Interpreters needed even after doctors study languages

[Harold F. Schiffman]

Interpreters needed even after doctors study languages
By Michael E. Hochman, Boston Globe Correspondent  |  September 5, 2005

Nationwide, hospitals and medical schools have started programs to help
caregivers learn foreign languages, particularly Spanish, so they can
communicate with the increasing number of patients with limited English
proficiency. There has even been talk among medical educators of requiring
would-be doctors to master a foreign language before entering medical
school. ''There are tremendous benefits when clinicians can speak the
language of their patients, even when clinicians are not fluent," said Dr.
Suzanne Sarfaty, who runs a Spanish program for medical students at Boston
University and works at a clinic for Spanish-speaking patients in East
Boston. ''The patients know that you are trying to work with them, and
they appreciate it. I feel like there's a huge wall between me and the
patient when I'm with a patient who speaks a language that I'm not
familiar with at all."

But not everyone agrees with this approach -- and some worry that language
programs have the potential to backfire. ''Being 80 percent proficient in
another language can sometimes be more dangerous than not knowing the
language at all," said Leighton Ku, a senior fellow at the Center on
Budget and Policy Priorities in Washington, D.C. ''Misinterpretation of
even small words can make a big difference in medicine, so it is important
critical that trained interpreters are used whenever a clinician is not
100 percent fluent." Others in health care believe that resources could be
used more efficiently to train more interpreters and teach caregivers to
better identify patients with limited English skills who need
interpreters.

''What we really need is systems in place to know what to do when someone
doesn't speak English," said Cindy Brach, a senior researcher at the
federal Agency for Healthcare Research and Quality. Few studies have
looked at whether language programs improve the quality of care, but
research has shown that physicians with even limited language skills are
better able to connect with their patients. Dr. Shari Barkin, an associate
professor at Wake Forest University School of Medicine, arranged for some
of her colleagues to take a two-week Spanish immersion course in
Guatemala, followed by monthly Spanish conversation classes for two years.
In 2003, she published a study showing that, after the language training,
the physicians were better at gaining the trust of their Spanish-speaking
patients and could communicate more effectively. Barkin emphasized,
however, that programs like hers will not, in most cases, obviate the need
for trained interpreters.

Three of the four Massachusetts medical schools -- at the University of
Massachusetts, Boston University, and Harvard University -- have
well-established programs to teach their students Spanish. Medical
students also often travel abroad to study languages at subsidized costs.
And an increasing number of health care providers in this country consider
themselves to be proficient in a language other than English. A recent
survey found that 28 percent of primary care physicians and 17 percent of
specialists in California speak Spanish, though the numbers are probably
much lower in other parts of the country.

Catherine Dower, an associate director of the University of California San
Francisco Center for the Health Professions, believes there should be a
''credentialing system" to gauge whether caregivers are proficient in a
foreign language, and financial incentives for those who are. This would
allow patients with limited English proficiency to choose a physician who
speaks their native language. But for now, it's up to physicians to
recognize when their language skills are not up to the task. ''If you
teach a course in medical Spanish, it should be couched in the
understanding that you will know your limits," said Dr. Joseph Betancourt,
director of the Disparities Solutions Center at Massachusetts General
Hospital.

http://www.boston.com/news/globe/health_science/articles/2005/09/05/interpreters_needed