Medical care sometimes lost in translation

NEW YORK?? Many doctors-in-training with shaky Spanish skills are willing to discuss medical care with their patients in Spanish ? but that may change after they are tested for fluency, a new study suggests.

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Researchers surveyed 76 pediatric residents and found 64 percent were willing to use Spanish with their patients. That number fell to 51 percent after they were evaluated on their Spanish skills ? a difference due to fewer non-proficient speakers using the language after testing.

Previous studies have shown residents often use their subpar second-language skills to talk with patients, the researchers wrote in the journal Pediatrics, sometimes with consequences due to misinterpretations.

"Residents are working hard and are possibly less likely to take the extra time to get a professional interpreter," said Dr. Casey Lion, the new study's lead author and a pediatrician at the University of Washington in Seattle.

Lion told Reuters Health she believes doctors may forego getting an interpreter because they want to build a rapport with their patient.

"That's the thing people don't want to give up. They don't want to have to speak through somebody else," she added.

Not using an interpreter may lead to serious consequences, however. A study released in March suggested using professional interpreters in emergency rooms cuts down on miscommunications that could lead to "clinical consequences."

Testing proficiency
For the study, Lion and her colleagues sent emails to 243 pediatric residents from Maryland, Missouri and Washington. Of those, 76 who reported some level of Spanish skills completed the study. The rest either didn't respond or could not find time to take the surveys or tests.

The residents who did respond were first asked how well they thought they were able to speak about health and medical issues in Spanish and how comfortable they would be using Spanish in specific medical settings.

Then they took a language proficiency test and were asked the series of questions again.

Before the test, 77 percent of the residents said they were less than proficient in Spanish. That number was about right, according to the test.

When the 57 residents with only basic or conversational skills were told their results, the number willing to speak with patients in a "straightforward clinical encounter" fell from 56 percent to 39 percent.

However, in more "complex" situations, such as dealing with children who have a long medical history, the testing seemed to lead more non-proficient speakers to be comfortable using Spanish ? possibly because some of them scored better than they originally expected.

Despite that, Lion said the results suggest testing residents' Spanish may be an effective piece of a multipronged approach -- along with increasing access to professional interpreters ? to deter the use of subpar language skills.

"The bottom line is that people should be tested to see if they should even see patients without an interpreter," said Dr. Francesca Gany, chief of the Immigrant Health and Cancer Disparities Service at Memorial Sloan-Kettering Cancer Center in New York.

'Have an interpreter present'
Gany told Reuters Health the "gold standard" should be for an interpreter to be present in every meeting that goes beyond just a greeting when a patient isn't fluent in English.

"What we've emphasized to our incoming residents is that it's OK to use (less advanced) language skills... as long as you have an interpreter present," Lion said.

"It's absolutely essential to have a trained interpreter there," said Gany. She added that it's important for hospitals and other medical centers to make interpreters and interpreter services readily available if they expect them to be used.

She said there are a number of reasons not to use family members as interpreters ? including confidentiality and privacy.

"Patients need to know their rights to an interpreter, but I don't think it should fall on the patient to make the system work. It should fall on the providers and the system to make it work," said Gany, who added there needs to be proper enforcement and funding in place.

Interpretation services can cost from $20 to $60 for a 30-minute medical visit.

Gany said more studies are needed to show the cost-effectiveness of using interpreters.

(c) Copyright Thomson Reuters 2012. Check for restrictions at: http://about.reuters.com/fulllegal.asp

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