A 74-year-old woman comes to the office for a new patient visit, accompanied by her son. The patient's first language is Spanish, but she indicates that she is also comfortable speaking English. She points to a nonhealing ulcer on her right forearm that has been present for approximately a year. The patient is otherwise in good health and takes no medications. She does not use tobacco, alcohol, or illicit drugs.
Physical examination shows an irregular, 1-cm erythematous scaly papule that is concerning for squamous cell carcinoma. As the physician explains the diagnostic possibilities and need for a biopsy, it becomes apparent that the patient is having difficulty understanding the information presented in English. The physician recommends using a medical interpreter, but the son suggests that his mother would be most comfortable if he served as her interpreter. The patient's nurse also offers to interpret, stating that he knows some Spanish.
Which of the following is the most appropriate next step?

Question

A 74-year-old woman comes to the office for a new patient visit, accompanied by her son.  The patient's first language is Spanish, but she indicates that she is also comfortable speaking English.  She points to a nonhealing ulcer on her right forearm that has been present for approximately a year.  The patient is otherwise in good health and takes no medications.  She does not use tobacco, alcohol, or illicit drugs.
Physical examination shows an irregular, 1-cm erythematous scaly papule that is concerning for squamous cell carcinoma.  As the physician explains the diagnostic possibilities and need for a biopsy, it becomes apparent that the patient is having difficulty understanding the information presented in English.  The physician recommends using a medical interpreter, but the son suggests that his mother would be most comfortable if he served as her interpreter.  The patient's nurse also offers to interpret, stating that he knows some Spanish.
Which of the following is the most appropriate next step?

Quizplus · Accepted Answer

According to census data, approximately 10% of the U.S. population has difficulty communicating in English. Coupled with a general health literacy rate of around 50%, medical interpreters are a critical component of cross-cultural health care. Physicians should ask patients about their comfort level communicating in English. Those who demonstrate difficulties in communication should be offered medical interpreter services for all aspects of the clinician-patient interaction (eg, interview, explanation of diagnosis, consent, treatment planning). Clinician-patient language barriers are associated with increased rates of medical errors and poor outcomes. Medical interpreters are trained in medical terminology, familiar with cultural beliefs, and guaranteed to have bilingual fluency. Family members should be used for interpretive services only in an emergency (Choice E). The risks of using a family member as a medical interpreter include unintentional or deliberate omissions, additions, substitutions, and opinions that may contribute to misinterpretation of medical advice; inaccuracies in obtaining the patient history and report; and potential compromise of patient privacy. The most appropriate next step in this scenario would be to obtain the services of a trained medical interpreter. (Choice B) Providing written educational materials in the patient's language is not an adequate substitute for an interpreter-facilitated discussion that allows the patient to express her concerns and ask questions. (Choice C) The patient has demonstrated an inability to adequately comprehend the diagnosis and treatment recommendations in English, so the most appropriate next step is to pursue an interpreter. (Choice D) Although the nurse is knowledgeable about medical terminology and procedures, medical interpreters require specific training. In addition, the nurse does not have guaranteed bilingual fluency, which could impair effective communication. Educational objective: Family members should be used as medical interpreters only in urgent situations. Otherwise, trained medical interpreters should be used for all aspects of the clinician-patient interaction (eg, interview, explanation of diagnosis, consent, treatment planning). __________ References: Language barriers and patient safety risks in hospital care. A mixed methods study. (http://www.ncbi.nlm.nih.gov/pubmed/25840899) Not just "getting by": factors influencing providers' choice of interpreters. (http://www.ncbi.nlm.nih.gov/pubmed/25338731)

A 74-Year-Old Woman Comes to the Office for a New