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Academia and the Profession |

Navigating Language Barriers under Difficult Circumstances

Yael Schenker, MD; Bernard Lo, MD; Katharine M. Ettinger, JD; and Alicia Fernandez, MD
[+] Article and Author Information

From the University of California, San Francisco, and California Pacific Medical Center, San Francisco, California.


Acknowledgment: The authors thank Leila Alpers, Robert Brody, Leah Karliner, and Jeff Kohlwes for their comments on an earlier draft of this manuscript.

Grant Support: By the National Institutes of Health (NIH) Career Development Award K23-RR018324-01 (Dr. Fernandez) and NIH Center Grant MH062246 (Dr. Lo), NIH Roadmap Clinical and Translational Sciences Award U01 AI46749 (Dr. Lo), and the Greenwall Foundation (Dr. Lo).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Alicia Fernandez, MD, University of California, San Francisco, Box 1364, San Francisco, CA 94143; e-mail, afernandez@medsfgh.ucsf.edu.

Current Author Addresses: Drs. Schenker, Lo, and Fernandez: University of California, San Francisco, Box 1364, San Francisco, CA 94143.

Dr. Ettinger: California Pacific Medical Center, 2395 Sacramento Street, San Francisco, CA 94115.


Ann Intern Med. 2008;149(4):264-269. doi:10.7326/0003-4819-149-4-200808190-00008
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The proportion of the U.S. population with limited English proficiency is growing. Physicians often find themselves caring for patients with limited English proficiency in settings with limited language services. There has been little exploration of the decisions physicians face when providing care across language barriers. The authors offer a conceptual framework to aid physicians in thinking through difficult choices about language services and provide responses to common questions encountered in the care of patients with limited English proficiency. Specifically, they describe 4 factors that should inform the decision to call an interpreter (the clinical situation, degree of language gap, available resources, and patient preference), discuss who may be an appropriate interpreter, and offer strategies for when a professional interpreter is not available. The authors use a hypothetical case to illustrate how decisions about language services may evolve over the course of an interaction. This conceptual and practical approach can help clinicians to improve the quality of care provided to patients with limited English proficiency.

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translators in the office
Posted on September 3, 2008
morton a kapusta
sir mortomer b davis jewish general hospital,montreal ,quebec canada
Conflict of Interest: None Declared

To the editor: The review by Schenker, et al,(1) " navigating language barriers under difficult circumstances," is a must read for all physicians living in a polyglot society. Montreal Quebec, Canada, is such a city. Indeed, most physicians can function in French and English. Nevertheless, the need for translation is still a frequent daily occurrence. Unfortunately, in an office, unlike the hospital setting, one must make do with what is available. This is frequently a translator with limited education and language skills.

In this case, it is necessary to ease the burden of translation by keeping questions as short as possible and request that the answers be limited to answering the question. The language of the question must be kept as simple as possible. These steps are time-consuming, but will diminish the possibility of serious errors in translation.

The translator may still be found to be totally inadequate, despite these accommodations. This makes meaningful communication impossible. As noted by Schenker, et al, this can present dangerous barriers to both diagnosis and treatment.

I believe that one's responsibility in this situation is to carefully note the communication difficulty on the chart, and examine the patient in order to determine whether there is any obvious pressing need for immediate medical intervention. If there is no such need, politely request that a future visit be made with a more competent translator.

Conflict of Interest:

None declared

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