Approximately 8 million foreign-born Americans say they speak English “not well.” Additionally, approximately 4 million foreign-born Americans cannot speak English at all.
These figures, from a study conducted by the U.S. Census Bureau, means there are 12 million people, which is about 30 percent of the foreign-born American population, who have difficulty communicating in environments where English is spoken.
In certain situations, such as a hospital or medical practice, lack of ability to communicate—and equally important, comprehend—could prove detrimental to the health and wellbeing of these individuals.
In her book, “Medicine in Translation,” Danielle Ofri, a physician at Bellevue Hospital, explores the cultural gap between doctor and patient. She also shares experiences where patient language skills were factors, and tells how she relied on phone-based medical interpreters.
Her experience is not uncommon.
What’s more, for many health care providers, interpreters are a legal requirement.
According to the law
Title VI of the Civil Rights Act of 1964 states: “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”
This means that health care providers, including hospitals, that receive federal funding, including Medicare and Medicaid, are required to provide language access services for their patients.
The Affordable Care Act (ACA) builds on this requirement of the Civil Rights Act and a later executive order addressing the issue signed by President Clinton in 2000, and offers additional protection by including any health program or activity any part of which receives Federal financial assistance including credit, subsidies, and contracts of insurance, including Health Insurance Exchanges.
In addition, the ACA specifically addresses patient communication. Section 1331 of the ACA indicates that patient care information must be given in “plain language,” and states: “The term ‘plain language’ means language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is concise, well-organized, and follows other best practices of plain language writing.”
Language Scientific, a corporate language services provider specializing in medical and technical language solutions, points out, that under this provision, patient communication must be clear, concise, and easy to understand. For speakers of other languages such communication may only be understandable when translated or interpreted into their native languages.
Meeting medical practice requirements
Many medical practices are therefore required by law to ensure that patients with limited or no English proficiency understand all communication related to treatment.
But even practices not legally obligated to comply with the ACA “plain language” provision would benefit from better communication with patients who don’t speak English.
In certain parts of the country, practices treat many such patients, leading to a rise in the use of medical interpreters. Sometimes interpreters are staff members or contract employees who are physically present and help facilitate communication between health care professionals and patients; other times, interpreters provide over-the-phone services.
“Live” medical interpreters are hired directly or through a company providing services—and for-hire medical interpreters are in demand. A recent search at job board Indeed returned nearly 1,600 job postings nationwide.
Certification is often required, and with good reason. The certification process first requires successful completion of a medical interpreter educational program. Then, the candidate must pass oral and written examinations, which not only verify language skills but assess communication ability as it relates to a medical environment. One accepted standard for certification is The National Certification Board of Medical Interpreters (CMI); another is the Certification Commission for Healthcare Interpreters (CCHI).
Practices that opt for over-the-phone services may want to inquire about interpreter training requirements and ask whether interpreters are certified by CMI, CCHI or other reputable organization.
Bridging the language gap
Although it might be assumed that medical interpreters communicate mainly with Spanish-speaking patients, that assumption would be incorrect.
The largest percentage of foreign-born Americans hail from Latin America and the Caribbean, and many do speak Spanish. However, foreign-born Americans from Europe, Asia, Africa, and other regions also represent large numbers of the non-English speaking population.
Spanish is the most frequently spoken non-English language. But Chinese, Tagalog, French, Vietnamese, German, Korean, Russian, Italian, and Portuguese are common as well. It’s also worth noting that there are regions of the country with concentrations of people who speak other languages. In Minnesota, for example, there is a need for medical interpreters who speak Somali; in Salt Lake City, Utah, there are openings for medical interpreters with Farsi language proficiency.
The demand for medical interpreters is expected to increase, and increase significantly. The Occupational Outlook Handbook from the U.S. Bureau of Labor Statistics (BLS) projects employment opportunities for interpreters will grow 46 percent from 2012 to 2022, much faster than the average for all occupations, driven by large increases in the number of non-English speaking people in the United States.
For medical practices, this outlook is worth considering, including the notation about large increases in the number of non-English speaking people. Even if your practice doesn’t currently treat non-English speaking patients, in the near future it very well may—and you will have need for the services of a medical interpreter.
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