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Patient was not ‘intoxicated’: The issue of language barriers in our health-care system

A lack of understanding between the patient and provider can have many serious consequences, including life-threatening misdiagnoses.

A large majority of the mistakes that occur during interpretation are the result of a lack of proper and adequate training.

One out of every 10 people in Minnesota speaks a language other than English within the home. Their limited ability to speak and understand the language has become a struggle in their daily lives of accessing necessities. This battle becomes especially prominent within the health-care setting because of a lack of adequate interpreter services.

Bushra Hossain

A study in the Journal of the American Medical Association revealed that limited English proficient (LEP) patients who do not receive adequate interpreter services when needed are unlikely to understand their diagnosis and treatment provided by their physician (MDH, 2015). Similarly, a lack of understanding between the patient and provider can result in life-threatening misdiagnoses. In one specific Florida case, the Spanish-speaking relatives of an 18-year-old LEP patient told health professionals that he was “intoxicado.” They meant “nauseous,” but were misinterpreted as meaning “intoxicated,” thus leading to a misdiagnosis of a brain aneurysm as a drug overdose. This costly mistake not only caused the teen permanent quadriplegia, but it also cost $71 million in a malpractice settlement.

Unfortunately, mistakes within the health-care system resulting from misinterpretation are fairly common. In a study that analyzed interpreter services in a pediatric clinic, results showed that official interpreters made 231 errors, 53 percent of which could have potentially caused clinical problems. In addition, ad hoc interpreters, including nurses and social workers, made 165 errors, 77 percent of which were potentially dangerous. The persistence of these mistakes have led LEP patients to experience higher incidences of medical errors and unnecessary tests and hospitalizations, adding to the costs in health care as well as human life).

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A large majority of the mistakes that occur during interpretation are the result of a lack of proper and adequate training. A person who is bilingual cannot be automatically considered an interpreter, yet it does happen that they become interpreters without sufficient background or medical training. This enhances the issue of the quality of interpreter services that are being provided. Interpreters in Minnesota do not share a universal set of qualifications and experience, which can lead to discrepancies in patient care, diagnosis, and treatment.

Standardizing the qualifications that interpreters are required to meet to practice in health-care settings is vital to ensuring the quality of care that LEP patients receive. The Minnesota Department of Health has drafted a legislative report, “Interpreting in Healthcare Settings.” [PDF] This report provides recommendations of a tiered registry for interpreters. All interpreters would be required to be listed in the registry and meet minimum qualifications of training. The minimum qualifications, as laid out by the Minnesota Department of Health require interpreters 1) to be at least 18 years of age, 2) pass a Medical Interpreter Ethics and Standards of Practice test, and 3) pass a Medical Terminology test (MDH, 2015). Each additional tier requires a higher set of qualifications, including attending medical interpreter training and attaining national certification in medical interpreting.

The recommended four-tier registry system for interpreters is intended to create a well-established system of providing competent interpreter services to health-care systems across Minnesota. In meeting the qualifications and recommendations presented by the Minnesota Department of Health, our health-care system can reduce medical errors and cost associated with inadequate interpretation and can effectively meet the health-care needs of the LEP population.

Bushra Hossain is working on her master’s degree in public health at the University of Minnesota, focusing on policy and advocacy for underserved populations.

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