A 65-year-old man is admitted overnight to the hospital with abdominal pain. It is determined that he has an uncomplicated small bowel obstruction that will require surgery in the morning. Temperature is 37 C (98.6 F), blood pressure is 130/82 mm Hg, and pulse is 90/min. The resident meets with the patient and his adult son, who has accompanied him to the hospital, to discuss surgical intervention. After introducing herself, the resident learns that the patient speaks primarily Vietnamese and has limited English proficiency, although his son speaks both Vietnamese and English. The son shares that he is a critical care nurse and offers to interpret the conversation for his father. Which of the following responses to the patient's son is the most appropriate?
Communicating with patients who have limited English proficiency | |
Initial consent |
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Preferred mode of communication |
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Alternate modes* |
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*Not recommended if medical interpreter can be obtained & patient consents. | |
This patient requires surgical intervention and must give appropriate consent before proceeding. However, he has limited English proficiency (LEP) and will require language assistance to make informed decisions about his health care. Best practices for medical communication with a patient who has LEP is to use an interpreter (or provider) trained in medical translation in the patient's primary language. Using a trained medical interpreter can help avoid potentially dangerous miscommunication, and leads to fewer clinical errors, higher patient satisfaction, and better clinical outcomes. However, using an interpreter or other personnel to provide care is subject to consent by the patient.
If a face-to-face interpreter is unavailable, video or telephonic remote translation services should be offered. If the situation is urgent and there is no time to wait for interpretation services, communication should be facilitated by any tools available (eg, friends/family, writing/drawing instruments, bilingual hospital staff); however, these options should not be considered standard procedure in nonemergency situations.
(Choice B) Printing out a Vietnamese language informed consent form would be helpful. However, it does not replace the need for a medical interpreter who can provide details of the procedure and guarantee that the patient's questions are answered thoroughly.
(Choices C and D) Friends and family members are not ideal for language interpretation due to lack of impartiality and possible barriers to open communication regarding sensitive topics (eg, domestic abuse). They may also be unfamiliar with medical terminology and may struggle to accurately convey complex medical information (although this patient's son has medical training). This patient should be offered the services of a trained medical translator; family would be used only if the patient declines an outside translator.
(Choice E) Although this statement reflects a potential reason to avoid using family members as interpreters, there is nothing in the family interaction to suggest a lack of objectivity, and such a direct response may be taken as demeaning or insensitive.
Educational objective:
Physicians must ensure the appropriate use of medical interpreters to promote adequate patient understanding and participation in the decision-making process. This is particularly important when obtaining informed consent for treatment.