by Michèle Curtis, CeeShell Consulting, lead editor of “Glass’ Office Gynecology”

As the world becomes more global and more technological, opportunities for communication errors only increases.  Communication errors are one of the fundamental precursors for safety and quality errors in healthcare.  Supporting this is data showing that a shared language between health care provider and patient results in better outcomes and quality as well as improved hospital costs and patient satisfaction.  In the healthcare setting, we rely on the words as well as the physical cues and signals patients give us when they are telling us their story.  But if the provider and the patient don’t speak the same language, the risk for misunderstandings and errors increases dramatically, especially if they try to ‘muddle through’ or if information is obtained through a family member or friend who is helping to translate.

Healthcare providers spend quite a few years learning ‘the language’ of healthcare and medicine.  Our skills in good communication with patients rely, in part, on our ability to ‘translate’ the complex ideas and processes of medicine into everyday terms and explanations.  In a very real sense then, healthcare providers act as interpreters when they are speaking their native language with another native language speaker in the context of a healthcare setting.  If the patient doesn’t share the same language as the healthcare provider, then an interpreter is needed.  But for the conversation to be optimal, the interpreter must also be familiar with medical concepts and terms and colloquialisms used regarding those terms (in both languages), as well as the culture relative to the patient’s native language.  For this reason, medical interpreters should be trained professionals (for more information, go to the International Medical Interpreters Association and the independent National Board of Certification for Medical Interpreters websites).

The overall goal of a healthcare encounter is to establish a good relationship with the patient but for health care providers, having a communication intermediary feels awkward or unwieldy.  Healthcare providers are taught how to communicate and interview patients during their training years; the use of interpreters is another way of communicating and interviewing but it also requires special training. Unfortunately, most healthcare providers never receive it, although there is data demonstrating effective training concepts as well as productive approaches and practices to be used in the actual clinical setting.   It is time to incorporate training health care providers the skill set of optimally working with interpreters, either in person or over the phone, as a means of delivering safer, high quality care to patients.

Here are some tips for working with a medical interpreter:

1)       Talk with the interpreter about the expected content of the interaction and the expectations of the interpreter, as well as providing relevant information to the interpreter about the patient

2)      Let the interpreter know what your style of communication as well as preferred method of interpretation and seating arrangements (having the interpreter sit behind the patient may help avoid conversations between the interpreter and patient for extended periods, which contributes to privileging the interpreter-patient relationship over the provider-patient relationship)

3)      Ask the interpreter if there are any cultural issues or factors that may create difficult areas of conversation or exploration as well as possible ways to mitigate them without sacrificing them as communication items

4)      Introduce the interpreter to the patient and explain what the process is going to be like; do this while looking at the patient directly, not the interpreter

5)      Look at the patient while talking – not the interpreter

6)      Plan what you want to say ahead of time – this helps to keep the interpreter from having to back up or rephrase things; avoid colloquialisms and idioms

7)      Use consecutive, not simultaneous, translation and keep sentence short

8)      If you have never worked with an interpreter, practice with one, using a colleague or, if you are lucky enough, a bilingual standardized patient

9)      At the end of the patient encounter, debrief with the interpreter over what went well and what to look to improve- you will most likely work with them again in the future!

• Practices & Tips