Breaking down barriers: How interpreters can enhance patient care

Sharing medical concerns with clinicians can be hard for anyone — a challenge that’s amplified in patients when English isn’t their first language. The results are troubling: One recent study by Boston Children’s pediatric hospitalist and researcher Alisa Khan, MD, MPH, found that patients and families who have limited English proficiency are three to five times less likely to speak up and ask questions of their care team.

“There are many ways patients who don’t speak English experience health care differently from those who do,” she says.

It’s a challenge that Esterlina MacInnes, family partnerships coordinator in Boston Children’s Office of Experience, experienced firsthand when she brought her son, Ian, who was born in the United States with Lowe syndrome and autism, to his first appointments.

“I remember the cultural dynamic between myself and my son’s doctor — rather than the language itself — being very challenging,” says MacInnes, who was born in the Dominican Republic. “He needed special care, but the doctor was not hearing what I was saying, which caused a lot of frustration.”

She now facilitates family workshops at Boston Children’s through Fuente de Luz (translated to “Source of Light” in English). These workshops support Spanish-speaking families in navigating the hospital system and provide them with resources to better advocate for their children. “Even if you understand some English, you should have an interpreter present at the appointment. It’s always best to have a professional interpreter rather than a family member advocate for you,” explains MacInnes.

Bridging language and culture

In fact, interpreters are more than just translators of language: They also help bridge cultural gaps. “Patients’ experiences are enhanced when they work with a trained medical interpreter and not just a person who is bilingual,” explains Luciana Canestraro, manager at Boston Children’s Interpreter Services. “Interpreters specialize in communication and in cultural brokerage to provide specific support translating cultural differences and offer mediation between patients and providers, ultimately enhancing patient safety.”

For example, families might not follow a treatment plan because it may interfere with their cultural beliefs. “When cultural beliefs conflict with medical care, interpreters will intervene and alert the care team. A partnership is then formed allowing the provider to explain to the family, through the interpreter, the importance of the treatment while still honoring their traditions and beliefs,” says Canestraro. Here’s how providers can work with trained interpreters to enhance patient care.

Draw on resources. Be mindful of how they’re communicating to patient families. “Data suggests that providers update families with language barriers less often,” says Dr. Khan. “Providers can avoid falling into that trap by using interpreter services at every step and offering those resources as frequently as possible.”

Partner with interpreters to bolster relationships. Building a rapport between patients and providers also builds trust. “We need to make sure that we’re building trusted relationships with patients who need interpreters, not just with those who speak English fluently,” explains Dr. Khan. Work with an interpreter to ask patients about their care goals and ask follow-up questions to make sure they understood everything discussed.

Don’t use acronyms — that way, interpreters can provide a clear translation. Offer written discharge notes in their preferred language so they can follow detailed instructions for at-home care. Use eye contact with the family and non-verbal cues to show that you’re listening and that you care. Ask how the patient and child are doing and about their interests. These seemingly small acts leave a profound impact on families.

Touch base first. Professional interpreters are often the ones who are relaying difficult news to patients and their families, usually hearing this information for their first time themselves. “I cannot stress this enough,” explains Canestraro. “Briefing the interpreter about any news, especially bad news, that will be delivered through them will allow the interpreter time to prepare and perform to the best of their abilities.”

Help patients find support. To help build stronger relationships between patients and providers, MacInnes runs a support group for Spanish-speaking families through Fuente de Luz, encouraging them to ask questions and advocate for themselves when working with their care team. “We support them in navigating the health care system and provide community resources. I’ve seen how empowered parents have become since joining the support group,” she says. “The parents have shared that speaking the same language and sharing common experiences together means the world.”

From communicating cultural differences to advocating for proper treatment, interpreters are an essential member of a patient’s care team when they are faced with a language barrier. Equitable care includes access to language services, so be sure to work with them at your next visit or work to include them in your practice.

To learn more about available language services at Boston Children’s, check out Interpreter Services.