Alice Watson and Marta Solis

By Yilu Ma, MS, MA, CMI, Director of Interpreter Services

On a sunny Friday afternoon, I sat down with Alice J. Watson, MD, of the Department of Dermatology, to talk about a teaching session for residents that she conducted with Marta Solis, a training coordinator in Interpreter Services. I had heard that some providers were not always using professional interpreters when treating patients with language barriers, and I was curious as to why.
Dr. Watson oversees the Professionalism and Cross-Cultural Care curriculum for the Harvard Combined Dermatology Residency program. Her charge is to ensure all residents meet the Accreditation Council for Graduate Medical Education (ACGME) core requirements in cultural competency training. The recent session on language and culture provided an opportunity for residents to better understand the training, role and value of medical interpreters and to speak with Marta about how best to partner with interpreters.

Experiencing her own learning curve in the delivery of culturally appropriate care after moving from Scotland to Boston, Dr. Watson is keenly aware of the challenges that clinicians face. This includes building rapport when caring for patients from other cultures and backgrounds, particularly when language barriers exist. She recalled situations when patients, who had been instructed to use a certain medication, presented months later without ever filling their prescriptions. Because of gaps in communication, they had misunderstood the directions, felt it was too expensive or didn’t believe it would be effective.

When asked why there were still gaps and inconsistencies in engaging professional interpreters in care delivery, Dr. Watson shared that clinicians are pressed for time and seeing more patients. If a patient unexpectedly needs an interpreter, or an interpreter is not available when the physician is ready to see a patient, visits sometimes proceed with the patient, physician or a medical assistant trying to bridge the language gap.

Dr. Watson explained that the potential consequences of delivering care without an interpreter are not always apparent. “Most times when we take shortcuts, nothing bad happens, so we don’t realize the risk,” she said. “Subsequently, our human nature gravitates toward at-risk behaviors.”

Another reason that providers may not use interpreters is because they are concerned that a patient with some English skills may feel insulted. “Regardless of the reason, we need people to know that not using a medical interpreter results in sub-standard care and can cause safety concerns,” she said.

Impressed by her elaborations and insights, I asked for her recommendations to address the gaps and inadequacies. Dr. Watson said educating residents in this joint training was an excellent start. Given that the challenges surrounding the use of professional interpreters are complex, she believes that it is essential to offer training to clinicians and faculty about the value of interpreters and hospital policy surrounding their use. She suggested that training should include case reviews and cover near-misses and adverse outcomes related to language and cultural barriers, as well as role-play or panel discussions with interpreters.

“These would be important opportunities to help staff understand the scope of interpreters’ value in providing culturally appropriate, highest quality, safe care to our limited-English proficiency patients,” she said.