Two studies by the University of Otago, Wellington, have shown that the use of trained interpreters by doctors and health professionals in New Zealand is inadequate, and needs more funding.
This is despite their use being cited as best practice in international guidelines, both in primary care and hospital settings.
The studies say this may result in inferior health care for patients who speak limited or no English, as well as increased risk of legal action against doctors and other health professionals.
“When you are consulting with any patient, good communication is essential to achieve the best diagnosis. This is probably even more true of new migrants, refugees or patients with limited English, where there is the potential problem of cultural misunderstandings in addition to language problems,” says lead author Dr Ben Gray from the Department of Primary Health Care and General Practice at the University of Otago, Wellington.
The first study, just published in the Australian Journal of Primary Health, examined a week of interpreter use at the Newtown Union Health Service in Wellington, where Dr Gray also works as a GP. This group practice has 25% of its patients from a refugee background, many of whom have limited English proficiency, and has been a national leader in the use of trained interpreters in primary care for nearly two decades.
The one-week study of the seven GPs, eight nurses and four midwives at the practice showed an interpreter was used for 14% or 53 consultations over the week (total 378), and for a further 4% of patients an interpreter was needed but not used.
“The GPs considered the use of a trained interpreter would have been better in 21% of consultations rather than other family members or phone interpreters,” says Dr Gray.
Only 26 consultations used a trained interpreter and most of these were for more complex pre-booked cases. The most common languages for which an interpreter was used were Assyrian or Arabic where an in-house interpreter is employed.
“Despite recommendations saying you should use a professional interpreter all the time interpreter use in our clinic is split 50:50 between professionals and family members.
“Now although this is working relatively well, it's not ideal. There is evidence to show that this high level of professional use of trained interpreters does not happen in primary care throughout the country.
“Clinicians at this practice also believe that there's a place for family interpreters in limited circumstances and less complex cases. But the difficulty is assessing when a trained interpreter may be needed,” he says.
Dr Gray says the main constraint against the use of trained interpreters in primary care is the cost. There is little funding available and this means that most clinics will think twice before using professionals, and make do with family members and friends.
The research concludes that lack of use of trained interpreters will in many circumstances be a breach of the right of adequate communication under New Zealand's Code of Health and Disability Services Consumers' Rights.
The study says that systems need to be introduced so limited English proficiency patients are identified and their needs met, more funding provided to pay for interpreters, and clinician training developed for deciding whether an interpreter is
The second study into interpreter use by Dr Gray and colleagues appears in the latest issue of the New Zealand Medical Journal. It surveyed 141 senior health professionals in Hutt Valley, Wellington and Kenepuru hospitals. It then interviewed 20 clinicians on their use of interpreters to assist diagnosis with patients with limited English proficiency (LEP), and the same number of clinicians (20) with English proficient patients.
The survey showed that when seeing LEP patients only 14% of doctors reported always using an interpreter, even though they had a high awareness of how to access them. In the field study of LEP patients none of the 20 clinicians used a professional interpreter to assist diagnosis.
“This limited study in Wellington hospitals on patients with limited English proficiency suggests that despite the clinical risks of impaired communication, professional interpreters are not widely used by doctors and other health professionals,” says Dr Gray.
For further information, contact
Dr Ben Gray
Department of Primary Care and General Practice
University of Otago, Wellington
Tel +64 4 918 5166 or +64 4 380 2020
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