Use of interpreters

• Use a professional interpreter whenever necessary.
• Have an established process to document when an interpreter is required.
• Be careful not to overload the patient with too much information in a single consultation.

Doctors have a duty to ensure their patients understand the information provided to them. When patients are not confident or capable of speaking and understanding the same language as the doctor, especially if they are under stress during a medical consultation, you should consider using qualified interpreting services.

The Medical Board of Australia’s ‘Good medical practice: a code of conduct for doctors in Australia’ identifies effective communication with patients as a basic standard of good clinical care. The code of conduct also refers to the need to engage in culturally safe practice. This includes understanding what the patient believes to be culturally safe and to engage in genuine efforts to adapt your practice as needed.

To meet that requirement, doctors should be prepared and able to obtain the assistance of a qualified interpreter when necessary.

It has been well documented that language barriers result in poor quality care. These barriers can result in less frequent communication, communicating large volumes of information at once and not directing communication to the patient. It has also been found that doctors will order a higher number of tests to accommodate a deficit in history taking.

A professional interpreter should be used whenever possible for patients with language barriers. All planned medical appointments should have a process in place to identify the need for a professional interpreter and to book the service in advance. Professional medical interpreters have a good understanding of medical terms, are objective in their choice of language and are bound by a confidentiality agreement. The use of professional medical interpreters has been shown to improve quality of care, have better health outcomes, increase access to services and lead to greater patient satisfaction.

Relatives or friends as interpreters

Relatives or friends are commonly used as interpreters in medical consultations with patients of non-English speaking backgrounds. While this may be convenient, and at times essential, there are disadvantages for patients.

For instance, there can be poor interpretation of medical terms, and therefore a higher likelihood of error, and even censoring (deliberately or otherwise) of vital information. A further risk is patient embarrassment about sensitive information.

We recommend caution when using family or friends as interpreters. Where possible, limit the use of family or friends to minor problems or emergencies. In sensitive clinical situations or where serious decisions have to be made, appropriately qualified medical interpreters are recommended.

Preparation

It is important to have a procedure that identifies when an interpreter is required. This may be needed during all parts of the process: when setting up the appointment, during the consultation and for ongoing care or follow-up.

Include a notation in the patient record about their spoken language and requirements for interpretation.

A practice waiting room or hospital environment should have clear advice to patients about the availability of interpreters.

Administrative staff should have policies about the process to book interpreters and the appropriate use of non- professional interpreters.

The best option is an independent, professional interpreter whenever possible (refer to Interpreter Services section).

Ensure you also adhere to any policy your practice, hospital or state/territory health department about the use of interpreters.

If a patient declines the offer of a professional interpreter but you are unsure that your communication will be adequate, you should reassure the patient that using an interpreter will be beneficial and confidential. The patient should be advised that the use of a professional interpreter will also assist you as the doctor and will help to get the best health outcome. If necessary, consider engaging a professional interpreter to explain this part and to confirm the patient understands the options available to them to assist with language support. If the patient continues to refuse the use of a professional interpreter, you will need to decide whether you can safely provide the health service. Document the conversation in the patient’s medical record, with details of the discussion about the use of an interpreter and the outcome.

During the consultation

If the interpreter is not present in person, consider having them appear on video rather than by telephone. It would be beneficial for many patients to see the interpreter rather than just hear them. Ensure introductions are made for everyone present.

Allow time for the patient and the interpreter to talk until the patient feels comfortable and confident about the arrangement, especially if the interpreter is on the phone.

Direct your speech and any non- verbal responses to the patient, not the interpreter.

Speak slowly and allow time for the interpreter to relay the conversation.

Speak in first person to the patient such as “do you have pain?”, not “can you ask the patient if they have pain?”.

Use signposts, such as “first I will ask you about… then I will…”.

Allow plenty of time for questions. Maintain eye contact with the patient.

Reinforce your message with diagrams and drawings where possible.

As with all matters pertaining to patient care, your obligation is to explain options and provide information to help the patient make an informed decision. Ensure the interpreter relays all information from the patient to you.

Following the consultation

If there is a lot of information, encourage a follow-up appointment.

Ensure the patient knows how to contact you if they have further questions after the consultation.

Establish with the patient who you can share their personal information with, particularly if family members are used for interpretation.

The difficulties faced by patients from non-English speaking backgrounds can be exacerbated if the appointment is done via telehealth. The challenges can arise both when setting up the appointment and during the appointment itself.

It is important to have processes in place to ensure patients can easily request an interpreter no matter the format of their appointment.

The Translating and Interpreting Service (TIS) is a national service provided by the federal Department of Immigration and Border Protection. It aims to use interpreters accredited by the national body that sets the standards for the translating and interpreting industry in Australia. Doctors in private practice are entitled to apply for free access to TIS for patient services covered by Medicare where patients are non-English speaking Australian citizens or permanent residents. Once registered with the service, you can access the Doctor’s Priority Line — a free phone interpreting service — and can request onsite interpreting services. Bookings can be made up to three months in advance and cancellations must be made in writing at least 24 hours prior to the appointment or service charges may apply.

Translating and Interpreting Service - Doctor’s Priority Line

To register your practice for this service, phone 1300 655 820. Call 131 450 to use an interpreter over the phone.

This service:

• is FREE for Medicare-rebatable services provided to Australian citizens or permanent residents
• aims to connect a phone interpreter within three minutes
• offers male or female interpreters on request
• allows online bookings for a phone interpreter or onsite interpreter at www.immi.gov.au
• can also be used for telehealth appointments

All state and territory health departments offer healthcare interpreting and translating services, which are available through a variety of means. We recommend that you identify the most appropriate translation or interpreting service for your practice and develop a protocol for administrative staff so arrangements can be made ahead of time for an appropriate person to be present at a consultation.

www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx (see section 4.3)

The experience of interpreter access and language discordant clinical encounters in Australian health care: a mixed methods exploration: https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-018-0865-2

Telehealth-consultations-with-patients-requiring-an-interpreter.pdf (racgp.org.au)

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