Why do we not use trained interpreters for all patients with limited English proficiency? Is there a place for using family members?

Abstract

Australia and New Zealand both have large populations of people with limited English proficiency (LEP). Australia's free telephone interpreter service, which is also used by New Zealand through Language Line (LL) but at a cost to the practices, is underused in both countries. Interpreter guidelines warn against the use of family members, yet the lack of uptake of interpreter services must mean that they are still often used. This paper reviews the literature on medical interpreter use and reports the results of a week-long audit of interpreted consultations in an urban New Zealand primary health centre with a high proportion of refugee and migrant patients. The centre's (annualised) tally of professionally interpreted consultations was three times more than that of LL consultations by all other NZ practices put together. Despite this relatively high usage, 49% of all interpreted consultations used untrained interpreters (mostly family), with more used in 'on-the-day' (OTD) clinics. Clinicians rated such interpreters as working well 88% of the time in the OTD consultations, and 36% of the time in booked consultations. An in-house interpreter (28% of consultations) was rated as working well 100% of the time. Telephone interpreters (21% of consultations) received mixed ratings. The use of trained interpreters is woefully inadequate and needs to be vigorously promoted. In primary care settings where on-going relationships, continuity and trust are important - the ideal option (often not possible) is an in-house trained interpreter. The complexity of interpreted consultations needs to be appreciated in making good judgements when choosing the best option to optimise communication and in assessing when there may be a place for family interpreting. This paper examines the elements of making such a judgement.

Explaining culturally and linguistically diverse (CALD) parents’ access of healthcare services for developmental surveillance and anticipatory guidance: qualitative findings from the ‘Watch Me Grow’ study

“…This is particularly important as the delivery of quality primary care health service to a CALD population needs to incorporate an interpreter resulting in longer consultations [46]. Gray et al [47] has shown that an in-house interpreter was rated as most appropriate during consultations at a primary care health care centre in New Zealand when compared to the use of family members and telephone interpreters.…”

Registered Nurse and Nursing Assistant Perceptions of Limited English-Proficient Patient-Clinician Communication

“…Despite recommendations for using interpreter services (13), limitations of interpreter services resulted in nursing personnel relying more heavily on other communication aids. Informants' perceptions suggest that improved interpreter services' availability and accessibility would save time and improve care, especially on weekends when interpreter services' availability is limited.…”

Migrant General Practitioners' Experiences of Using Interpreters in Health-care: a Qualitative Explorative Study

“…Problems such as accessing interpreter agencies, interpreters not respecting booked consultations, and poorly functioning technical equipment (14). In other previous studies the authors have shown that healthcare professionals experience a lack of easily available interpreters (15, 16) complications in communicating with using an interpreter (17, 18) not least because of lack of training in the practical use of interpreters and also because of financial considerations (18, 19). …”