Case Scenario During the past yea...

Case Scenario

During the past year, I have noticed an increasing number of Spanish-speaking patients coming to my practice. I'm fortunate enough to have a bilingual staff member--and I'm glad she is with me because I don't believe that my medical Spanish can adequately explore the complexities and nuances of patient interactions. However, this staff member has other duties to attend to besides interpreting, and I can't afford to use a full-time interpreter. Sometimes my patients bring their confess interpreter--usually a family member, and ofttimes a child. Because many doctor-patient interactions explore private or personal information, is it appropriate for me to use a child or other family member as an interpreter when interviewing or examining a patient? What are my ethical and legal obligations to my non-English-speaking patients? Can the quality of care be affected through a language barrier?

Commentary

Many physicians are facing a similar dilemma because the Hispanic population is growing rapidly, and Spanish is the preferr language for many Hispanic race The use of interpreters is a multifaceted issue. First, the physician is ultimately responsible for communication. If a physician is not bilingual, the best alternative is to make use of the skills of a trained medical interpreter or translator. Use of separated interpreting services (such as telephone interpreters) also has prov to be prosperous (1, 2)

According to the American Medical Translators, a medical translator or interpreter is a specially trained professional who has proficient knowledge and skills in a primary language or languages and who make use ofs that training in medical or health-related settings to make possible communications among parties speaking different languages. The skills of a medical interpreter or translator include cultural sensitivity and awareness of and heed for all parties, as well as mastery of medical and colloquial terminology, which make possible conditions of mutual trust and accurate communication that lead to effective provision of medical health services.

It is important to be aware that errors of interpretation are made by dint of well-intentioned interpreters, and that like errors occur more frequently with ad hoc interpreters (untrained nonprofessionals, as it was as family members, friends, and health care workers). (3) The greatest in quantity frequent errors in medical interpreting involve omissions and editing, and they have potential clinical events (3) Patients, however, may fancy the use of friends and family members because of their ongoing relationship and their knowledge of the patient's needs; therefore, it is important also to apply the mind at the situation from the patient's perspective. (4)

Considerations in the use of interpreters oftentimes revolve around patient satisfaction and quality of care. The Institute of Medicine report released in April 2002 showed that health disparities exist in Hispanic populations. Patients state that they believe their quality of care is better when it is delivered according to a person of their confess culture or by someone who understands their agriculture Timmins' systematic review (5) of the biomedical journals from 1990 to 2000 gazeed at language barriers in health care for Hispanic patients in three areas: access to health care, quality of care, and health status/health results Six of seven studies place significant detrimental effects of language barriers upon quality of care, including misdiagnosis, prescribing inappropriate medications, lack of patient information leading to poor compliance, lack of follow-up and a decrease in preventive services. It benefits us all to be culturally sensitive and culturally adequate and to provide cultural and linguistically appropriate care, because the consequence will be better health consequences and healthier patients.

There also is a legal obligation to provide cultural and linguistically appropriate care. The laws are well intentioned, however they are not as effective as anticipated because many do not have an enforcement arm and are unfund mandates. Relevant laws include the following:

Title VI of the Civil Rights Act of 1964 This act, administered within the Office for Civil Rights of the Department of Health and Human Services, is the basis for legal obligations to provide language access accommodations for bodily forms who are limited in English language proficiency when they access health care. This law applies to any health care provider who receives federal capitals and includes physicians who treat Medicaid or Medicare patients, as well as hospitals that receive federal funds

Title VI guarantees freedom from discrimination. The Office of Minority Health released a put of standards for culturally and linguistically appropriate services. Guidelines state that any agency receiving stocks from the federal government should not withhold a person who does not understand English a culturally able translator.

Medicaid Law and Related Regulations. Several Medicaid provisions require Medicaid agencies and providers to eliminate language barriers. In several states, managed Medicaid health plans have expanded the availability of linguistically appropriate health care services. These contracts repeatedly require that plans enrolling Medicaid recipients provide appropriate interpreting and translation services to non-English-speaking enrollees