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Alterations in Medical Interpretation During Routine Primary Care

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ABSTRACT

BACKGROUND

Increasing numbers of patients require medical interpretation, yet few studies have examined its accuracy or effect on health outcomes.

OBJECTIVE

To understand how alterations in medical interpretation affect health care delivery to patients with limited English proficiency (LEP), we aimed to determine the frequency, type, and clinical significance of alterations. We focused on best-case encounters that involved trained, experienced interpreters interacting with established patients.

DESIGN

We audio-recorded routine outpatient clinic visits in which a medical interpreter participated. Audiotapes were transcribed and translated into English. We identified and characterized alterations in interpretation and calculated their prevalence.

PARTICIPANTS

In total, 38 patients, 16 interpreters, and 5 providers took part. Patients spoke Cantonese, Mandarin, Somali, Spanish, and Vietnamese, and received care for common chronic health conditions.

MEASURES

Unlike previous methods that report numbers of alterations per interpreted encounter, we focused on alterations per utterance, which we defined as the unit of spoken content given to the interpreter to interpret. All alteration rates were calculated by dividing the number of alterations made during the encounter by the number of utterances for that encounter. We defined clinically significant changes as those with potential consequences for evaluation and treatment.

KEY RESULTS

We found that 31% of all utterances during a routine clinical encounter contained an alteration. Only 5% of alterations were clinically significant, with 1% having a positive effect and 4% having a negative effect on the clinical encounter.

CONCLUSION

Even in a best case scenario, the rate of alteration remains substantial. Training interpreters and clinicians to address common patterns of alteration will markedly improve the quality of communication between providers and LEP patients.

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Acknowledgment

This work was funded in part by the Sterling Munro Public Service Teaching Award, granted by the University of Washington to JCJ. The associated stipend supported research by DN.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Refugee and Immigrant Health Promotion Program, Harborview Medical Center, University of Washington, Seattle, WA, USA

    J. Carey Jackson MD, MPH, MA & Diem Nguyen PhD

  2. International Medicine Clinic, Harborview Medical Center, University of Washington, 325 Ninth Avenue, 98104, Seattle, WA, USA

    J. Carey Jackson MD, MPH, MA & Genji S. Terasaki MD

  3. Department of General Internal Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA

    J. Carey Jackson MD, MPH, MA, Raymond Harris PhD & Genji S. Terasaki MD

  4. College of Education, University of Washington, Seattle, WA, USA

    Diem Nguyen PhD

  5. Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA

    Nan Hu PhD

Authors
  1. J. Carey Jackson MD, MPH, MA
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  2. Diem Nguyen PhD
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  3. Nan Hu PhD
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  4. Raymond Harris PhD
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  5. Genji S. Terasaki MD
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Corresponding author

Correspondence to J. Carey Jackson MD, MPH, MA.

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Jackson, J.C., Nguyen, D., Hu, N. et al. Alterations in Medical Interpretation During Routine Primary Care. J GEN INTERN MED 26, 259–264 (2011). https://doi.org/10.1007/s11606-010-1519-2

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  • DOI: https://doi.org/10.1007/s11606-010-1519-2

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