Optimizing the Involvement of Language Interpreters During the Clinical Encounter

Abstract

Many clinicians attend to the needs of patients who do not speak the same language as they do. In the U.S., such patients are most likely to have limited English proficiency (LEP). Clinicians at medical centers with interpreters available either on staff or over-the-phone may wonder how to structure interpreter participation in the clinical conversation. There has been an explosion of literature on the provision of culturally competent medical care, and most everyone would agree that there is an association between race/ethnicity and health disparities, that language barriers contribute to these disparities, and that medical providers who encounter language barriers should request a professional interpreter. However, the nuances in how the involvement of an interpreter can be calibrated to a particular patient’s degree of proficiency, needs, and preferences remain under-explored. In particular, when deciding how to involve an interpreter, how should clinicians weigh the balance between under-reliance on the interpreter, failing to sufficiently involve an interpreter for patients whom the service could benefit, and over-reliance on the interpreter? The literature on language barriers overwhelmingly focuses on the drawbacks of interpreter under-reliance.1 In this Comment, we focus on the other side of the equation: possible harms of interpreter over-reliance. Our primary aim is to stimulate research exploring the benefits of more flexible interpreter involvement. In the meantime, we also provide guidance for clinicians on new approaches to conversations with LEP patients.