Medical interpretation: a patient safety initiative
By Michael O'Connor, MD
Chief Medical Officer
Recently, there has been a significant focus on language interpretive services. The Centers for Medicare & Medicaid Services, the Joint Commission and others have weighed in on the requirement for translation services. These organizations require that patients with limited or no proficiency in the English language have the opportunity to use a language interpreter when they are receiving care. Banner Health has a policy that addresses this issue. Some providers feel that these proscriptive requirements for medical interpretation are unnecessary at best and get in the way of good communication (at worst) by interfering with convenient natural communication. Why, some say, when the patient has bilingual family members, or when there is a bilingual staff member present, would we need a certified interpreter?
Let’s think about this for a moment - when sentinel events (or serious reportable events) are investigated, at least one root cause for the event is communication in more than 65-percent of cases. Patients are challenged in the best of situations to understand their physician’s communication regarding their medical needs. We give our patients medications that alter their sensorium. They are anxious about themselves (i.e. What will be the result of my illness? Will I survive?) and others (i.e. How will my family/dog/cat/other pet get by while I am not there to care for them?). Additionally, they may have clinical reasons they do not understand our verbal communications.
As physicians, we have spent years of our lives learning to speak medical English. The terms we use accurately describe clinical conditions, diagnostic testing and therapeutic options. Patients with no limitation to their English language skills will often have difficulty with medical English. These patients often look to friends and family members in the medical profession (trained medical interpreters) to translate what we as physicians have told them. This “interpretation” is difficult because we are expecting the patient to adequately represent what their physicians have stated. This is similar to the old game of telephone.
Now, add to the complex problem of communication with the patient with limited medical proficiency, the patient with limited English proficiency. The risk for errors (gathering information, explaining tests and therapies, obtaining consent and providing the post discharge plan) multiply significantly. Is the patient’s untrained interpreter accurately communicating the needs of the patient? Even the question of whether the patient is doing better, can lead to misinformation. When we have limited proficiency in the patient’s primary language, how do we know the patient is really hearing and filtering our communication accurately?
The trained medical interpreter combines medical translation with language translation. This is of benefit to both the patient and to us. The ultimate goal is the safest care possible, reducing the risk of patient harm through communication errors. While care efficiency may be impacted by accurate translation requirements, we can never sacrifice safety for efficiency.
While we have placed a lot of emphasis on the Joint Commission’s requirement to use accredited interpreter services, we really need to see this as a patient safety practice.
What does Banner Health offer for language interpretation? At Banner Ironwood Medical Center, both Cyracom (telephone) translation services and VRI (video – including sign) are available. Both are easy to use and highly reliable certified medical translation services. If you have any questions regarding the use of these devices, staff on all units can assist you in operating these devices.
Finally, when you use the services, please document that in the Medical Record. If you didn’t document it, you didn’t do it!
Thank you in advance for your commitment to excellent patient care.