Use of a medical interpreter

What it is

A medical interpreter is used so that a medical interview can take place with a patient who has limited English capabilities. Physicians should use trained interpreters whenever possible, to avoid the mistakes and pitfalls associated with using family members or untrained interpreters for medical interviews. When a family member is there and happy to interpret, the step to recommend as best medical practice is the telephone interpreting service.

How it is treated

Simply being bilingual does not mean someone will be an appropriate interpreter, so confirming a family member's understanding of English is not the test to apply. It is also not appropriate to ask the patient, through her family member, about her preferences for interpreting. Although it may be technically legal to use a nontrained interpreter, title VI of the Civil Rights Act requires interpreter services for all patients with limited English capabilities who are receiving federal assistance, except Medicare Part B, and where a patient is not covered it is ethically appropriate to extend the same courtesy. A full history and physical examination are indicated for all refugees within 30 days of arrival, with a professional medical interpreter if needed.

The emergency changes the answer. When a 75-year-old man who speaks a language the physician does not understand is brought to the Emergency Department by a grandson who translates for him, and there are no interpreters in the building though one is on call, the best next step is to continue to evaluate the patient using his grandson as an interpreter. This is the answer even with a blood pressure of 85/52 mm Hg, a heart rate of 130/min and a respiratory rate of 40/min. Having the interpreter paged and then waiting for their arrival is not the step, and neither is performing a physical assessment first to determine if an interpreter is needed, giving medication for the pain and waiting for the interpreter, or asking the grandson to track down an adult family member.

The family member who interprets may also try to steer what the patient is told. When a daughter interpreting for a father who does not speak the language asks that nothing be mentioned about a cancer because it will upset him, the course of action is to explain to the daughter the need to properly inform the patient. Complying with her wishes is not it; nor is requesting the involvement of an ethicist, asking for a professional interpreter and excluding the daughter from further involvement, or recommending referral to another physician because her request cannot be met.