Letter to the editor regarding aranguri et al.

Abstract

To the Editor:—“Patterns of Communication through Interpreters: A Detailed Sociolinguistic Analysis,”1 seemingly addresses the important issue of interpreters and their impact on provider-patient communication. The authors state, “many of the structural difficulties exist regardless of who is interpreting for whom, based more in the nature of interpreter discourse itself and the time constraints of a medical interaction than through the specifics of the interpreter.” This is an alarming, and false, conclusion based on the data. This study only documents the negative impact of untrained interpreters on health communication. Immigrant patient advocates and the health care system are working hard to ensure that Title VI of the Civil Rights Act2 is enforced to decrease immigrant health disparities. Published data, used to help inform such service delivery, need to be scientifically rigorous. This study, with its sweeping conclusions based on untrained interpreters, could be potentially misleading. There are marked differences between trained, professional interpreters and the ad hoc interpreters they studied. Because of this, the Department of Justice “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition against National Origin Discrimination Affecting Limited English Proficient Persons”3 strongly discourages the use of untrained interpreters. The Center for Immigrant Health has conducted a randomized controlled study of outcomes by various interpreting modalities, as well as in same language encounters. In fact, our audiotape analyses of 214 encounters reveal that in visits using a trained remote simultaneous interpreter, physicians give an equal number of instructions per visit as they do in Spanish language concordant encounters (mean # per encounter 14.29, SD 6.9; 14.33, SD 6.33). Usual and customary interpreting, however, results in significantly fewer instructions (mean # per encounter 11.9, SD 6.17). Trained, professional medical interpreters are key to the elimination of health care disparities.