In-Between: An Exploration of Visibility in Healthcare Interpreting

Introduction

For the majority of English-speaking Americans seeking healthcare, an appointment with medical professionals typically proceeds as follows. The patient arrives at a medical facility. She gives her name to the receptionist at the front desk and takes a seat in the waiting room. After a period of time, her name is called, and she follows a nurse into an examination room. She engages in conversation with the nurse about medical history and the reason for the current visit while the nurse takes vitals such as pulse, blood pressure, and temperature. The nurse then leaves, usually with the assurance that a physician will be in soon. The patient then waits for the physician to appear. Once the doctor has joined her, there is extensive conversation about a number of topics with some informal banter included as the discussion proceeds. The patient feels rapport with her physician. She feels heard and well attended to. She leaves with an understanding of her health concern and the plan for treatment. With this understanding, the patient complies with the plan; getting prescriptions filled, scheduling necessary appointments, doing as directed by the physician. Having followed the treatment plan, she has a complete recovery with no need for further procedures or appointments. The above scenario assumes the interaction goes as intended by all people involved.

Healthcare outcomes are vastly improved for patients who experience quality communication with their physicians (Collins et al., 2002). This requires the patient and healthcare professional share a language in common. However, in the United States, 21.6% of the U.S. population over the age of 5 is speaking a language other than English at home (U.S Census Bureau, 2017). In the medical context, physicians see an ever-increasing number of patients with whom there is not a shared language, and these patients suffer as a result. Speakers of Languages Other Than English (SOLOTEs), including persons who are deaf and use American Sign Language, experience disparities in healthcare. Such degrading of access to wellness is directly linked to access to communication with healthcare professionals (Smith, 2009).

The use of professional interpreters has shown to greatly improve the healthcare experience for SOLOTE patients (Karliner, Jacobs, Chen, & Mutha, 2007; Bernstein et al., 2002.). The use of interpreter services increases the frequency with which these patients seek care. The improved quality of communication reduces misunderstandings for both patient and physician (Hornberger et al., 1996; Lee, Rosenberg, Sixsmith, Pange, & Abularrge, 1998). The improved quality of communication results in improved accuracy of diagnoses, improved patient compliance with medical directives, improved overall health for the patient (Angelelli & Geist-Martin, 2005; Aranguri, Davidson, & Ramirez, 2006; Davidson, 2000; DeVault, Garden, & Schwartz, 2011; Jacobs, Lauderdale, Meltzer, Shorey Levinson, & Thisted, 2001; Major, 2013) and improved rapport and trust between patient and professional (Jacobs et al., 2001).

Interacting with physicians via an interpreter also has been reported to improved patients’ trust of their physicians (Angelleli, 2003; Green et al., 2005; Jacobs et al., 2001). What is not much discussed is that the foundation of the relationship between patient and medical professional may be built on the rapport established between patient and interpreter (Major, 2013). SOLOTEs who use interpreters are more likely to rate their overall experience in the medical encounter as a high-quality experience if they rate the experience with their interpreter the same (Flores, 2005).