Study: Pediatricians underuse trained medical interpreters

U.S. pediatricians are not using trained language interpreters as often as they should despite evidence that such services are vital to improving the care of children and families with limited English, according to findings from research conducted jointly by the Johns Hopkins Children's Center and the American Academy of Pediatrics.

Using data from two national surveys of pediatricians caring for patients with limited English proficiency, the researchers compared differences in pediatricians' use of language services from 2004 to 2010.

The study's findings, published online July 8 in the journal Pediatrics, reveal that 57 percent of pediatricians still report using family members to communicate with patients and their families, a practice which previous studies have shown can lead to miscommunication and errors that compromise health care quality and patient safety.

"We found only small improvements in pediatriciansí use of language services over a six-year period," says Johns Hopkins pediatrician Lisa DeCamp, lead investigator on the study. "Pediatricians continue to rely on the use of suboptimal communication methods, such as family members."

These studies show improved communication, patient satisfaction, and health care outcomes, as well as fewer interpretation errors, when patients with limited English have access to bilingual providers or trained professional interpreters.

"Family members are not preferred because we don't know their skill level, and they are prone to make more errors in actual translation of the information, or they may censor information either from the patient or the provider because of their relationship with the patient," DeCamp says.

DeCamp says that previous research has affirmed that children from families with limited English are less likely to have health insurance, access to preventive health care, and optimal communication between their parents and clinicians. Also, past research shows that they tend to have lower parental care satisfaction and are more likely to experience adverse hospital events. Such factors point to a critical need for pediatricians' use of language services such as bilingual physicians and formally trained interpreters.

Interestingly, DeCamp says, she and fellow researchers found that pediatricians in states that offer reimbursement for language services were more than twice as likely to use those services than were pediatricians in states that do not. While federal regulators mandate that health care organizations receiving federal funding provide meaningful access to language services, most do not meet this standard, the researchers say.

"Our findings suggest the need for policy change to support pediatricians' use of appropriate language services," DeCamp says. "National third-party reimbursement for language services may be one mechanism to increase formal interpreter use."

Without such an accommodation, DeCamp says, parents with limited or no English are more likely to misunderstand a physicianís instructions or the medication dosage being prescribed, a situation that can be dangerous and, at times, even fatal.

"If the physician says give acetaminophen every four to six hours as needed for fever, but the parents hear 'give it every two to three hours,' and instead of 5 milliliters they give 15 milliliters, then that could pose a health hazard for the child," DeCamp says. "Or if the doctor says take your child to the [emergency department] immediately, and the parents misinterpret the orders and do it later, the child may not get the treatment he needs at the time he needs it."

An estimated 25 million people in the United States speak English less than "very well" and thus are classified as having limited English proficiency. Pediatricians increasingly encounter such patients in their practices. Since 2004, the number of people with limited English in the United States has increased by 3 million people, with rapid growth among Latino populations in the Southeast and Midwest, DeCamp notes.

The research was funded by the American Academy of Pediatrics and the National Center for Medical Home Implementation, a Medical Home Capacity Building for CSHCN federal grant, and a Health Resources and Services Administration's Maternal and Child Health Bureau grant.

Cynthia S. Minkowitz, of the Johns Hopkins Bloomberg School of Public Health, was one of the co-investigators.