Trained interpreters: a necessary expense

Ethics Forum. Dec. 3, 2007.

Why should doctors provide interpreter services, and how can they afford to?

Title VI of the 1964 Civil Rights Act, which prohibits discrimination on the basis of ethnicity by any entity receiving federal funds, directs that physicians who receive Medicare and Medicaid funds must arrange interpretation for patients with little or no proficiency in English. How far must I go in implementing this unfunded mandate?

Response

If you've ever been ill while vacationing in a land whose language you did not speak, you probably don't need to be convinced of the compassion and fundamental humanity of having foreign language interpreters for medical encounters. In the U.S., having interpretation available has been federally mandated since 2000 for anyone who receives Medicare or Medicaid funds for patient care.

The dictates of our professional ethics long preceded the law in emphasizing that physicians must provide care with compassion and respect for human dignity; must, while caring for a patient, regard responsibility to that patient as paramount; and, more recently, must participate in efforts to reduce medical error.

It doesn't take any stretching of the imagination or even any deep thinking to realize that errors are more likely to occur when patients and physicians don't understand each other than when they do. The documented reduction in adverse drug events and improvements in patient safety in hospitals where computerized physician order entry replaced handwritten orders demonstrates that misunderstanding of the written word contributes to medical error. How much more likely, then, that misunderstanding of the spoken word would do so. The lion's share of the medical encounter is conducted in oral speech.