Clinical Case

Your next patient is a Spanish-speaking 24-year-old female who begins by telling you that she is embarazada. Despite her bashfulness, you debate whether or not to call in the interpreter, since the waiting room is overflowing and between her broken English and your high-school Spanish you think you can get by without formal interpretation.

Medical Interpreting

According to the U.S. Census Bureau, 60.6 million Americans (approximately 20.8 percent) do not speak English as a primary language, and 25 million of those speak English less than well (known as “limited English proficiency” or LEP); many indicators show this number will only continue to grow. This demographic is higher risk of adverse events during hospital encounters, often due to communication issues, leading to tragic outcomes and malpractice suits including cases of missed intracerebral hemorrhages, unnecessary or incorrect surgeries, misused medical devices, and fatal medication dosing.^1,2 Medical interpreters (as opposed to translators who work with the written word), are essential to bridging the language gap.

Regulations

Section 1557 of the Affordable Care Act focuses on services available to limited-English-proficiency patients and builds on anti-discriminatory precedents set by Title VI of the Civil Rights Act. Current rules mandate that covered entities must communicate availability of interpreter services and are, “obligated to take reasonable steps to ensure access to services.” It also limits the use of ad hoc (or nonqualified) interpreters such as family, friends, or untrained staff to certain situations (e.g., emergencies, patient’s request).³ A new 2022 proposed change to Section 1557 hopes to expand its scope to other HHS activities (including Medicare Part B) and telehealth services, require staff training on availability of services, and further define the roles of qualified versus nonqualified interpreters.⁴ The Joint Commission’s standards follow similar requirements. However, actual increases in available services in emergency departments based on prior state-level requirements have been mixed.⁵

Many medical interpreters are certified by organizations such as the National Board of Certification for Medical Interpreters, or the Certification Commission for Healthcare Interpreters, which require both written and oral testing and documented experience, as well as additional training in medical ethics, terminology, and patient privacy regulations. These include ASL interpreters. However, it has not been feasible to develop and validate certifications for all of the over 350 different languages spoken in the U.S., let alone find qualified interpreters for each language. Some certifying bodies may provide provisional interpreters in cases where they cannot certify an interpreter for a certain language or dialect. In other cases, medical staff may have to rely on ad hoc interpreters.