Practice Tips: Overcoming language barriers in your practice

Physicians need to be prepared to use tact and skill when communicating with patients with limited English proficiency and those with hearing impairments.

Even well-educated patients can find navigating our complex health care system to be intimidating at best. But for non-native speakers and people with hearing impairment, getting good care can be especially challenging.

Quality care and patient safety depend on effective communication between patient and physician (as well as office staff). With an ever-increasingly diverse population, particularly in urban and suburban areas, physician practices today need to be prepared to use tact and skill to care for patients with limited English proficiency. If communication is not accurate, patient outcomes may not be optimal and could endanger the patient and put the practice at risk.

Title VI of the Civil Rights Act of 1964 and the Americans with Disabilities Act place the responsibility to provide access to interpreter services on the practice, not the patient. There are several ways to accomplish this. The first thing the practice should do is to develop policies and procedures for physicians and staff to use as guidance. The policy should state that it is the practice's responsibility to identify the need for translation (whether language for limited English proficiency or signing for the deaf), who can and cannot provide translation services, and a list of services that are available to use.

For practices whose patients speak a predominant language, the easiest solution is to hire bilingual staff who can help with scheduling as well as during the appointment. However, in urban areas where many nationalities and cultures are represented, there will still be patients who speak other languages for which interpretation is needed. In that case, there are interpreter services available via telephone, and in some larger communities, in person. Sometimes the patient will offer a family member or friend, but this is not ideal for a variety of reasons. Laypeople may or may not interpret everything exactly as said, they may not understand medical terminology, and they may have emotional, personal, or other biases that interfere with accurate translation. It is important that any interpreter be over age 18.

Most options for providing translation services have costs associated with them that far exceed the reimbursement for the visit. Unfortunately, it is one more cost of doing business. However, there are sometimes sources of funding for interpreter services. A few states reimburse for interpretation through the state Children's Health Insurance Program and Medicaid, some directly to the clinician and some to the interpreter service. Because of the added time it takes to work through an interpreter, another option is to code using time-based E&M codes (in addition to the appropriate E&M visit code). It is important to document the time evaluating the patient, coordinating care, and counseling.

In the case of sign language interpreters, an accountant can offer advice on tax credits for expenditures made to comply with the Americans with Disabilities Act.

Another way to at least limit the cost of the services would be to negotiate discounted interpreter rates (both remote or on-site) by joining forces with your local hospital or other practices in your medical building or locality.

ACP's Practice Advisor offers a free module, “Communicating with Patients,” that includes sample policies, articles, videos, and websites to help improve communication with patients who have limited English proficiency and those who are deaf or speech-impaired, as well as many resources on health literacy and motivational interviewing.