Abstract
BackgroundCurrent evidence highlights that language discordant clinical encounters seriously compromise patient quality of care and health outcomes. We aimed to characterise patterns of interpreter service use in medical inpatient wards use and explore clinician experience of language discordance.MethodsParticipants included medical students, residents, attending physicians, nursing and allied health professionals working in General Internal Medicine wards across two tertiary referral hospitals servicing a large Australian health care area. This study involved a retrospective electronic medical record audit of interpreter use. Six focus groups were conducted with 32 participants. Data were analysed using an inductive thematic approach with constant comparison.ResultsAllied health professionals were identified as the largest users of interpreter services, followed by medical doctors. Distinct themes emerged regarding clinician experiences of language discordant encounters including: (1) Negotiating care when unable to get an accurate assessment; (2) Over servicing to fill in the gaps; (3) Using family members instead of professional interpreters: a vexed solution; (4) Disparities in care provision; and (5) Communication drought: broken by a flood.ConclusionsPatients with low English proficiency are at risk of being less informed of care processes, and having a very large volume of information given in a shorter period of time when an interpreter is present. There is a need for systematic and transformative change that addresses utilisation of professional interpreters as well as embedded healthcare culture and practices leading to less interaction with patients with limited English proficiency and reliance on family members as informal interpreters.
Highlights
Current evidence highlights that language discordant clinical encounters seriously compromise patient quality of care and health outcomes
Growing evidence highlights that patients with low English proficiency (LEP) express dissatisfaction with their health care, and are less likely to adhere to crucial follow-up care [13, 14]
Use of interpreters was generally low on a per-patient basis and allied health professionals were identified as the largest user of the interpreter service, followed by medical doctors (Fig. 1a)
Summary
Current evidence highlights that language discordant clinical encounters seriously compromise patient quality of care and health outcomes. Language discordance occurs when a patient, carer and/ or health care professional lack proficiency in the same language. This is an issue for the national and international health care systems due to increasing cultural diversity in terms of country of birth, languages and religious affiliation [1, 2]. Evidence show that patients with low English proficiency (LEP) who experience language discordant clinical. Growing evidence highlights that patients with LEP express dissatisfaction with their health care, and are less likely to adhere to crucial follow-up care [13, 14]. Clinical uncertainty due to language discordant clinical encounters can lead to additional costs to the health care system such as increased diagnostic testing and increases in length of hospital stay [15, 16]
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