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Patient centeredness in medical encounters requiring an interpreter

      To the Editor
      I agree with Rivadeneyra and colleagues (
      • Rivadeneyra R.
      • Elderkin-Thompson V.
      • Cohen Silver R.
      • et al.
      Patient centeredness in medical encounters requiring an interpreter.
      ) that Spanish-speaking patients are often at a disadvantage in encounters with English-speaking physicians. It is encouraging to see research on this important topic. However, I would like to make two points about their interpretation of the study’s findings.
      First, culture could have affected the reduced number of patient offers by Spanish-speaking patients. The authors state they addressed this issue by comparing English-speaking Latinos with Spanish-speaking Latinos, but this method does not fully address possible confounding by culture. In many settings, language and acculturation are correlated; indeed, language is often used in measures of acculturation (
      • Deyo R.A.
      • Diehl A.K.
      • Hazuda H.
      • et al.
      A simple language-based acculturation scale for Mexican-Americans validation and application to health care research.
      ,
      • Acevedo M.C.
      The role of acculturation in explaining ethnic differences in the prenatal health-risk behaviors, mental health, and parenting beliefs of Mexican American and European American at-risk women.
      ,
      • Solis J.M.
      • Marks G.
      • Garcia M.
      • et al.
      Acculturation, access to care, and use of preventive services by Hispanics findings from HHANES 1982–84.
      ,
      • Sundquist J.
      • Winkleby M.A.
      Cardiovascular risk factors in Mexican American adults a transcultural analysis of NHANES III, 1988–1994.
      ,
      • West C.M.
      • Kantor G.K.
      • Jasinski J.L.
      Sociodemographic predictors and cultural barriers to help-seeking behavior by Latina and Anglo American battered women.
      ). English-speaking Latinos may have made as many offers as English-speaking non-Latinos because they were more acculturated, not because they did not face the language barrier of communicating through an interpreter.
      Second, the type of interpreters used in the encounters could have biased the results of the study. The authors do not state how the bilingual nurses in this study were trained or staffed to function as interpreters. Given that they are nurses, it is possible that they are fluent in medical terms in both English and Spanish, but this does not ensure that they meet professional interpreter standards. Professional interpreters are taught to interpret accurately (conveying the content of what is said, which may not be conveyed in word-for-word interpretation), completely (conveying everything that is said), and in a manner that conveys cultural frameworks (

      Medical Interpreter Code of Ethics. Cross Cultural Health Care Program. Available at: http://www.xculture.org/interpreter/overview/ethics.html. Accessed March 25, 2000.

      ). The interpreted encounters in this study could have been less patient-centered because the bilingual nurses were not taught these concepts and they did not convey accurate, complete, or relevant cultural information that might have prompted more exploratory responses on the part of the physician. It is also not clear whether the bilingual nurses were fully dedicated interpreters or were responsible for additional duties. Bilingual staff who are pulled to interpret have competing responsibilities that may reduce the quality of an encounter because they simplify language or rush the encounter so as to return to their other tasks.
      Despite these comments, the article by Rivadeneyra and colleagues and the accompanying editorial (
      • Perez-Stable E.J.
      • Napoles-Springer A.
      Interpreters and communication in the clinical encounter.
      ) highlight the importance of language in the health care encounter and the need for more research on the communication needs of patients who speak limited English.
      Editor’s note: The authors were offered a chance to respond, but they did not.

      References

        • Rivadeneyra R.
        • Elderkin-Thompson V.
        • Cohen Silver R.
        • et al.
        Patient centeredness in medical encounters requiring an interpreter.
        Am J Med. 2000; 108: 470-474
        • Deyo R.A.
        • Diehl A.K.
        • Hazuda H.
        • et al.
        A simple language-based acculturation scale for Mexican-Americans.
        Am J Publ Health. 1985; 75: 51-55
        • Acevedo M.C.
        The role of acculturation in explaining ethnic differences in the prenatal health-risk behaviors, mental health, and parenting beliefs of Mexican American and European American at-risk women.
        Child Abuse Negl. 2000; 24: 111-127
        • Solis J.M.
        • Marks G.
        • Garcia M.
        • et al.
        Acculturation, access to care, and use of preventive services by Hispanics.
        Am J Publ Health. 1990; 80: 11-19
        • Sundquist J.
        • Winkleby M.A.
        Cardiovascular risk factors in Mexican American adults.
        Am J Publ Health. 1999; 89: 723-730
        • West C.M.
        • Kantor G.K.
        • Jasinski J.L.
        Sociodemographic predictors and cultural barriers to help-seeking behavior by Latina and Anglo American battered women.
        Violence Vict. 1998; 13: 361-375
      1. Medical Interpreter Code of Ethics. Cross Cultural Health Care Program. Available at: http://www.xculture.org/interpreter/overview/ethics.html. Accessed March 25, 2000.

        • Perez-Stable E.J.
        • Napoles-Springer A.
        Interpreters and communication in the clinical encounter.
        Am J Med. 2000; 108: 509-510