Interpreter Use in Health Care

1. Interpreter Use in Health Care FelishaRohan-Minjares, MD Assistant Professor, FCM Director of Cultural Competency Curriculum Development Office of Diversity

2. At the end of today’s session, residents will be able to: • Explain the importance of language access and why interpreters should be utilized when needed • Explain best techniques of how to utilize medical interpreters Objectives

3. A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross- cultural situations. Cross, T L et al. Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children, National Center for Cultural Competence, Georgetown University, 1989. Cultural and Linguistic Competence

4. No one provider can or should be expected to know about every type of culture they might encounter. What is important is that they learn to listen respectfully and learn and respect that patients bring their own health beliefs and value systems into each encounter. Fundamental Principle

5. Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation. • Required of all health organizations receiving federal funds. Language Access: A Federal Requirement

6. Translator a person who takes a written document in one language and converts it to another language • Interpreter a person who takes a spoken language and converts it to another language. • Cultural Broker Definitions

7. When should you get an interpreter?

8. Resident physicians recognized that they underused professional interpreters, and described this phenomenon as "getting by” • Resident physicians made decisions about interpreter use by weighing the perceived value of communication in clinical decision making against their own time constraints Why Residents DON’T Call InterpretersGetting by: underuse of interpreters by resident physicians. Diamond LC, et al. Journal of Gen Int Med. 2009 Feb;24(2):256-62. Epub 2008 Dec 17.

9. The decision to call an interpreter could be preempted by the convenience of using family members or the resident physician's use of his/her own second language skills • Resident physicians normalized the underuse of professional interpreters, despite recognition that patients with LEP are not receiving equal care. Why Residents DON’T Call Interpreters

10. Who should you get to interpreter for you?

11. Chance Interpreters – Family, Friends • Bilingual Support Staff – Untrained • Bilingual Support Staff – Trained • Professional Medical Interpreters – in person, via video, via telephone The Interpreter Pool

12. Omit questions or instructions • Leave out or instruct patients not to answer personal questions • Try to influence the patient’s decisions • Summarize the message instead of relaying it exactly • Answer questions on their own Tendencies of the Untrained Interpreter

13. The Ideal Solution:Professional On-Site Interpreters

14. At UNM Hospital and Clinics:All interpreters in hospital carry a pager and numbers are listed on AMIONor2-TALK • Spanish, Vietnamese, Navajo & American Sign Language in house • Services available in person, video, and via telephone • Contracted Language Services Provider Pacific Interpreters for over 200 languages

15. Find the best interpreter available. • Never use a child. • If it all possible, avoid family members interpreting. Tips for Using Interpreters Effectively

16. Tips for Using Interpreters Effectively • Avoid the Triangle.

18. Introduce yourself to the interpreter. • You may briefly tell the interpreter about the patient and the case if you are familiar with the patient. • Speak in the 1st person and make eye contact with the patient while speaking, not the interpreter Tips for Using Interpreters Effectively

19. Speak clearly and in your normal tone of voice. Speak at a normal to slow-normal pace. • Use short sentences. • Be aware that many concepts you express have no linguistic or conceptual equivalent in other languages. Don’t use idioms. (i.e., “It’s a long shot”, “kill two birds with one stone”) Tips for Using Interpreters Effectively

20. Cultural Context • Education • Socioeconomic status • Role in family • Role in community • Bias • Immigration history • Etc. • Language • Cultural Background • Religion • Spirituality • Family Structure • Historical Trauma • Familiarity with and acceptance of western medicine

21. 21 yo Vietnamese female patient accompanied by her husband. Husband tell you that he wants to interpret for her Case 1 WHAT WOULD YOU DO?

22. 65 yo Swahili speaking man comes in to the clinic at 4:45pm on Friday with chest pain. He is accompanied by his 16 yo grandson Case 2 WHAT WOULD YOU DO?

23. You saw a 72 yo Iraqi man yesterday. Today you are reviewing his labs from the hospital and find that his sodium is 118. Case 3 WHAT WOULD YOU DO?

24. You are doing your rural rotation in Santa Rosa. A 16 year old Spanish-speaking patient is accompanied by her aunt who knows English and is serving as interpreter. You are ready to ask the questions about risk behaviors including sexual history and drug and alcohol use. You don’t speak Spanish and there are no trained interpreters at the clinic. Several clinic staff members speak Spanish. Case 4 WHAT WOULD YOU DO?

25. Explain the importance of language access and why interpreters should be utilized when neededExplain best techniques of how to utilize medical interpreters

26. Thanks for your attention. Please call an interpreter when you need to!