When using a medical interpreter for an lep patient, which of the following is not accurate?

Internet Citation: Chapter 1: Background on Patient Safety and LEP Populations. Content last reviewed September 2020. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/health-literacy/professional-training/lepguide/chapter1.html

Healthcare providers have multiple challenges when working with Limited English Proficiency (LEP) patients. These patients come from a variety of cultural, socio-economic, and educational backgrounds. Consequently, breaking down cultural and language barriers with LEP patients requires additional effort in order to set the right expectations and provide adequate healthcare.

Title VI of the Civil Rights Act mandates that interpreter services be provided for patients with limited English proficiency who need services. Providing these services is also a way to ensure that your patients feel welcome and well cared for, and that your practice is protected. According to the American Family Physician, “The use of professional interpreters (in person or via telephone) increases patient satisfaction, improves adherence and outcomes, and reduces adverse events, thus limiting malpractice risk.”1 

I have worked in the language industry for over 14 years, three of which I spent as a medical interpreter. This experience exposed me to various types of complicated situations, including routine medical exams, emergency procedures, and labor and delivery. Some of these situations were intense and challenging. They helped me to understand how a healthcare provider’s task of communicating and exchanging information with LEP patients would be very daunting without the assistance of qualified and professional interpreters.

Here are my top tips and advice for healthcare professionals when working with LEP patients and medical interpreters:

• Identify patients who may need an interpreter as quickly as possible • Allow extra time for the appointment, if possible. Build rapport, and set goals • Document the interpreter’s name and ID number when they arrive to the appointment • Realize that most patients understand some English, so do not make comments you do not want them to hear • Speak directly to the patient, not the interpreter. Use first-person statements (“I” statements); avoid saying “he said” or “tell her” • Speak in short sentences or short thoughts • Ask only one question at a time • Allow appropriate time for the interpreter to finish each statement. Prioritize and limit the key points to three or fewer • Do not use idioms, acronyms, jargon, or humor • Insist on sentence-by-sentence interpretation to avoid tangential conversations • Allow 10-minute breaks for every hour of interpretation

• Use the “teach back” or “show me” technique to ensure patient comprehension

If you’re a healthcare provider who works with some of the 25 million limited English proficient (LEP) patients in the U.S., you know how important interpretation is to successful patient outcomes. Poor communication increases the chance of medical errors with any patient, and LEP individuals are especially vulnerable in this regard.

Providing high-value language services for LEP patients requires the use of trained medical interpreters (not relying on "ad-hoc" interpreters, such as family members or friends). But simply having an interpreter present, whether by phone or in the room, does not guarantee success. Clinicians should feel well-prepared to communicate with LEP patients via an interpreter to ensure they are confident and effective. The following best practices can be integrated into any team training around working with medical interpreters.

Best practices for communicating via medical interpreters

Prior to speaking with the patient

• Meet briefly with the medical interpreter before the patient interview. Take this time to set goals, build rapport, and provide any clinical background that may be relevant.
• Note the interpreter’s name in the patient’s chart.
• Plan for extra time for the patient’s appointment.

During the patient interview

• Always address the patient, not the interpreter.
• Use first-person “I” statements, not “he said,” or “tell her.”
• Prioritize three or four key points to make during the interview.
• Remember that the patient will likely understand some English, so don’t make comments you wouldn't want overheard by the patient.

Dialogue tips

• Keep your statements short.
• Ask only one question at a time.
• Avoid medical jargon and idiomatic expressions.
• Use the “teach back” technique to confirm understanding with the patient and agreement with the plan.

After the patient interview

• Debrief with the interpreter following the patient interview.
• If you have questions about cultural or emotional subtleties, use the interpreter as a resource.
• Make corrections to the record if necessary.

language & literacy medical interpreters