Journal of General Internal Medicine

, Volume 26, Issue 3, pp 259–264 | Cite as

Alterations in Medical Interpretation During Routine Primary Care

  • J. Carey Jackson
  • Diem Nguyen
  • Nan Hu
  • Raymond Harris
  • Genji S. Terasaki
Original Research

ABSTRACT

BACKGROUND

Increasing numbers of patients require medical interpretation, yet few studies have examined its accuracy or effect on health outcomes.

OBJECTIVE

To understand how alterations in medical interpretation affect health care delivery to patients with limited English proficiency (LEP), we aimed to determine the frequency, type, and clinical significance of alterations. We focused on best-case encounters that involved trained, experienced interpreters interacting with established patients.

DESIGN

We audio-recorded routine outpatient clinic visits in which a medical interpreter participated. Audiotapes were transcribed and translated into English. We identified and characterized alterations in interpretation and calculated their prevalence.

PARTICIPANTS

In total, 38 patients, 16 interpreters, and 5 providers took part. Patients spoke Cantonese, Mandarin, Somali, Spanish, and Vietnamese, and received care for common chronic health conditions.

MEASURES

Unlike previous methods that report numbers of alterations per interpreted encounter, we focused on alterations per utterance, which we defined as the unit of spoken content given to the interpreter to interpret. All alteration rates were calculated by dividing the number of alterations made during the encounter by the number of utterances for that encounter. We defined clinically significant changes as those with potential consequences for evaluation and treatment.

KEY RESULTS

We found that 31% of all utterances during a routine clinical encounter contained an alteration. Only 5% of alterations were clinically significant, with 1% having a positive effect and 4% having a negative effect on the clinical encounter.

CONCLUSION

Even in a best case scenario, the rate of alteration remains substantial. Training interpreters and clinicians to address common patterns of alteration will markedly improve the quality of communication between providers and LEP patients.

KEY WORDS

interpretation translation communication barriers language physician-patient relations limited English proficiency quality of health care 

References

  1. 1.
    Shin HB, Bruno R. Language Use and English-Speaking Ability: 2000. US Census Bureau 2003.Google Scholar
  2. 2.
    Flores G, Laws MB, Mayo SJ, et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111(1):6–14.CrossRefPubMedGoogle Scholar
  3. 3.
    Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19(2):60–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Jackson J, Zatzick D, Harris R, Gardiner L. Loss in translation: Considering the critical role of interpreters and language in the psychiatric evaluation of non-English speaking patients. In: Loue S, Sajatovic M, Roberts L, eds. Diversity Issues in the Diagnosis, Treatment, and Research of Mood Disorders: Oxford University Press; 2007.Google Scholar
  5. 5.
    Karliner LS, Perez-Stable EJ, Gildengorin G. The language divide. The importance of training in the use of interpreters for outpatient practice. J Gen Intern Med. 2004;19(2):175–83.CrossRefPubMedGoogle Scholar
  6. 6.
    Carrasquillo O, Orav EJ, Brennan TA, Burstin HR. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999;14(2):82–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Hornberger JC, Gibson CD Jr, Wood W, et al. Eliminating language barriers for non-English-speaking patients. Med Care. 1996;34(8):845–56.CrossRefPubMedGoogle Scholar
  8. 8.
    Jacobs EA, Shepard DS, Suaya JA, Stone EL. Overcoming language barriers in health care: costs and benefits of interpreter services. Am J Public Health. 2004;94(5):866–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Johnstone MJ, Kanitsaki O. Culture, language, and patient safety: Making the link. Int J Qual Health Care. 2006;18(5):383–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Lee LJ, Batal HA, Maselli JH, Kutner JS. Effect of Spanish interpretation method on patient satisfaction in an urban walk-in clinic. J Gen Intern Med. 2002;17(8):641–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Carmona RH. Improving language access: a personal and national agenda. J Gen Intern Med. 2007;22(Suppl 2):277–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Gany F, Leng J, Shapiro E, et al. Patient satisfaction with different interpreting methods: a randomized controlled trial. J Gen Intern Med. 2007;22(Suppl 2):312–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255–99.CrossRefPubMedGoogle Scholar
  14. 14.
    Sentell T, Shumway M, Snowden L. Access to mental health treatment by English language proficiency and race/ethnicity. J Gen Intern Med. 2007;22(Suppl 2):289–93.CrossRefPubMedGoogle Scholar
  15. 15.
    Brach C, Fraser I, Paez K. Crossing the language chasm. Health Aff (Millwood). 2005;24(2):424–34.CrossRefGoogle Scholar
  16. 16.
    David RA, Rhee M. The impact of language as a barrier to effective health care in an underserved urban Hispanic community. Mt Sinai J Med. 1998;65(5–6):393–7.PubMedGoogle Scholar
  17. 17.
    Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care. 1988;26(12):1119–28.CrossRefPubMedGoogle Scholar
  18. 18.
    Crane JA. Patient comprehension of doctor-patient communication on discharge from the emergency department. J Emerg Med. 1997;15(1):1–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–54.CrossRefPubMedGoogle Scholar
  20. 20.
    Smedley BD, Stith AY, Nelson AR, Institute of Medicine (US). Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press; 2003.Google Scholar
  21. 21.
    Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination AffectingLimited English Proficient Persons. (Accessed September 10, 2010) http://www.hhs.gov/ocr/civilrights/resources/specialtopics/lep/policyguidancedocument.html
  22. 22.
    Narayan MC. The national standards for culturally and linguistically appropriate services in health care. Care Manag J. 2001;3(2):77–83.PubMedGoogle Scholar
  23. 23.
    NCIHC Announces National Standards for Healthcare Interpreters Training Programs Advisory Committee. National Council on Interpreting in Health Care, 2010. (Accessed September 10, 2010) http://www.prlog.org/10553026-ncihc-announces-national-standards-for-healthcare-interpreter-training-programs-advisory-committee.html
  24. 24.
    International Medical Interpreters Association. 2010. (Accessed September 10, 2010) http://www.imiaweb.org/
  25. 25.
    Hospitals, Language, and Culture: A Snapshot of the Nation. 2004. (Accessed May 17, 2010, at http://www.jointcommission.org/PatientSafety/HLC/HLC_Joint_Commission_Standards.htm)
  26. 26.
    Certification Commission for Healthcare Interpreters, 2010. (Accessed September, 10, 2010) http://www.healthcareinterpretercertification.org/
  27. 27.
    Aranguri C, Davidson B, Ramirez R. Patterns of communication through interpreters: a detailed sociolinguistic analysis. J Gen Intern Med. 2006;21(6):623–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Laws MB, Heckscher R, Mayo SJ, Li W, Wilson IB. A new method for evaluating the quality of medical interpretation. Med Care. 2004;42(1):71–80.CrossRefPubMedGoogle Scholar
  29. 29.
    Pham K, Thornton JD, Engelberg RA, Jackson JC, Curtis JR. Alterations during medical interpretation of ICU family conferences that interfere with or enhance communication. Chest. 2008;134(1):109–16.CrossRefPubMedGoogle Scholar
  30. 30.
    Lavizzo-Mourey R. Improving quality of US health care hinges on improving language services. J Gen Intern Med. 2007;22(Suppl 2):279–80.CrossRefPubMedGoogle Scholar
  31. 31.
    Rivadeneyra R, Elderkin-Thompson V, Silver RC, Waitzkin H. Patient centeredness in medical encounters requiring an interpreter. Am J Med. 2000;108(6):470–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Elderkin-Thompson V, Silver RC, Waitzkin H. When nurses double as interpreters: a study of Spanish-speaking patients in a US primary care setting. Soc Sci Med. 2001;52(9):1343–58.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • J. Carey Jackson
    • 1
    • 2
    • 3
  • Diem Nguyen
    • 1
    • 4
  • Nan Hu
    • 5
  • Raymond Harris
    • 3
  • Genji S. Terasaki
    • 2
    • 3
  1. 1.Refugee and Immigrant Health Promotion Program, Harborview Medical CenterUniversity of WashingtonSeattleUSA
  2. 2.International Medicine Clinic, Harborview Medical CenterUniversity of WashingtonSeattleUSA
  3. 3.Department of General Internal Medicine, Harborview Medical CenterUniversity of WashingtonSeattleUSA
  4. 4.College of EducationUniversity of WashingtonSeattleUSA
  5. 5.Department of Biostatistics, School of Public HealthUniversity of WashingtonSeattleUSA

Personalised recommendations