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Background Information on Health Care Interpreting

Community or public service interpreting, which includes health and court interpreters, has gained attention in the United States with the increase in the foreign born population and a growing body of evidence linking disparities in health outcomes to language barriers. The Civil Rights Act of 1967 prohibits discrimination due to national origins. Requirements for equal access mandate federal programs to monitor language barriers that may prevent those who speak little or no English from accessing public services. These mandates trickle down to health organizations who receive payments through these programs. Looking for expedient and practical solutions, doctors, hospitals and other healthcare organizations turn to patients’ families, friends, or others who are nearby, to interpret.

Many providers rely on heritage communities (meaning language minority communities) for help. Health care interpreters are often heritage speakers, persons who learned their native language at home, not in school, and whose language proficiency varies widely.

With demographic changes, doctors and hospitals are challenged with increasing numbers of patients who speak little or no English. Many healthcare organizations hire bilingual employees for first contact positions—as receptionists and business office staff or in patient support positions like that of health educators—in order to help patients in their own languages. Frequently, bilingual workers are also expected to interpret for others, in which case they are referred to as dual role interpreters. To learn how physicians are responding to language barriers during health visits, please see the report commissioned by Hablamos Juntos on physician perspectives on communication barriers.

Important information between doctor and patient can be lost in the interpretation. In one study, untrained interpreters were found to make an average of 31 errors per encounter (Flores et al, 2003). Furthermore, the errors made by untrained bilingual staff and family members serving as interpreters can greatly impact patient-provider communication. The most common errors include:

  • Omission - where an important piece of information is left out by the interpreter.
  • False fluency - where words or phrases that do not exist are used by the interpreter.
  • Substitution (13%) - a word or phrase is replaced with another word or phrase of a different meaning.
  • Editorialization (10%) - the interpreter’s opinion is added to the interpretation.
  • Addition (8%) - a word or phrase is added by the interpreter.

In order to avoid these errors to the greatest extent possible, health care interpreters must be trained for the situations that are presented to them. There are many critical elements of interpreter training discussed on this site that include not only language proficiency, but also mastery of medical and health care terminology, interpreting skills, and health care and interpreting ethics. These myriad skills are particularly important given the flexible and complex role that interpreters can play in different situations. In her book entitled Medical Interpreting and Cross-cultural Communication, Claudia Angelleli explores the numerous metaphorical roles that interpreters say they assume in different situations. According to Angelleli, the complexity of health care interactions demands that interpreters serve as metaphorical detectives, bridges, diamond connoisseurs, and miners. This multiplicity of roles further underscores the importance of training and experience in interpreter development.