Research News & Information
Content:Errors in Medical Interpretation and Their Potential
Clinical Consequences in Pediatric Encounters (January 2003)
Pediatrics Journal: Glenn Flores, M. Barton
Laws, Sandra J. Mayo, Barry Zuckerman, Milagros Abreu, Leonardo Medina, and Eric
J. Hardt
What a Difference an Interpreter Can Make: Health
Care Experience of Uninsured with Limited English Proficiency (April, 2002)
(Andrulis-SUNY, Goodman - Cornell, Pryor - Access Project, Brandeis)
Hepatitis A Rate among California's Latino Children at Epidemic Level (April 16, UCLA Center for the Study of Latino Health and Culture Study)
Institute of Medicine Report, (March 2002)
(March 2002)MINORITY
AMERICANS LAG BEHIND WHITES ON NEARLY EVERY MEASURE OF HEALTH CARE QUALITY:
Washington D.C., March 6, 2002
A survey by The Commonwealth Fund reveals that on a
wide range of health care quality measures minority
Americans do not fare as well as whites... more
Kaiser Family Foundation Synthesis of Disparities Research
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Doc-Patient
Interpreters Often Make Mistakes
Go to abstract of study: NEW YORK (Reuters Health) - A review of meetings between doctors and non-English-speaking patients reveals that language interpreters make many mistakes, more than half of which could have a negative impact on the patient's health. An analysis of 13 doctor-patient visits that included a Spanish-English interpreter found interpreters made an average of 31 mistakes per visit, 19 of which could have negative consequences for the patient. The visits took place in an urban outpatient clinic in a Massachusetts hospital. Half of the interpreters were professionals employed by the hospital, while the others were so-called "ad hoc" interpreters, such as untrained family members, friends or people at the hospital. Lead author Dr. Glenn Flores of the Medical College and Children's Hospital of Wisconsin in Milwaukee told Reuters Health that although these results stemmed only from Spanish-speaking patients, "these results apply to any low English speaking group." In the year 2000, approximately 45 million people living in the US spoke a language other than English at home. One-third of those people are not Spanish speakers, Flores noted. And for those less common languages, the problems of translation in a doctor's office are likely much worse, he added. These findings may explain why non-English speakers, in general, receive poorer medical care than fluent speakers, Flores added. For instance, studies have shown that people who struggle with English are less likely to take their medications as directed, tend to have a higher risk of complications from drugs and schedule fewer preventive procedures such as pap smears. Flores and his colleagues obtained their findings from reviewing transcripts of 13 taped visits that required a Spanish interpreter. Ad hoc interpreters included an 11-year-old family member, nurses and social workers. Reporting in the January issue of Pediatrics, the authors found that errors made by ad hoc interpreters were more likely to be serious than those made by professionals. However, more than half of the errors committed by professional interpreters could have had a negative impact on the patient, they note. Discovering a total of 31 errors per patient was "disturbing," Flores conceded, but added that many of the professional interpreters at the hospital had not received any training in medical terminology, and had not been screened by employers to determine if they were, in fact, fluent. While the institution included in the study now currently incorporates more training into its translation services, during the time this study was conducted, it is easy to see why some interpreters could have made mistakes, Flores noted. These findings appear conclusive enough to recommend that medical insurers cover the cost of paying for an interpreter during doctors' visits, Flores said. Errors run up medical bills, the researcher noted: wrong information can bring the patient back to the hospital, while a doctor who cannot understand a patient may be more likely to order additional tests or admit the patient into the hospital. And one mistake can be very expensive, Flores said: one court awarded $71 million to a patient as a result of one misinterpreted word uttered in the emergency room. "It's either you pay a little bit upfront, or you pay a lot more later for all the things that happen," Flores said. However, for less common languages, Flores admitted it may be too expensive to have a full-time interpreter available for patients. This problem is not insurmountable, he noted: hospitals could train volunteers in a particular language, bring in high school students who are learning the language to interpret or designate certain days for certain languages in the clinic. So even people who speak a relatively uncommon language should have resources to help them understand their doctors, Flores noted. "If you're really strapped for cash, there are ways to do it," he added. SOURCE: Pediatrics 2003;111:6-14 |
What a Difference an Interpreter Can Make: Health Care Experience of Uninsured with Limited English Proficiency(study by Dennis Andrulis-SUNY, Nanette Goodman - Cornell Center for Policy Research, Carol Pryor - The Access Project, Brandeis)Hospital patients who speak little or no English are at greater risk of medical error or misdiagnosis if they are not provided with an interpreter, according to a new study released by the Access Project of Brandeis University, and reported on by a number of journals, including Newsday. The study calls on hospitals to increase the number of interpreters available to patients as a way to reduce the risk of errors. Researchers at the Access Project, a health care resource center at Brandeis University, conducted a survey of 4,161 uninsured individuals with limited English proficiency who were treated between May and August 2000 at 23 hospitals in 16 cities. Of those patients, 3,557 said that they did not need an interpreter and 604 patients said that they did. In the latter group, 273 patients received language assistance and 331 did not. According to the study's main findings:
"The patients in our survey who could not speak English are sending a strong message: Failure to communicate effectively may cost patients their health -- and be bad business for doctors and hospitals," Dennis Andrulis, a professor at State University of New York Downstate Medical Center in Brooklyn and the study's lead author, said. The report concludes that greater use of interpreters by hospitals could significantly reduce medical errors among patients who cannot understand doctors' instructions. In addition, the report suggests that providing interpreters would improve patients' knowledge of public insurance programs. Elena Rios, president of the National Hispanic Medical Association, said, "Medical interpreters should become recognized as allied health professionals who bill for this service, which should be reimbursable just like lab services." According to researchers, the survey results are "consistent with other ... studies which have found that patients experiencing language barriers are less satisfied with their care, less likely to have a usual source of care, less likely to keep follow-up appointments and less likely to receive preventive care" (Access Project release, 4/25). The study, "What a Difference an Interpreter Can Make: Health Care Experiences of Uninsured with Limited English Proficiency," is available online. Note: You will need Adobe Acrobat Reader to view the study. |
Hepatitis A Rate Among California's Latino Children at Epidemic LevelDate: April 16, 2002 The impact on California's children is significant because nearly half of the children in the state are Latino, and the number of Latino children is rising. Hepatitis A is a contagious viral infection of the
liver. It is spread by household or sexual contact with a person who is
infected, or by eating contaminated food or drinking contaminated water.
The recovery time averages 28 days, and the illness can be expensive to
treat. If untreated, people with hepatitis A can suffer liver damage.
click here for full
story |
REPORT from the Institute of Medicine (March 2002): Minorities tend to receive lower-quality health
care than whites do, even when insurance status, income, age and severity
of conditions are comparable, says Unequal Treatment: Confronting
Racial and Ethnic Disparities in Health Care. |
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MINORITY AMERICANS LAG BEHIND
WHITES ON NEARLY EVERY MEASURE OF HEALTH CARE QUALITY: Many Have Communication and Financial Barriers to Care, and Lack Trust in Doctors by: MARY MAHON, Public Information Officer, The
Commonwealth Fund, A new survey by The Commonwealth Fund reveals that on a wide range of health care quality measures, including effective patient-physician communication, overcoming cultural and linguistic barriers, and access to health care and insurance coverage, minority Americans do not fare as well as whites. African Americans, Asian Americans, and Hispanics are more likely than whites to experience difficulty communicating with their physician, to feel that they are treated with disrespect when receiving health care, to experience barriers to access to care such as lack of insurance or not having a regular doctor, and to feel they would receive better care if they were of a different race or ethnicity. While the health care experiences of different minority groups do vary significantly, many common concerns emerge. The survey findings also frequently reveal wide variation within racial and ethnic groups. "Communication is essential to quality medical care, and a disturbingly high proportion of patients feel that their doctors do not listen to them or report that they do not understand what their doctors say. So even when a patient reaches the doctor's office, they might not receive optimal care," said Karen Scott Collins, M.D., vice president at The Commonwealth Fund. "Physicians need support to make communication a priority, both during medical training and in practice."
Patient-Physician Communication Difficulties Are Widespread Minority Americans were more likely than whites to experience difficulty communicating with their physicians. Hispanics were more than twice as likely as whites (33% vs. 16%) to cite one or more communication problems such as not understanding the doctor, not feeling the doctor listened to them, or that they had questions for the doctor but did not ask. One-fourth of Asian Americans (27%) and African Americans (23%) experience similar communication difficulties. Fewer than half of Hispanics (45%) report it is very easy to understand information from the doctor's office, compared with three of five whites (59%). Nearly one of four adults who had visited a doctor in the last two years said there was a time when they did not follow their doctor's advice; the reasons most often given for not following a doctor's advice are disagreement with the advice (39%) and that it cost too much (27%). Among those who did not follow a doctor's advice, two of five (41%) Hispanics and nearly one of three African Americans (30%) noted that high cost was the reason for non-compliance, compared with about one of four whites (24%) and Asian Americans (27%). Language Barriers Exist for Many Minorities Minority Americans More Likely to Feel Treated With
Disrespect When Obtaining Health Care... |
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National Institutes of Health:
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A Synthesis
of the Literature: Racial & Ethnic Differences in Access to
Medical Care This
Kaiser Family Foundation document (1999) summarizes a literature review on
the subject from 1985-1999. Research topics addressed in the report
include racial disparities in heart disease and stroke, cancer, diabetes,
HIV/AIDS, mental health, and maternal and child health.
click here for this article in Adobe PDF format (3.2Megabyte size file - will take about 45 minutes to download with 28.8 Mhz modem!) |