Volume 60, Number 3 - Summer 2009

 

By Steve Osborn, MA

Almost two-thirds (65%) of the physicians who responded to the SCMA survey on cross-cultural medicine reported that they seldom or never use medical interpreters. Those who do, however, indicate that interpreters are among the most effective means of understanding patients who speak limited English. 

Perhaps the main reason for the infrequent use of medical interpreters is money. Several survey respondents noted that they simply can’t afford to hire interpreters, so they depend on other sources for translation, such as bilingual staff or family members.

To address this problem, some local hospitals have hired interpreters and made their services available to physicians affiliated with the hospital. A prime example is the Ayudante (“helper”) program at Healdsburg District Hospital, which offers Spanish translation services throughout the hospital and at local physician offices.

Begun in 1999 with a $500,000 grant from The California Endowment, Ayudante currently employs about 20 interpreters who have completed a 40-hour training program in medical interpreting. Last year the interpreters served more than 5,600 patients in all phases of hospital interactions, from physician office visits, to registration, to surgical pre- and post-op.

Mario Guzman, the director of Ayudante, estimates that about one-third of the patients at Healdsburg are Spanish speakers with limited English proficiency (LEP). Almost all of them use translators. “It’s huge,” he says. “It really comes down to not just a language barrier with them. It is understanding the system. They are like a deer in the headlights. They just don’t know what to do. It’s complicated enough for those of us who speak English!”

Guzman, who has been with Ayudante since its inception, stresses that medical interpreters are trained to interpret the complete patient-doctor encounter while interfering as little as possible. “We stand where both the physician and the patient can see us clearly,” he explains. “We look at the patient, we ask the patient to speak to the doctor directly, make eye contact. As they speak, we will let them speak a sentence or two or three, and then we interpret, the doctor understands, and the conversation continues.”

There’s more to interpreting than just words, however. “Speaking languages is a must, but you have to really connect culturally with the patient,” says Guzman, echoing the comments of many physicians who responded to the SCMA survey. In his experience, LEP patients quickly determine whether an interpreter is culturally sensitive or merely bilingual. “Once they understand and feel that, wow, this interpreter understands me, everybody relaxes. The patient feels like they actually have a voice now.”

In addition to interpreting doctor-patient interactions, Ayudante also provides financial counseling for uninsured LEP patients. Before discharged LEP patients leave the hospital, for example, Ayudante staff sit down with them to fill out applications for Medi-Cal, Healthy Families, CMSP and other entitlement programs. “It’s a win-win situation,” Guzman observes. “We get our reimbursement, they keep their dignity. … They are not walking away from a bill.”

Guzman agrees that the biggest obstacle to providing interpreter services is budgetary. Beyond that, it’s a question of training. “What the hospitals have tried to do is use their existing bilingual staff and utilize them in a dual role as an interpreter,” he notes. “What has become evident over the last five years is that really doesn’t work either. … You have to train an interpreter. Speaking Spanish, being bilingual, doesn’t qualify you to go into the emergency room in a trauma situation and interpret. You are not mentally prepared, you are not trained.”

A recent report from the California Academy of Family Physicians supports the need for programs like Ayudante. The report, Addressing Language and Culture, notes that medical interpreters are fully bilingual and have training in medical terminology, in managing three-way conversations, and in medical ethics. Such interpreters, the report concludes, “are considered the ‘gold standard’ for communication with LEP patients.”