Tips to Help You Better Care for Patients with Limited English Proficiency

As an International Rescue Committee office site, Charlottesville has a diverse population of immigrants and refugees who speak a variety of languages. But Charlottesville isn’t the only city seeing an increase in non-English-speaking residents. More than 16% of people in Virginia now have limited English proficiency (LEP). As care providers, it’s our duty to ensure these patients have the resources they need to easily access healthcare and health information.

In fact, the U.S. Government requires it. Agencies that receive any federal funding must provide accommodations to non-English speakers. “There was an executive order passed in 2000 to improve access to services for people with limited English proficiency,” says UVA certified medical interpreter Sylvana Fernandez-Ellauri. “One of the highlights of this order was the provision to provide trained professional interpreting services in the healthcare setting.” 

UVA has a team of 11 certified medical interpreters (10 Spanish-speaking and one trained in American Sign Language) on staff. In addition to in-person interpretation services, they provide patients access to telephonic interpreting and interpreting via videoconferencing technology. “Spanish speakers are the biggest population we serve,” says Fernandez-Ellauri. “But there is also a growing demand for Arabic, Dari, Nepali, ASL and Chinese.”

Although the demand for interpretation services may not be as great in your clinic, the tips below from Fernandez-Ellauri will help ensure you’re up to speed on best practices for caring for LEP patients and utilizing interpreters.

  • Make accommodations for longer appointments

It takes more time to relay information via a third party, so keep this in mind when using an interpreter.

  • Use simple language

Avoid complex terms and technicalities whenever possible when speaking to LEP patients. Repeat information and use the teach-back methodto ensure the patient understands what is being shared with them.

  • Reassure patients that their privacy will be protected

Some patients may be hesitant to open up about sensitive health or personal information when there is another person besides the doctor present. “We remind patients that their personal information — legal status, social issues, history of infectious diseases, etcetera — will not be shared. It’s confidential,” says Fernandez-Ellauri.

  • Think of new ways to make a connection

The personal connection between a provider and patient may be slower to develop when there isn’t a direct line of communication. “I think the camaraderie may be lost because sometimes there’s no translation for those little things that doctors say that allow them to connect with a patient, those nuances of daily life or jokes that sometimes don’t have a linguistic or cultural equivalent and are difficult to interpret,” says Fernandez-Ellauri. If words aren’t an option, you might try opening up to these patients and connecting with them using body language and facial expressions. “Make eye contact with your patients and speak directly to them, not to the interpreter,” she adds.

  • Make sure you are using a trained (professional) medical interpreter

You or a staff member may be a native speaker of another language or consider yourself proficient enough to be able to communicate directly with your LEP patient. However, only a certified medical interpreter has the training required to interpret complex medical information appropriately. You may be held liable if the patient does not receive accurate information and a medical error results from that.

  • Discourage patients from relying on family members to interpret health information

Despite their best intentions, family members may not convey information accurately to or from the patient. They may withhold facts they feel are too personal or they may try to protect the patient from hearing a diagnosis that isn’t favorable.

Especially important to remember: minor children are not legally permitted to act as an interpreter; they are not proficient enough in the English language to understand medical terminology and they may not be emotionally mature enough to handle sensitive information. A patient may have family members in the room, but a certified interpreter should also be present.

  • Be sensitive to cultural differences

Certified medical interpreters are trained to consider the cultural variances that make each patient unique. But they cannot know all things about all types of patients. “Each patient is a universe,” says Fernandez-Ellauri. “It’s impossible for us to know about all of the nuances of different cultures. But as interpreters, we are more aware and more sensitive. We may be able to help a doctor or nurse explore those differences, but we are careful not use our perceptions to put culture into the mouths of the patient. For example, just because I am from Uruguay doesn’t mean that I drink mate and like soccer. Generalizations are not always accurate. So we are sensitive to that.”

Learn more about UVA Interpreter Services.