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Many resident physicians not trained
in the use of medical interpreters
Reliance on untrained interpreters,
including children, is frequent
BOSTON - September 5, 2006 - A significant number of resident
physicians receiving training in U.S. hospitals report they have
not received instruction in key aspects of communicating with patients
who do not speak English, despite federal regulations requiring
adequate interpreter services for such patients. In the Sept. 6
issue of the Journal of the American Medical Association,
researchers from the Massachusetts General Hospital (MGH) Institute
for Health Policy report the results of a national survey on residents'
education and practices when caring for patients with limited English
proficiency.
"Residents need to be taught not only how to obtain trained
interpreters at their hospitals but also why they should use them
and how to do so more effectively," says Karen C. Lee, MD,
MPH, lead author of the JAMA report. "Improved availability
and proper use of trained interpreters could help improve quality
of care and health outcomes for patients with limited English proficiency,
who may have problems accessing the health care system and communicating
with their providers. Using multilingual written materials may also
enable these patients to understand what they've been asked to do
after they go home" Lee worked on this study when she was associated
with the MGH Center for Child and Adolescent Health Policy.
The research team mailed surveys to about 3,500 residents in the
final years of their training programs at 149 academic health centers
across the U.S. The survey asked residents whether they had received
instruction on several topics related to the use of interpreters
- including how to obtain trained medical interpreters, the legal
rights of patients with limited English skills to have professional
medical interpreters, and the dangers of using untrained interpreters.
Among the more than 2,000 respondents, more than half replied they
had not been taught that patients with limited English proficiency
have a legal right to professional interpreters. (Guidance issued
in 2000 by the U.S. Department of Health and Human Services states
that denial of adequate interpreter services to patients with limited
English proficiency is a form of discrimination.) While 77 percent
of respondents said they sometimes or often used professional interpreters
when facing language barriers, 84 percent admitted to frequently
using untrained interpreters, such as patients' family members and
friends. More than 20 percent admitted to sometimes or often relying
on children under age 12 to interpret for family members, a practice
cited as particularly risky.
"The use of untrained interpreters, who may not be familiar
with medical language, can cause problems." says Joel S. Weissman,
PhD, of the MGH Institute for Health Policy, the senior author of
the JAMA report. "And the use of children is particularly
problematic because it can upset family dynamics. One can only imagine
how awkward it can be when a doctor asks a 12-year-old girl about
some of her grandfather's personal health problems." Weissman
is an associate professor of Medicine at Harvard Medical School.
More than half the responding residents reported that lack of access
to interpreters and to written materials in other languages, as
well as lack of time, posed moderate or major problems in providing
cross-cultural care. Residents reporting inadequate access to professional
medical interpreters were 40 percent less likely to say they used
such interpreters.
"As with other areas in which doctors are expected to communicate
with patients, training really matters," says Weissman. Residents
receiving some or a lot of training in working with interpreters
were about twice as likely to use professional interpreters as those
who reported little or no training. However, the only factor significantly
associated with decreased use of children as interpreters was instruction
in patients' legal rights to professional interpreters.
"Lack of appropriate medical interpreters not only makes it
harder to make the right diagnostic and treatment choices, it also
can make care more costly, since studies have shown that providers
tend to order more tests in these instances," says Joseph Betancourt,
MD, MPH, director of the MGH Disparities Solutions Center and a
co-author of the JAMA report. "As we become an ever-more-diverse
nation, we need to assure that our future physician workforce is
prepared to deal with the challenges of our changing population."
Additional co-authors of the report are Jonathan Winickoff, MD,
MPH, MGH Center for Child and Adolescent Health Policy; Minah Kim,
PhD, Ewha Women's University, Korea; and Eric Campbell, PhD, Elyse
Park, PhD, and Angela Maina of the MGH Institute of Health Policy.
The study was supported by grants from The California Endowment
and The Commonwealth Fund.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of nearly $500 million and
major research centers in AIDS, cardiovascular research, cancer,
computational and integrative biology, cutaneous biology, human
genetics, medical imaging, neurodegenerative disorders, regenerative
medicine, transplantation biology and photomedicine. MGH and Brigham
and Women's Hospital are founding members of Partners HealthCare
HealthCare System, a Boston-based integrated health care delivery
system.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
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