Why don't more doctors work with medical interpreters?

Updated: Aug 10, 2022

Recent US census data shows that 21.5% of people - more than 1/5 of the US population - speak a language other than English at home. 8.2% say they speak English “less than very well”. Even those who feel fairly comfortable speaking English may have a difficult time in a medical setting, where specialized terminology, stress, and other emotions make communication more challenging. But being able to communicate in the language they feel most comfortable with is crucial for patient well-being, on both a mental and physical level. Patients must be able to clearly understand diagnoses, treatment options, instructions, and other crucial information, and any questions they have should be understood and addressed. When this isn’t the case, the results can be catastrophic. For instance, the American Medical Association’s Journal of Ethics reported on a case where Latinx children in one hospital’s ICU had a significantly higher mortality rate than other children. When the hospital responded by implementing cultural sensitivity training, hiring bilingual staff, translating information material, and calling on interpreters, the mortality rate fell to become equal with other patients’. It may seem surprising that this is what it took for the hospital to use interpreters, since US law requires a medical interpreter (including for ASL) for all patients who need one. But unfortunately, this isn’t always the reality. A number of barriers keep patients from access to medical interpreters and translated patient material. These include:

- cost. Federal law requires the care provider to cover interpreter costs. This can be difficult for small or free clinics and other organizations. Patients do have a right to hire or provide their own interpreter, but not all patients may be able to afford this, either.

- lack of knowledge/training. Despite the importance of medical interpreters, many healthcare providers don’t know how to use them, or how to use them effectively when dealing with patients. The AMA reports that only 23% of medical trainees were taught how to work with interpreters. Issues like integrating an interpreter into a consultation, scheduling on-site interpreters, and finding and connecting with remote interpreters, are significant challenges for many healthcare providers. Additionally, many healthcare workers and institutions also forget about the importance of translated medical information and patient education material, including documents and instructions patients receive when they’re discharged from the hospital. - technical issues. Problems like unreliable internet connections, telehealth platforms not adapted to multiple-party calls make it difficult or impossible for many healthcare providers and patients to have access to a medical interpreter.

- language limitations. Although US law requires medical interpreters for patients, it may be difficult to find interpreters for less commonly spoken languages, especially for on-site interpreting. Remote interpreter services, which give access to a translation team proficient in many different languages, around the clock, is a possible solution.

- the medical interpreter shortage. The US is currently experiencing a medical interpreter shortage. Explanations for this shortage vary, and as this article points out, it’s hard to get clear information about both patient language proficiency and interpreter availability on a wide scale. But what little concrete data we have suggests that only slightly more than half of hospitals offer interpreting and translation for non-English proficient patients. The problem is often blamed on an increase demand for interpreters. But the more you look into it, it doesn’t help that the role of the interpreter is undervalued or even ignored by many hospitals, medical practices, and schools. If future doctors and nurses were taught how to work with interpreters, one wonders if they might be more likely to seek them out and make them a part of their practice, whether in an on-site or virtual capacity. Medical interpreters not only need to be fluent in the languages they work in; they must, of course, have knowledge of medical terminology in these languages. They also need to know effective ways to communicate with patients. This includes being familiar with cultural practices and ideas that might make straightforward communication about things like treatment options and diagnoses challenging for the layperson. That’s why medical interpreters have to undergo specific training and certification. But when interpreters aren’t available, bilingual medical staff could be a literal lifesaver. This has led to some members of the medical community suggesting that medical students be taught a second language. Another solution that many have started to bring up is using med students proficient in other languages as on-site medical interpreters. When it’s possible, virtual interpreters are also an excellent solution, especially for less commonly spoken languages. For instance, aiaTranslations has a team of certified medical interpreters for any language, available around the clock. There’s hope that some of these suggestions could make the medical interpreter shortage less painful. But the heart of the problem also seems to be the need for the medical field to recognize the importance of working with interpreters and to consider that, from both a legal and an ethical perspective, access to understandable medical information and communication should be a basic right for all patients.

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