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Communication challenges: Interpreters key to medical teams

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GINA R. HEINE
January 9, 2011

Being a patient in an emergency room can be scary enough.


Not being able to communicate with doctors can only increase the anxiety.


That's why medical providers say good interpreters are an important part of a treatment team.


Somebody who can clearly relay a patient's symptoms and translate a doctor's evaluation provides critical communication and adds comfort for families in traumatic situations.


"Basically, they use interpreters all the way from trauma/emergency room to hospitalization to choosing meals from the menu," said Saúl Arteaga, director of Southern Wisconsin Interpreting & Translation Services based in Delavan.


The field of health care interpretation is maturing and becoming more professional with new national certifications, local medical interpreter officials say.


"It really just brings standards to the profession that haven't been there," said Grant Foster, manager of health information and interpreter services for Dean Clinic.


How it works

Dean Clinic uses software that stores the preferred language for each patient and whether an interpreter is needed. When a non-English-speaking patient calls to make an appointment, a staff interpreter or over-the-phone interpreter is automatically booked, Foster said.


Dean has six full-time Spanish interpreters and an American Sign Language interpreter on staff, he said. When the interpretation of other languages is needed (interpreters were used for more than 40 languages last year) Dean turns to a bank of more than 100 local interpreters or a telephone service.


The process is similar at Mercy Health System, which contracts with Southern Wisconsin Interpreting & Translation Services and uses telephone and video interpreting.


Getting accurate information is always a physician's biggest concern in an emergency—even when everyone is speaking the same language, said Dr. Robb Whinney, a trauma surgeon at Mercy.


A language barrier only adds difficulty, he said.


Video and telephone interpreting are used when a live interpreter isn't available.


Wheeled to a bedside, a cart with a laptop computer and web camera allows everyone to see each other, said Dawn Olson, director of customer relations at Mercy.


Staff interpreters aren't cost-effective for Mercy because there's not enough demand for 24-hour, seven-day-a-week service, she said.


Medical interpreting differs from interpreting in other settings because the interpreter is part of the treating team for the patient, Arteaga said.


"The interpreter has to ensure that effective communication takes place even if the interpreter has to adjust the language so that the patient (understands the doctor)," he said.


In a courtroom, for example, an interpreter cannot adjust the language for the sake of understanding, he said. A medical interpreter follows guidelines to ensure that the patient has clear understanding "and they are keeping the autonomy of the patient at all times," he said.


The need

Interpreting for medical patients has always been needed in Rock and Walworth counties, but Arteaga thinks awareness of that need has increased.


"Therefore, there are more requests by health care providers, by finance departments to arrange for bill payments and for human resources," he said.


Among 148,255 Rock County residents age 5 and older, 11,019—about 7 percent—speak a language other than English at home, according to the 2005-09 American Community Survey. Among the non-English speakers, 7,736—about 70 percent—speak Spanish at home.


In Walworth County, the survey shows 9,850—about 10 percent—of the county's 93,914 residents age 5 and older speak a language other than English. Of those residents, 6,855—about 70 percent—speak Spanish.


Last year, Mercy Health System logged about 1,000 video and face-to-face interpreting sessions across all of its clinics and hospitals and about 600 hours of phone interpreting, Olson said.


Dean has seen the number of Spanish speakers increase but not dramatically, Foster said.


American Sign Language and Spanish are the top languages requiring interpretation in the area, followed by Albanian, Russian, Chinese and Korean, Arteaga said.


Spanish accounts for 70 percent of interpreting needs at Dean, while about 10 percent is sign language, Foster said.


By law, health care providers who receive federal funding must provide interpreters.


The difference between interpreting and translating is the medium: An interpreter translates orally while a translator interprets written text.


Certification

New national certifications for medical interpreters set standards and ensure a minimal level of competency, Arteaga said.


"It's a good thing," he said. "I would say that any assessment is important because you set a standard for minimal requirements, and it also makes the field more professional."


Foster has helped develop the assessment for a pilot certification with the Certification Commission for Healthcare Interpreters, which now has certification for Spanish medical interpreters.


It's a critical move, he said, noting sign language interpreters have had national certifications for years. Certification ensures ongoing training and an overall level of professionalism, he said.


Dean also has worked with Dane County health care organizations to develop a Spanish medical interpreter assessment, which is a standard Dean uses across its system, including Rock County.



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