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Lost In Translation: The Need for Interpreter Certification

Cheryl Clark, for HealthLeaders Media, October 14, 2009

It's a Tower of Babel out there.

I'm not referring to the fact that more than 8% of the U.S. population has limited English reading or speaking proficiency, or that in America, residents speak languages from more than 172 countries.

What I'm referring to is that there is no uniform accreditation or certification process to guarantee the competence of language interpreters in healthcare settings. It seems that for the most part, everyone is speaking in tongues.

But that may soon change.

A large for-profit provider of interpretation solutions, Language Line Services has teamed up with the International Medical Interpreters Association to create just such a national medical certification program.

It is being run as a non-profit organization, The National Board of Certification for Medical Interpreters, and 12 members of its board were named earlier this week. The effort includes employers, physicians, health advocates and regulators.

Although the nonprofit effort is just getting off the ground, the entities hope to launch a written test to determine the translator's knowledge of ethical standards, privacy laws, medical terminology, and an oral exam to measure proficiency and sensitivity.

Martin Conroy, Language Line Services senior manager, says the groups will seek the blessing from The National Commission for Certifying Agencies, an organization that certifies professional competence.

Yes, there would probably be a fee. And existing translators will probably fret about whether they will be able to pass. For a time, they will oppose any constriction on their work or any training they may have to undergo.

But qualified translators are essential to convey a non-English speaking patient's symptoms and circumstances to English speaking providers. They are needed to make sure the patient understands the process of diagnosis, and the instructions for medications and follow-up care to get better. Occasionally, a translator is required to help a provider, for whom English is not the native tongue, communicate with English-speaking patients.

They need to be people that patients and providers can trust. Because if the patients can't understand the doctors or the doctors can't understand them, much that is provided in the way of medical care will be useless, misguided, and potentially harmful. And there may be a bottom line reason for having such certification.

According to a recent report by Language Line Services President Louis F. Provenzano, Jr., "Breaking the Language Barrier," the consequences of relying on haphazard interpretation services "can be deadly—and costly" because language barriers are a major factor in misdiagnosis and instances of poor hospital treatment as well as delays in service or access to preventive care.

"Limited language proficiency hospital patients are more likely than their English-speaking counterparts to experience adverse events that result in harm, and the severity of that harm is often greater," according to a report by the Joint Commission.

Another study in Health Affairs (http://content.healthaffairs.org/cgi/content/abstract/24/2/435 ) in 2005 documented that patients who don't speak English are more likely to defer medical care, leave the hospital against medical advice, miss follow-up appointments, and experience complications from medications.

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