Mrs ‘K’ greets you when she arrives for an eye exam with her daughter. In response to questions, she smiles and nods, but struggles to answer. An interpreter may be required, says DR PATRICK CLANCY.
Healthcare practitioners have a duty to take reasonable steps to communicate effectively with patients – including using qualified language interpreters wherever necessary. However, recent research suggests that culturally and linguistically diverse patients are not always being offered access to professional interpreters.
Think about how much information you exchange in even the most straightforward patient consultation. As well as being a professional responsibility, it’s in your interests as well as the patient’s that you communicate effectively and avoid misunderstandings.
The clinical risks of miscommunication are clear: inadequate history taking; missed or delayed diagnosis; patients not being able to follow treatment plans. Other reported issues can include longer consultations, additional referrals and tests, and complaints due to lack of informed consent to treatment.
There may be multiple reasons why interpreters are not offered: concerns about cost, time taken to access, being unsure how to access interpreters, not recognising an interpreter is required, waiting for a patient to ask, or assuming a family member can translate.
Use professional interpreters wherever possible
Professional codes of conduct require practitioners to be familiar with and use qualified language interpreters wherever necessary. This includes access to sign language interpreters if required for deaf or hearing-impaired patients.
Relying on the patient’s relatives or friends to interpret can be risky and may be inappropriate.
Patients may be unwilling to disclose clinical issues to a family member, particularly a child. Even if their conversational English is good, a relative or friend may not be able to translate medical terminology. Family members may also filter what they relay to the patient. Even if this is well-intentioned, out of a desire to soften the message, or please the practitioner, it means the patient does not receive the information they need.
Identify the need for an interpreter
There are several guides to help practitioners identify when an interpreter may be needed (see references in the online version of this article). Often it is as simple as asking open questions. While ‘yes’ or ‘no’ answers can mask a lack of understanding, having the patient describe their symptoms or repeat back what you told them can make it easier to spot language barriers.
Accessing professional interpreters
Make sure that the practice team understand how to access professional interpreters when needed. Practices may have posters or signage letting patients know they can ask for an interpreter and the languages available. (For more information on interpreter services, see the references listed in the online version of this article).
Patients sometimes feel concerned about involving an interpreter. It’s often helpful to reassure them that your discussion will be confidential. An interpreter can help you explain this part if necessary.
Save time by communicating clearly
Whether or not you are using an interpreter, clear communication can take time, but generally saves time and misunderstandings later.
If you haven’t worked with an interpreter, it can feel a little awkward to get the balance right. Key tips include:
• Allow time initially for the patient to speak with the interpreter and to feel comfortable and confident about the arrangement, especially if the interpreter is on the phone.
• Speak directly to the patient and engage with them rather than asking the interpreter to relay questions.
“Do you have pain?” not “Can you ask the patient if they have pain?”.
• Pace your communication. Think about how much information you deliver at once. Pause so the interpreter has time to relay the information.
• It can also be helpful to signpost the consultation – explain the steps you will be working through – so both the patient and interpreter know what’s coming.
• Allow plenty of time for questions.
• Diagrams and other materials may also be helpful.
Think about follow-up
Ensure the patient knows how to get in contact if they have questions, and check whether they wish you to share their personal information with any family members or support people.
NOTE: Supporting resources and reference material can be found in the online version of this article.
Disclaimer: This article is intended to provide commentary and general information. It does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision making with regard to the individual circumstances.
ABOUT THE AUTHOR: Dr Patrick Clancy is a senior medical adviser in the Advocacy, Education and Research team at Avant. He has been a doctor for over 25 years and was previously a member of a state medical board. Clancy has presented and written widely on medico-legal topics, with a focus on minimising the risks faced by doctors.
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