This article is the third part in a series, Where culture meets health.
Almost one quarter of the Australian population speaks a language other than English at home. But health services in Australia are largely delivered in English only.
We know Australians from culturally and linguistically diverse backgrounds are less likely to access health services, which leads to poorer health outcomes. One major reason for this is the language barrier between health-care providers and consumers.
Access to interpreters in health care should be seen as a basic human right.
Interpreters benefit both patients and practitioners
Interpreters are a vital bridge between health services and consumers. Interpreters enable consumers to be fully informed about their health condition and options for treatment.
They also give consumers a voice to express themselves freely in their dominant language. This means people can share exactly what they need to say to health-care professionals and can ask the questions they want answered.
Research has found the use of professional interpreters improves the experience of medical care for patients with limited English proficiency.
The use of professional interpreters significantly reduces the risk of communication errors that can lead to negative clinical consequences. Errors could include gaps in information about patient allergies, and instructions around the use of prescription medicines being misconstrued.
But failure to provide access to interpreters in health settings can literally be a matter of life or death.
Particularly in an emergency, if a patient and their loved ones are unable to communicate details about the patient’s medical situation to the treating doctors, this may impact whether the patient receives appropriate and timely treatment.
In one case in the United States, a hospital acted on advice provided by a Spanish-speaking family with limited English proficiency when admitting their son. A court found language confusion contributed to delayed diagnosis of a brain haemmorhage, which resulted in the patient becoming a paraplegic.
But not everyone is given access to an interpreter
Despite the benefits of using an interpreter, a recent study in a Sydney hospital found although interpreters were required in 15.7% of admissions, just 3.7% of patients were actually provided with an interpreter.
A person who needs an interpreter may not get one because they’re deemed not to require the service, because an interpreter can’t be sourced within the required timeframe (for example, in emergency situations), or because there’s no interpreter available in the language or dialect required by the patient.
The use of interpreters in regional, rural and remote Australia may be even lower given the lack of available interpreters in those areas.
When health professionals and consumers don’t speak the same language, delivering health services without an interpreter raises a number of ethical issues.
For example, if a person is unable to understand what is being said to them by a health-care practitioner, they can’t give their informed consent. Proceeding with any treatment without informed consent is in breach of the code of conduct of all health professions in Australia.
Family members as interpreters
The Australian government funds the provision of professional interpreters in health-care settings free of charge. But professional interpreters are not always on hand when they are needed. This often results in the use of family members as interpreters.
This practice is fraught with issues and in some instances this can do more harm than good for both the interpreter and the patient.
Relatives don’t have formal training as interpreters and may not be familiar with the medical terminology being used or how to translate it.
Family members may add their own interpretation or opinion in the delivery of the message, thereby not delivering the message intended by the health-care practitioner or the patient.
In many migrant families, children or young adults have the best knowledge of English in the family and so are often called upon to be the interpreter. The use of underage interpreters raises further ethical issues as they are tasked with interpreting sensitive health information about a loved one.
So caution is needed when using family members as interpreters.
How can the use of interpreters be increased and improved?
There are some key actions that should be taken to improve health-care experiences and outcomes for people with limited English proficiency.
First, training for both interpreters and health-care professionals is essential to develop skills for effective collaboration.
Second, there should be additional time allocated for appointments where interpreters are used. This is because each sentence must be said twice during the exchange of information and time is needed for briefing and debriefing about the session.
Third, health services need to collect accurate information to determine whether an interpreter is needed. A person may present with functional English but still require an interpreter for ease of communication given the complex terminology and the seriousness of medical conversations.
And finally, professionally trained interpreters must be available in the languages and dialects required. There are more than 300 languages spoken in Australia and many have multiple dialects.
Investment in interpreting services is essential to ensure the provision of equitable, high quality health care to all Australians. In a country where interpreters may improve care for one quarter of the population, we can’t afford not to.