May 2010 Volume 34 No. 5

Faculty geriatrician Peter Pompei says he relies on SHC interpreters,
such as Russian language professional Margarita Bekker, right,
during every clinic appointment.

Helpful cultural guides to avoid at peril

Faculty geriatrician Peter Pompei says he relies on the help of SHC’s Interpreter Service at every clinic he attends, because among its benefits is good evidence-based medicine that can sometimes prevent dangerous misunderstandings.

That’s how he learned about sunspots and intermittent use of blood pressure medications from Russian language interpreter Margarita Bekker.

[See tips and pitfalls from SHC physicians and hospital's interpreters and translator service staff >>]

“I kept wondering about a predilection among so many of my Russian patients to take their blood pressure medications episodically, and Margarita told me one day that there is a belief in Russia that high blood pressure is related to sunspot activity. The newspapers even report sunspots in the daily weather forecasts,” recalled Pompei. “Margarita was able to interpret not only for me, but she has huge credibility to reinforce to my Russian patients why they need to take meds consistently.

“I’m a big user of interpreters. They provide an invaluable service as cultural guides in being able to connect with a patient, not to mention that often what they uncover and interpret can save lives,” Pompei said.

It was to avoid misunderstandings and provide optimal medical care that Alberto Molina, assistant director of Interpreter Services, wrote to Chief of Staff Bryan D. Bohman and other leaders in April to remind attending physicians to call on interpreters every time they interact with a patient with limited English proficiency (LEP).

Molina cited such cases as a patient who was taken to Stanford in critical condition after he thought his doctor at another institution had told him to stop taking “a” medication. The patient reportedly interpreted the instruction as “all” medications. The patient did not survive.

Another patient suffered the indignity of having a neighbor she barely knew observe her gynecological exam because no one understood he was a casual acquaintance who had driven her to a clinic appointment. “In this case, having an interpreter present might have corrected the assumption that the person was a close family member entitled to be in the room,” Molina said.

“Accurate and complete information simply facilitates better decisions and treatment outcomes,” said Molina. “SHC and the Joint Commission see it as a matter of quality care and patient safety.”

“When you try to cut corners and rely on a family member or your own social, family or vacation-based knowledge of a language, you are doing so at your own peril,” said Bohman. The literature documents the evidence-based importance of clear communication, Molina noted.

“House staff members seem to understand the need for our services,” said Molina, who regularly brings in-service training sessions to SHC clinical service meetings as well as medical students, “but it’s important for attendings to support the use of professional interpreters both for themselves and for their trainees.”

Stanford offers interpretation in about 200 languages provided 24/7. On staff are 34 certified medical interpreters, who provide both face-to-face interpretation and video conference links that can be activated flexibly in outpatient clinics. A pool of interpreters in virtually any language anytime via telephone or on-call.

Bohman, Pompei and Molina all agree that, realistically, scheduling delays can occur when a physician walks into a room to find a patient with whom he or she cannot converse in English. “But the decision to proceed using a family member or limited non-English skills is not worth the risk, and in fact opens the physician and the hospital to potential regulatory or legal sanctions,” Bohman said.

“There is almost always something important that is disclosed with the intervention of interpreters,” noted Pompei. “Delays in care can be minimized, he said, by having staff proactively schedule the interpreter at the time the appointment is made.

The interpreters are tested not only for language proficiency but also in medical terminology and related skills they need to be effective. About 60 percent of the in-house interpreters came to Stanford as interns while completing a master’s degree at the Monterey Institute of International Studies. Interpreters are rigorously tested for critical short-term memory agility before they are hired, Molina explained, “and this is one of the most important skills our professionals bring to the table.”

Internal Medicine Specialist Clarence H. Braddock, associate dean for medical education and professor of medicine, said a variety of support services in patient communication will soon be implemented for physicians, including simulation-based training in LEP. Ongoing in-service training for the full range of caregivers is available by contacting Interpreter Services.

While many attending physicians see the need for interpreters in so called “cognitive” specialties, John Morton, chief of bariatric surgery and section chief of minimally invasive surgery, recently invited Molina to participate in grand rounds to augment the cultural competency of surgeons.

“Surgeons need interpretation as much if not more than other physicians, Morton explained. For example, in bariatric surgery, physicians need to be able to reinforce important dietary information.

“And perhaps most critically, when we go over risks, benefits and alternatives with our patients prospectively, we need to understand goals and be able to communicate options,” Morton explained. “It’s simply a crucial component of good medicine.”

To contact or schedule an interpreter, call (650) 723-6940. To contact an interpreter, call (650) 723-6940, page (24/7) 17726, or email interpreterservicesSHC@stanfordmed.org.