2.2 Role of the Communicator

Why is Medical Interpretation Needed?4-1border

Evidence shows that patients who can’t communicate effectively:

  • Lack understanding during medical encounter
  • Are less satisfied with care received
  • Are less adherent to medical instruction
  • Seek more care in the Emergency Department
  • Have a higher chance of being misdiagnosed and/or prescribed inappropriate medication

Types of Interpreters

Type of Interpreter Advantages Disadvantages

 Professionally trained medical/cultural interpreter

  • Trained and accurate
  • Able to also provide cultural interpretation
  • High confidentiality
  • Requires booking and coordination
  • Often unavailable in community setting
  • Cost
 Telephone interpretation service
  • Easy and rapid access
  • Confidential
  • Impossible to capture non-verbal cues
  • Cost/minute
  • Requires speaker phone/dual handset phone
 Ad-hoc interpreter
(i.e. person with no interpretation training)
  • Often easy to access
  • Some appreciation of confidentiality
  • May not correctly interpret medical terminology
  • Accuracy concerns
 Family or friend
  • Usually shares common socio-cultural background as patient
  • Often accessible
  • Sensitive subjects may not always be addressed
  • Confidentiality cannot be assured, accuracy concerns

Special Considerations: Communicating With Elderly Immigrants and Refugees4-1b-border

  • Older immigrants and refugees represent a heterogenous population with diverse sets of needs
  • Their life experience and different backgrounds may influence their communication style and health perceptions
  • It is important to assess the individual needs and competencies of this cohort and avoid ageist assumptions or beliefs
  • Older refugees and immigrants may face increased vulnerability if they are experiencing a natural decline in physical and cognitive health, while also not being able to properly communicate due to language barriers

Tips for Successful Communication With Elderly Immigrants and Refugees

Recommendation Explanation 
Speak slowly and clearly
  • Cognitive functioning can decline with age and speaking at a slower pace allows older individuals more time to process and understand information
Stick to one topic at a time
  • Grouping topics within the conversation may help reduce confusion and facilitate comprehension of each core issue
 Avoid distractions
  • If patients are experiencing hearing loss or cognitive decline, auditory and/or visual distractions can greatly hinder communication and understanding
  • Background noises can greatly interfere with what is being said and can distract both the patient and the interpreter
 Sit face-to-face
  • Older patients are at an increased risk for hearing loss and may benefit from reading the lips of the physician or interpreter
  • A face-to-face set-up will also help to reduce distractions and demonstrates physician attention and interest
 Use visual aids
  • Charts, pictures or models can help with explanations of a patient’s condition and/or treatment, especially when language barriers are present
Apply the “teach-back” method
  • Patients can confirm their understanding by repeating the explained information or instructions back to the healthcare provider
  • Benefits of this strategy include reinforcing patient understanding and consequently improvements in medication adherence, self-efficacy and rates of readmission

Adapting communication styles to meet the needs of older immigrants and refugees helps respect individual autonomy and allows the individual to be an active participant in their own health decisions. Special considerations must be made to ensure that all immigrants and refugees feel understood and heard regardless of their age.

Thomas E. Robinson II, PhD, George L. White Jr., PhD, MSPH, and John C. Houchins, MD. Fam Pract Manag. 2006 Sep;13(8):73-78.

Definitions for Selected Terms:

Ground Rules
Ground rules for discussion with interpreter before interview: discuss whether the interpreter’s social position in country of origin and local community could influence the relationship with the patient. Explain the need for especially close translation in the mental status examination. Ask the interpreter to indicate when a question or response is difficult to translate. Discuss any relevant etiquette and cultural expectations. Arrange seating so that clinician and patient are face to face.3
Communication in our module describes both verbal communication and tacit communication: body language, eye contact, or also hand gestures.
Cultural Interpreters
Individuals who acknowledge the value of other beliefs and knowledge systems and the importance of facilitating a bridging of approaches and beliefs. They draws together different people and different cultures – knowledge brokering is a dialogue that builds a relationship and trust.”4