Getting By: Underuse of Interpreters by Resident Physicians
Language barriers complicate physician–patient communication and adversely affect healthcare quality. Research suggests that physicians underuse interpreters despite evidence of benefits and even when services are readily available. The reasons underlying the underuse of interpreters are poorly understood.
To understand the decision-making process of resident physicians when communicating with patients with limited English proficiency (LEP).
Qualitative study using in-depth interviews.
Internal medicine resident physicians (n = 20) from two urban teaching hospitals with excellent interpreter services.
An interview guide was used to explore decision making about interpreter use.
Four recurrent themes emerged: 1) Resident physicians recognized that they underused professional interpreters, and described this phenomenon as “getting by;” 2) Resident physicians made decisions about interpreter use by weighing the perceived value of communication in clinical decision making against their own time constraints; 3) The decision to call an interpreter could be preempted by the convenience of using family members or the resident physician’s use of his/her own second language skills; 4) Resident physicians normalized the underuse of professional interpreters, despite recognition that patients with LEP are not receiving equal care.
Although previous research has identified time constraints and lack of availability of interpreters as reasons for their underuse, our data suggest that the reasons are far more complex. Residents at the study institutions with interpreters readily available found it easier to “get by” without an interpreter, despite misgivings about negative implications for quality of care. Findings suggest that increasing interpreter use will require interventions targeted at both individual physicians and the practice environment.
KEY WORDScommunication doctor–patient relationships physician behavior decision making qualitative research
Dr. Diamond was supported during this research by the Robert Wood Johnson Clinical Scholars Program and the United States Department of Veterans Affairs. Dr. Schenker is a General Internal Medicine Fellow at UCSF, funded by the Department of Health and Human Services, Health Resources and Services Administration (DHHS HRSA D55HP05165). Dr. Bradley is supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation Investigator Award. Dr. Fernandez is supported by an NIH Career Development Award (K23-RR018324-01).
The data presented in this manuscript were presented at both the California Regional Society of General Internal Medicine Meeting in San Francisco, CA in March of 2008 and the Society of General Internal Medicine Annual Meeting in Pittsburgh, PA in April of 2008.
Conflict of Interest
- 1.Institute of Medicine. Crossing the Quality Chasm: A New Health System for the Twenty-first Century. Washington: National Academy Press; 2001.Google Scholar
- 2.Shin HB, Bruno R. United States Census Report: Language Use and English-Speaking Ability: 2000. Available at: http://www.census.gov/prod/2003pubs/c2kbr-29.pdf. Accessed November 17, 2008.
- 26.Patton MQ. Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage Publications; 2002.Google Scholar
- 27.Kroon C. Written Communication - Coordinator, Interpreter Education and Quality Improvement, Yale-New Haven Hospital. June 2007 and October 2008.Google Scholar
- 28.Garcia-Orme G, Dao, DM. Written Communication, Director of Interpreter Services, Interpreter Services Department Supervisor, San Francisco General Hospital. March 2006 and October, 2008.Google Scholar
- 31.Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine Publishing Company; 1967.Google Scholar
- 32.Crabtree BF Miller WL, eds. Doing Qualitative Research (Research Methods for Primary Care). Thousand Oaks, CA: Sage Publications; 1999: 33–46.Google Scholar
- 34.Miles MB, Huberman M. Qualitative Data Analysis, 2nd edition. Thousand Oaks, CA: Sage Publications; 1994.Google Scholar