be full of people that care about the patient, their preferences should be prioritized.
Clinicians are also encouraged to ask each patient’s preference. Family and friends offer valuable insight and support, however, it is very difficult to communicate effectively at the same time. The emotional connection and investment with the patient, unfamiliarity with medical terminology, and lack of training often lead to misunderstanding, misinterpretation, and decisions being made without the patient having the opportunity to speak for themselves or have full knowledge of everything being discussed. When this occurs, patients become spectators instead of active participants in their own healthcare.
If it is officially decided that the family or friend will interpret it is critical that the clinician document the decision and record it in the patient’s chart. This language access arrangement is contrary to the ACA section 1557 and the ADA Title III provisions that protect the interests of the hospital and/or clinic and therefore requires documentation. However, a patient’s preference for family does not have to overrule the clinician’s own preference to use a professional interpreter. Clinicians may feel more at ease relying on a professional to protect the interests of the hospital/clinic and avoid potential communication pitfalls when relying on a bilingual family or friends.
Professional interpreters provide the best and most effective communication. The assurances of training, boundaries, ethics, and unbiased involvement of an interpreter allows family and friends to stay firmly planted in the role of support person, caregiver, and advocate without the burden of also facilitating language access. Professional interpreters are an integral member of the care team protecting both patient and clinician from potential errors and liability.
InDemand offers nationally certified ASL interpreters, certified Deaf interpreters, and professional medically trained spoken language interpreters to facilitate effective communication between patients and providers.