Interpreters Ensure Equitable Health Care Access

More than 2,000 times a month, Michigan Medicine's Interpreter Services is called to assist patients with language barriers in clinics and hospitals.

The four foreign languages the team most commonly speaks are Spanish, Arabic, Japanese and Chinese. Collectively, face-to-face interpreters can speak 15 different languages and over the phone, more than 70. But often overlooked, are the language barriers that affect the deaf, deaf/blind, hard of hearing and limited English proficient. Interpreter Services works to accommodate these patients as well.

From making medical documents available in the patient's language to providing accurate translations of billing records and education materials, Michelle Harris, manager of Interpreter Services at Michigan says these services are an obligation to each patient that walks into our hospital.

"These are our patients, no matter what language they speak," she says. "We owe it to them to give them equitable access to great healthcare."

According to Kaiser Health News, the Trump administration recently proposed easing a federal regulation that demands certain health care organizations provide patients with limited English skills a written notice of free translation services.

The administration also proposed no longer requiring directions be given to patients on how they can report discrimination they experience. The changes could save billions for the health care industry, the administration claims.

The changes are part of a broader proposed regulation that would roll back protections banning discrimination based on gender identity. The public comment period on these changes ends Aug. 13.

Interpreter services are in high demand at Michigan Medicine, which has been providing medical interpreters since before 1990. Carefully screened and highly trained, their team is made up of 44 staff interpreters, 15 contract sign language interpreters, four administrative staff and 20 temporary staff interpreters.

Patients can also use a service called DIAL which allows them to utilize an interpreter over the phone when they call a toll free number to communicate with their Michigan Medicine provider.

However, there's a lot more to being an interpreter than just comprehensive language proficiency. It's required that interpreters take medical terminology courses to be able to explain body systems or complex conditions.

Included in their 40+ hour training, interpreters study the ethical standards of practice at Michigan Medicine and attend workshops on palliative care and mental health.

To be an effective interpreter, it's important to follow well-established protocols, like speaking in first person and communicating in a measured, reflective tone. However, language isn't only verbal. For example, how physicians position themselves to the patient can make a great difference in that patient's experience, which is why Interpreter Services offers cultural competency training for Michigan Medicine employees.

Harris and her team have been surveying patients that use interpreter services over the past three years and has found that more than 90 percent of patients felt that they received equal access to care during their visit.

"This is a free service," she says. "I want patients and their family members to know that they can rely on our team to accurately interpret, sometimes very complex, medical information or instructions."

A malpractice, and civil rights issue

Matthew Galvan, Michigan Medicine's Patient Civil Rights Coordinator, oversees, facilitates, and supports efforts to ensure equal opportunity for all patients, regardless of factors like national origin, race, disability or religion.

Galvan implements discrimination complaint procedures and investigates allegations of discrimination. He also is responsible for coordinating and monitoring compliance with federal civil rights requirements, like Section 1557 of the Patient Protection and Affordable Care Act, which the Trump administration has proposed to revise.

"When patients leave their appointment not understanding everything the physician said, this isn't just potentially a malpractice issue," he says. "It's a civil rights issue.

In 2016, additional protections were added to the Patient Protection and Affordable Care Act, like posting of the non-discrimination policy notice. Recent proposed revisions to Section 1557 get rid of certain requirements that affect interpreters and Galvan.

If successfully revised, it will no longer be required to dedicate a specific procedure to process discrimination complaints nor provide taglines at appointments. A tagline is a short statement in several languages that states the patient has the right to access an interpreter.

"When patients don't know what their rights are, they won't utilize them, or ask questions," Galvan says. "Even if we provide information to our patients that only 20 percent will find useful, I did my job. Civil rights laws exist to protect the minority." 

He adds: "Even if you don't get a tagline from your physician at your next appointment, know your rights. You have the right to ask for an interpreter and receive one in a timely manner, whether face-to-face or on the phone. "