Bilingual Individuals: Who Can Serve as an Interpreter in Health Care Settings?
According to law and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), it is the responsibility of your institution to provide patients with Limited English Proficiency (LEP) with access to interpreter services to ensure that they can effectively communicate with their providers. Patients qualify as LEP if they do not speak English as their primary language and have a limited ability to read, speak, write or understand English.
Your institution is responsible for identifying the preferred language of your patient, determining if the patient will require an interpreter for their session, and providing that interpreter. It is important to note that family members or family friends of the patient should not be asked to interpret for a variety of reasons. Relying on family members as interpreters does not meet the legal requirements for caring for patients of Limited English Proficiency (LEP), may place unnecessary stress on established family dynamics, and may compromise the quality or completeness of the information being relayed. No matter how capable or willing, Julie should not rely on the patient’s brother or other willing family members to serve as an interpreter for the parents during the genetic counseling session.
Additionally, relying on bilingual staff members to provide interpreting services is not the same as working with a formally trained medical interpreter. Although bilingual staff members certainly have expertise in the patient’s preferred language, medical interpreting is a skill that includes more than just having extensive knowledge of the foreign language. Medical interpreters are trained in the vocabulary involved in a medical interview, the role of the interpreter, the ethics of interpreting, and techniques for facilitating a patient-provider communication while staying in the background (National Council on Interpreting in Health Care, 2005). However, if bilingual staff members are involved in patient interactions, it is entirely appropriate for them to interact in the foreign language if a medical interpreter is present or if they have received formal training in medical interpreting at some point. In fact, having a staff member who is able to conduct some of the session in the target language of the patient may enhance the rapport between the patient and the provider. Furthermore, medical interpreters are trained in what their role should be when the provider can speak the target language but is not skilled in medical interpreting.
Although she may be eager to work with this family in Spanish, it is important for Julie to be evaluated by her clinic’s Interpreter Services department to determine if she has the necessary fluency to conduct the medical appointment in Spanish. Depending on the institution’s policies, Julie may want to arrange an interview in the target language with an interpreter in order to formally evaluate her skills. If this is not possible, the California Academy of Family Physicians Foundation’s publication “Addressing language and culture: A practice assessment for health care professionals” offers many strategies for verifying the skills of bilingual staff that Julie could look into, including companies that will perform online and phone skills tests. Until Julie’s language skills have been verified, she should be conservative in relying on her fluency in Spanish to conduct any sessions without an interpreter present.
For providers without some level of fluency in the target language of the patient, it is still a good idea to learn and use some basic phrases in the languages spoken by your patients, such as greetings. Taking the time to do this can send a strong positive message to your patient: you respect their culture and are motivated to learn more about it. There are many simple phrasebooks that one can purchase online (search for terms like “Spanish phrases for health care providers” and multiple websites such as http://www.practicingspanish.com to help you learn these basics.
