Patient speaks. Interpreter speaks. Nurse practitioner speaks. Interpreter speaks. Repeat. The process of providing patient care through an interpreter seems simple enough, right? A closer look at the data, however, shows that this approach often leaves patients in the dark and providers exposed to malpractice liability.
According to the Agency for Healthcare Research and Quality, nearly 9% of the U.S. population is at risk of an adverse health event as a result of a language barrier. In the emergency department, I have witnessed a situation firsthand, where a nurse practitioner failed to use interpretation services appropriately and almost missed a serious complication a patient was experiencing. Even with language services, crossing cultural barriers comes with risks. Untrained interpreters, for example, may make mistakes, conveying incorrect information to the NP or patient.
As nurse practitioners, we maintain ultimate responsibility for our patient’s outcomes regardless of the language the patient speaks. To mitigate the potential risk and frustrations associated with communicating through an interpreter, nurse practitioners can use these basic principles.
1. The path of least resistance has limitations
Using a patient’s friend, family member, or a fellow coworker without formal training as a medical interpreter will not yield the same results as using a trained interpreter. The individual may, for example, insert personal perspective or advice into the conversation. Or, the patient may have concerns about the confidentiality of the discussion. Whenever possible, get the patient encounter off on the right foot by using formal language services.
2. Don’t rely on your own language skills
If you have basic knowledge of a non-English language, it’s tempting to forge through the patient encounter relying on your own skills. Most commonly, providers run into a pitfall in that it’s easier to ask questions than to understand the response. Unless you’re truly fluent, you stand to loose valuable information by conducting the conversation on your own.
When using an interpreter, it’s natural to speak directly to the interpreter. Instead, look at the patient, leaving the interpreter as an observer. The conversation should appear as if you are holding a conversation directly with the patient. Avoid using phrases like ‘tell her’ or ‘he says’. Rather, use first person ‘I’ statements.
4. Pay attention to the seating arrangement
Just like at a dinner party, the seating arrangement between the provider, patient, and interpreter can make or break the conversation. The American Family Physician suggests placing the interpreter next to, or slightly behind the patient for the most effective interpretation dynamic.
5. Maintain control of the conversations
Conversations can quickly get away from you, particularly when using an untrained interpreter. As the provider, you must maintain control. Insist on sentence-by-sentence, direct interpretation. Do not allow for side conversations between the interpreter and patient, or between the interpreter and yourself.
Just as with the clinical details of the patient encounter, nurse practitioners must also note that the patient interaction was facilitated by an interpreter. The name of the interpreter should be noted in the patient record as well, so that details of the encounter can be corroborated at a later time if necessary.
7. Keep it Simple
English is chock full of colloquialisms that may not translate well. Avoid using such phrases which are prone to misinterpretation. Rather, speak plainly and simply. Stick to no more than three key takeaways from the visit. Even without communication barriers, patients have trouble keeping track of multiple instructions. It’s better to schedule a follow up appointment than to cram too much content into a single visit.
What tips have helped you communicate through an interpreter in your practice?
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