By Kathryn Doyle
NEW YORK (Reuters Health) - Close to half of pediatricians do not use a professional interpreter when seeing patients and families with a limited understanding of English, according to a new study.
"We were surprised that the majority of pediatricians still use family members to communicate with patients who do not speak English well," said lead author Dr. Lisa DeCamp of Johns Hopkins University School of Medicine in Baltimore.
Using family members is not recommended because they are more likely to make errors while translating or to withhold sensitive or painful information for emotional reasons, DeCamp told Reuters Health by email. A professional interpreter or a bilingual doctor are the best options, she said.
DeCamp and her coauthors compared data from surveys conducted in 2004 and 2010, each including about 700 U.S. pediatricians who saw patients with limited English proficiency.
The surveys asked doctors how they communicated with those patients: via bilingual family members, staff, a formal interpreter or educational materials written in patients' primary language.
Most pediatricians said they used a bilingual family member, although the proportion reporting that technique fell from 70 percent to 57 percent between 2004 and 2010. The proportion of doctors using formal interpreters grew from 50 percent to 56 percent over the same period.
"Good communication is essential for accurate diagnosis and treatment," DeCamp said. "If the patient and their provider don't speak the same language errors in diagnosis can occur, treatment may be delayed or expensive tests may be ordered when they are not necessary."
Though more pediatricians use interpreters now, they are still struggling to keep up with the demand from patients, she said.
Doctors in the study were twice as likely to use a formal interpreter in states where Medicaid reimburses for those services as in states without coverage, according to the results published in the journal Pediatrics.
More than 25 million people in the U.S. do not speak English "very well," and would benefit from an interpreter in the doctor's office, according to the U.S. Census Bureau. That number was 22 million in 2004.
"I am not surprised that physicians are not using professional interpreters as frequently as they should be," said Dr. Darcy Thompson, who studies low-income and immigrant families at the University of Colorado Denver and was not involved in the new study.
"Medical schools and residency programs are not adequately training providers on this topic," Thompson told Reuters Health.
States and medical schools are moving toward requiring "cultural competency" training for doctors, which is important, but more needs to be done, she said.
Federal mandates require providing language services with healthcare, but those are difficult to enforce and often go unheeded, according to Dr. Lisa Diamond of Memorial Sloan-Kettering Cancer Center's Immigrant Health and Cancer Disparities Service in New York, who also was not part of the study team.
One problem is there are too few bilingual doctors, and often a poor supply of interpreters, especially in rural areas, DeCamp said.
But in Diamond's experience, even when interpreters are available in hospitals 24 hours a day, many doctors do not use them and instead rely on their own limited language skills, she told Reuters Health.
The researchers all cited costs as an important factor.
According to the U.S. Bureau of Labor Statistics, interpreters and translators were paid about $21 per hour in 2010.
"At the time of our study only 13 states and D.C. reimbursed providers for the cost of interpretation," and then only for patients with public health insurance such as Medicaid, DeCamp said.
"Private insurance companies rarely cover the cost of interpretation, except in California where there is a law mandating it," she said.
Hospitals usually pay for translation services with federal funds set aside for uninsured patients. But those funds will likely start to dry up soon, DeCamp said, since the Affordable Care Act aims to lower the number of uninsured people.
One way to solve the problem, she said, would be with mandates like those in California for private and public insurers to reimburse for interpreters.
SOURCE: http://bit.ly/170Rrak Pediatrics, online July 8, 2013.