A Matter of Interpretation

I open the chart for my next patient and notice the red flag for limited English proficiency. My anxiety levels shoot up. I’m already running behind and it’ll take me twice as long to see her.  Where’s the interpreter? How will I get to my other patients on time? 

If this sounds familiar, you’re not alone. As clinicians, we often juggle competing demands in time constrained settings. Optimally caring for patients with non-English language preference adds another layer of complexity that can feel overwhelming at times. But some planning, practice, and an intentional approach can help us give better care to patients. Here are three tips to make a little easier for you and your patient: 

1. Prepare. 

Make sure that professional interpreter services have been arranged ahead of the encounter. Remember that there are different options: phone, video, and in person. Decide which is most appropriate for your patient. This may depend on the complexity of care, the sensitivity of the conversation, the importance of visual cues, and the patient’s needs or preferences. For example, phone interpretation may be the best and fastest option for a simple conversation, but for a mental health assessment, the interpreter’s ability to see facial expressions may be key. For some situations, like end-of-life discussions or family meetings, in-person interpretation may be more appropriate. While we may not have the luxury of choosing which type of interpretation services are available to us at a moment’s notice, with some planning, interpretation level services can be escalated as needed.   

2. Use a team approach.   

Professional medical interpreters provide much more than technical support. Their nuanced linguistic and cultural expertise is critical to patient care; they’re part of the team and should be engaged as such. Before seeing the patient, take a few minutes to touch base with the interpreter to convey the goals of the visit and anticipated challenges. Debrief after the visit to see if anything was missed or there are other concerns. As cultural and emotional brokers, the interpreter may have valuable insights that can facilitate future interactions. For example, the interpreter may suggest more frequent visits with less information for some patients, such as those with lower health literacy or familiarity with Western medicine, greater cultural differences, or medical mistrust. In some cases, the same interpreter may be available for follow-up visits to maintain continuity of the care team and help build rapport and trust with patients.   

3. Talk to the patient, not the interpreter. 

Remember that the clinical relationship is between you and your patient. Try to be as natural as possible, greet your patient as you normally would, and use small talk to put them at ease. Be aware of the temptation to use shortcuts to save time, such as asking only yes/no questions. This may feel efficient, but could leave essential things untold. Intentionally start and end your visit with open-ended questions like, “What’s your main concern today? What else is on your mind? Is there anything I missed?” 

There’s no doubt that communicating with patients in our own language is easier than through an interpreter. Data showing that language-congruent care improves outcomes isn’t surprising and speaks to the importance of diversifying the healthcare workforce. But in the absence of language-congruent clinicians, professional medical interpreters are uniquely trained and positioned to facilitate communication. Used effectively, they can seamlessly broker even the most complex conversations. As with most things in medicine, practice, preparation, and intentionality are essential to mastering skills, including how to communicate effectively through interpreter. This is a matter of patient safety, health equity, and core to our professional values to provide the highest standard of care for all. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.