When health care providers and patients do not speak the same language, interpretation is a crucial part of communication. Ideally, multiple modalities for interpretation are available for patient visits when necessary. However, resources are limited for many academic medical clinics, so how best to appropriately allocate funds for interpretation services clearly warrants attention. By exploring patient and provider perceptions of and attitudes toward interpreter usage, we hope to provide some information to help managers and directors of academic medical clinics improve their services.
The costs of having both a telephone interpretation service and professional on-site interpreters are substantial. At the rate of $2.20 per minute of usage, about $3,500 is spent per month or $42,000 per year on the telephone interpretation service under contract to the hospital, which is used predominantly by the MPCU. Likewise, one full-time interpreter for the MPCU costs approximately $25,000 per year.
One solution is to use family members or friends as interpreters. Although physicians-in-training are often reminded of the hazards of using family members and friends as interpreters because they are biased and untrained, our data showed patients had high levels of satisfaction and comfort with using family members and friends as interpreters. Patients from certain cultures may prefer their use over unfamiliar interpreters. Hispanic patients, for example, may value a close family network over individualism.5
Family members and friends are a readily available and inexpensive source of information who can also assist the patient with tasks such as arranging transportation and follow-up visits.
There are some limitations to our study. First, our findings may not be generalizable to other outpatient clinics or other languages. Many clinics do not have access to as many interpreter options. Cultural differences as well as language proficiency may independently influence patients' expectations for satisfactory medical care and how they report them.6,7
Second, we did not record data on physicians and patients who did not consent to participate, although they were small in number (constituting less than 10%). Reasons for patients' refusal to participate included not feeling well, not having time because their appointment time had been reached, and not wanting to participate without family members present.
We used Spearman Rank Correlation and Wilcoxon Rank-Sum Test to determine if patients' satisfaction and comfort levels were related to age or gender. Male patients seemed more satisfied than females with the use of family members and friends ( p = .022), but otherwise age and gender did not affect the general satisfaction scores for the other methods of interpretation. Levels of comfort for sensitive issues were higher for older compared with younger patients for all methods of interpretation (p < .05) except for the bilingual physician. These differences in comfort may suggest that each interpretation method is not appropriate for all patients.
The Spanish-speaking patient population poses a challenge to many academic clinics like the MPCU at Rhode Island Hospital because of the relative scarcity of bilingual providers. Diminishing financial resources are likely to cause uncertainty at such sites as practice administrators consider whether formal on-site interpreter programs or telephone interpreters are sufficiently advantageous relative to other modalities to warrant their expense. Our study suggests that using family members and friends as interpreters should be more seriously considered despite differences in satisfaction with this modality between residents and patients.