When someone arrives at the hospital who doesn't speak English very well, it's common for workers at the hospital who are fluent in that language —doctors, nurses, even administrative staff — to step in and act as the patient's interpreter.
Though they may be well-meaning, not to mention more affordable than trained interpreters, relying on such accidental interpreters during medical treatment is not the best idea, research has found.
Trained interpreters made about half the number of errors with potential clinical significance as so-called ad hoc interpreters, such as hospital staff or family members, in encounters at two large pediatric emergency departments in Massachusetts, according to a recent study published in the Annals of Emergency Medicine.
In order to pass training in medical interpretation at the Northern Virginia Health Education Center, students must complete at least 40 hours of course work, which includes study in medical terminology, medical privacy issues and ethics, says Dallice Joyner, the program's executive director.
In addition, students must score at least 80 percent on a language fluency test to get into the program. "Not everybody passes," she says. "Just because somebody says they're bilingual doesn't mean they're actually fluent."
Under Title VI of the Civil Rights Act of 1964, medical providers that accept federal funds — for treating Medicare or Medicaid recipients, for example — have to provide access to language services for patients who don't speak English well. But funding for such services can be problematic, since many insurers don't reimburse providers for them.
Some hospitals nevertheless have rigorous training programs to ensure that the staffers they use for medical interpreting are up to the task, say experts.
At Inova Health System in Northern Virginia, for example, in addition to several full-time in-house interpreters, more than 300 people on the staff have completed a 40-hour medical interpreting course to prepare them to step in and help patients at the system's five main hospitals, says Alejandro Muzio, language services manager for Inova. They also use outside vendors when needed, he says.
In their service areas, providing such assistance is critical, he says. "In Fairfax County, 1 in 3 households speaks a language that's not English."
But at other hospitals, where staff with no formal training are pressed into providing interpreting services, common errors such as omitting or substituting words, editorializing, or making up words — called "false fluency" — are more likely to occur.
They may occur less often in the future. Starting in July, the Joint Commission, which accredits healthcare providers, will begin to eyeball specifics related to interpreter services more closely in their evaluations, as part of an initiative to promote cultural competence and patient-centered care.