Health Interpreters for Spanish Speaking Patients - Quality of Care Issue

What options does a non Spanish speaking healthcare have to insure his/her Spanish speaking patients achieve quality care? Tried methods include the use of bi-lingual children, other relatives, non healthcare employees such as those in housekeeping, maintenance, and dietary who have some English language skills are used and continued to be used to translate conversations between healthcare providers and their Spanish speaking patients. While this might seem to be an appropriate avenue, such an approach should only be used in dire emergencies.

The challenge with this approach is the provider may assume the translator is literate and competent to translated medical terms and related conversations. Given that education is only mandatory up to the 6th grade in Mexico it may be a huge error to assume an immigrant who is asked to translated may have sufficient literacy to serve as a translator. Medical terms are not commonly spoken in Spanish by the general population or for that fact with USA residents who have low educational levels.

Given the privacy of communication between the healthcare provider and the patient the use of non health professionals who lack proper education and credentialing to service as translators is inappropriate. Issues such as HIV status, substance abuse, mental health issues such as child maltreatment and domestic abuse need to be discussed using the highest levels of confidentiality. Thus using a child or other relative to serve as the translator is totally inappropriate, particularly in these situations.

For some time healthcare providers can out source translations to vendors who will provide such services via the telephone. This is certainly a step in the right direction, particularly if the provider is unable to secure such translation services locally. The provider needs to insure the questions being asked of the non English speaking are kept short so the translator can provide an accurate word for word translation and not attempt to summary a lengthy questioning and/or discussion. The same is also true when the patient is asked to respond to the provider question. There is always the danger that the translator may not be able to retain all of the information and accurately summarize the response. The provider should ask the translator to repeat back to the him/her the question to help assure the individual doing the translation did understand the communication. While this is a more time consuming process the accuracy of the translation is improved. The tendency for the non Spanish provider to limit the interaction with the patient due to the language problem is common. This can lead to the patient not fully understanding the communication and may lead to more frequent follow-up visits by the patient to seek answers that were not addressed during the initial interview.

Increasing Health and Human Service Administration requirements for cultural competent care and new standards from the Joint Commission on Healthcare Organizations means that healthcare providers must find more suitable solutions to insure competent translations as well as confidentiality of the communications. Spanish speaking individuals who are appropriated educated in the use of medical terminology and knowledgeable about health privacy issues, and can provide proper word for word translations are urgently needed. These individuals with such training and resulting credentialing should be employed in clinics, emergency rooms, and hospitals. They can potentially make an significant contribution to improving the quality of care provided to our monolingual Spanish speaking patients.