Original Article

Bridging Language Gaps in Health Care: Clinician Experiences and Challenges in Utilizing Medical Interpreters

Authors: Tharani Ravi, MD, Jasmine Rodriguez ,MPH, Robert Wood, DrPH, Anthony Pascullo, MS, Etny Candelario, MD, Daniela Estrada Gomez, MD, Mario Hernandez, MD, Carolina Sanchez, MD, Fozia Ali, MD

Abstract

Objectives: Providing high-quality care to patients from diverse ethnic and linguistic backgrounds demands effective communication using interpreters and the ability to build patient–physician relationships. This study aimed to explore clinician perceptions of healthcare quality when using interpreter services and identify barriers to effective interpreter use in a family medicine clinic.

Methods: This was a multimethod study involving clinician and staff surveys and resident/faculty focus groups about experiences using interpreters. The study was conducted in a residency clinic in Bexar County, Texas, where 48% of the population speaks a foreign language.

Results: Of the 70 clinicians and staff participants in the surveys, 87% were at least “somewhat comfortable” using qualified interpreters, and 76% believed that they could effectively overcome language barriers; however, only 39% were satisfied with the medical care they provided. More than 70% of clinicians felt capable of diagnosing and treating diseases (74% and 78%, respectively) using interpreters, but fewer than 50% were satisfied with their ability to empower patients (44%) or establish a personal connection (33%). Fifty-one percent of clinicians reported that they did not use interpreters at least once in the preceding 3 months, even when necessary, citing long wait times to connect to interpreter services, poor interpreter telephone connection, and patient request to use family/friend as interpreter. Focus groups identified other logistical challenges when using interpreters, as well as the impact of interpreter use on clinician–patient relationships.

Conclusions: Clinicians and staff were comfortable using interpreter services and could fulfill their essential duties, yet they expressed dissatisfaction with both the medical care delivered and the relationships created with patients.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Diamond L, Izquierdo K, Canfield D, et al. A systematic review of the impact of patientphysician non-English language concordance on quality of care and outcomes. J Gen Intern Med 2019;34:1591–1606.
 
2. Data USA. Bexar County, TX. https://datausa.io/profile/geo/bexar-county-tx/#demographics. Accessed September 17, 2020.
 
3. Karliner LS, Jacobs EA, Chen AH, et al. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res 2007;42:727–754.
 
4. Bagchi AD, Dale S. Examining effectiveness of medical interpreters in emergency departments for Spanish-speaking patients with limited English proficiency: results of a randomized controlled trial. Ann Emerg Med 2011;57:248–256.
 
5. Boylen S, Cherian S, Gill FJ, et al. Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI Evid Synth 2020;18:1360–1388.
 
6. Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev 2005;62:255–299.
 
7. Kwan M, Jeemi Z, Norman R, et al. Professional interpreter services and the impact on hospital care outcomes: an integrative review of literature. Int J Environ Res Public Health 2023;20:5165.
 
8. Lindholm M, Hargraves JL, Ferguson WJ, et al. Professional language interpretation and inpatient length of stay and readmission rates. J Gen Intern Med 2012;27:1294–1299.
 
9. Lee KC, Winickoff JP, Kim MK, et al. Resident physicians’ use of professional and nonprofessional interpreters: a national survey. JAMA 2006;296:1050–1053.
 
10. Diamond LC, Schenker Y, Curry L, et al. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med 2009;24:256–262.
 
11. Sandler R, Myers L, Springgate B. Resident physicians’ opinions and behaviors regarding the use of interpreters in New Orleans. South Med J 2014;107:698–702.
 
12. Mayo R, Parker VG, Sherrill WW, et al. Cutting corners: provider perceptions of interpretation services and factors related to use of an ad hoc interpreter. Hisp Health Care Int 2016;14:73–80.
 
13. Rosenberg E, Leanza Y, Seller R. Doctor-patient communication in primary care with an interpreter: physician perceptions of professional and family interpreters. Patient Educ Couns 2007;67:286–292.
 
14. Guerrero N, Small AL, Schwei RJ, et al. Informing physician strategies to overcome language barriers in encounters with pediatric patients. Patient Educ Couns 2018;101:653–658.
 
15. Martin FC, Philip J, McLachlan SA. Healthcare professionals’ views of working with medical interpreters in a cancer setting: an exploratory study. J Cancer Educ 2022;37:1115–1121.
 
16. Schwei RJ, Guerrero N, Small AL, et al. Physician perceptions of the types of roles interpreters play in limited English proficient pediatric encounters and how they evaluate the quality of interpretation. Prim Health Care Res Dev 2019;20:e25.
 
17. Silva MD, Adelman RD, Singh V, et al. Healthcare provider perspectives regarding use of medical interpreters during end-of-life conversations with limited English proficient patients. Am J Hosp Palliat Care 2022;39:220–227.
 
18. Suarez NRE, Urtecho M, Jubran S, et al. The roles of medical interpreters in intensive care unit communication: a qualitative study. Patient Educ Couns 2021;104:1100–1108.
 
19. Karliner LS, Pérez-Stable EJ, Gildengorin G. The language divide. The importance of training in the use of interpreters for outpatient practice. J Gen Intern Med 2004;19:175–183.
 
20. Kim SC, Kim S, Boren D. The quality of therapeutic alliance between patient and provider predicts general satisfaction. Mil Med 2008;173:85–90.
 
21. Friedberg MW, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Health Q 2014;3:1.
 
22. Jacobs B, Ryan AM, Henrichs KS, et al. Medical interpreters in outpatient practice. Ann Fam Med 2018;16:70–76.
 
23. White J, Plompen T, Osadnik C, et al. The experience of interpreter access and language discordant clinical encounters in Australian health care: a mixed methods exploration. Int J Equity Health 2018;17:151.
 
24. Cheng JH, Wang C, Jhaveri V, et al. Health care provider practices and perceptions during family-centered rounds with limited English-proficient families. Acad Pediatr 2021;21: 1223–1229.
 
25. Locatis C, Williamson D, Gould-Kabler C, et al. Comparing in-person, video, and telephonic medical interpretation. J Gen Intern Med 2010;25:345–350.
 
26. Fiedler J, Pruskil S, Wiessner C, et al. Remote interpreting in primary care settings: a feasibility trial in Germany. BMC Health Serv Res 2022;22:99.