INTERPRETERS
And the Doctor-Patient Relationship
by Adriana Mulet Miranda, BS, & Steven Lippmann, MD
Over 25 million people in the U. S. have limited English proficiency. 1 Therefore, some of them avoid seeking medical help in fear of being ostracized, misunderstood or ignored. Good communication between the patient and physician is vital to achieving proper care. 2 For instance, take Mr. S, a 30-year-old man from Cuba, who presented with suicidal thoughts and extreme social anxiety. He was too afraid to seek care when his symptoms began and by the time he saw us, he was nearly immobilized with fear. While non-verbal cues provide insights on patient behavior, verbal communication is the leading factor in effective care and good doctor-patient relationships. Clear communication improves understanding and maximizes prognoses. 3 Federal law mandates that health care facilities provide interpreter services. This should be available at no cost to patients through bilingual staff or professional interpreters. 4 However, it remains unclear whether interpreters improve care and satisfaction outcomes as compared to medical care with English speaking patients. 4
In the health care system, there are three types of interpreters: informal, professional and / or bi- or multi-lingual staff. Ad hoc interpreters are informal, utilized when trained interpreters are not available and / or upon patient request. 3 They can be family, friends and / or others. 5 Professional interpreters know the language and the medical terminology, and have learned various things about diseases, ethics and cultural competencies. 5 Bi- or multi-lingual personnel, when trained, can be very valuable. 5
Concordant language providers, or multilingual staff, are preferred by some English-language compromised people, and that may optimize outcomes. 3 Ad hoc interpreters are often preferred, due to a lack of concordant language physicians. 6 People often want family members as interpreters, especially amongst older persons who commonly defer health management to family members. 6 Having no interpreter worsens
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