Interpreters and Language

The Solution?

Interpreters often are viewed as the standard solution to language barriers between providers and patients by health care communities and policy makers. In the United States, since the late 1970s, there have been federal and state legislative efforts to require physicians to provide interpreters for patients with LEP. The most recent action at the federal level is an Executive Order, Improving Access to Services for Persons with Limited English Proficiency, issued by former president Bill Clinton on August 11, 2000, which resulted in U.S. Department of Health and Human Services' guidelines in 2003 to require health care providers to offer language assistance for persons with LEP. As of 2012, many national and regional interpreter associations in the United States have advocated for a national certification for medical interpreters, although a standardized process is still a work in progress.

The assumption that interpreters are the solution to language barriers is largely based on the [Page 749]conceptualization that interpreters can act as cultural brokers and patient advocates in cross-cultural encounters, improving patients' access to and quality of care. However, providers often are concerned about interpreters' involvement and power, fearing their influence over the provider–patient relationship as well as the content and process of provider–patient communication. As a result, the codes of ethics for medical interpreters traditionally view interpreters as a conduit, requiring them to adopt a passive, noninterfering role that provides neutral and faithful relay of information. Many researchers, however, have demonstrated that such an expectation is unrealistic and impractical due to the complexity and dynamics of cross-cultural medical encounters. Rather than prescribing a limited role to interpreters to ensure high quality care, researchers have recommended that providers receive training on working with (different types of) interpreters, be adaptive to the communicative needs and contexts in interpreter-mediated interactions, and nurture institutional cultures and practices that promote interpreters' (appropriate) involvement in the delivery of care.

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