Appropriate use of medical interpreters.

More than 25 million Americans speak English "less than very well," according to the U.S. Census Bureau. This population is less able to access health care and is at higher risk of adverse outcomes such as drug complications and decreased patient satisfaction. Title VI of the Civil Rights Act mandates that interpreter services be provided for patients with limited English proficiency who need this service, despite the lack of reimbursement in most states. Professional interpreters are superior to the usual practice of using ad hoc interpreters (i.e., family, friends, or untrained staff). Untrained interpreters are more likely to make errors, violate confidentiality, and increase the risk of poor outcomes. Children should never be used as interpreters except in emergencies. When using an interpreter, the clinician should address the patient directly and seat the interpreter next to or slightly behind the patient. Statements should be short, and the discussion should be limited to three major points. In addition to acting as a conduit for the discussion, the interpreter may serve as a cultural liaison between the physician and patient. When a bilingual clinician or a professional interpreter is not available, phone interpretation services or trained bilingual staff members are reasonable alternatives. The use of professional interpreters (in person or via telephone) increases patient satisfaction, improves adherence and outcomes, and reduces adverse events, thus limiting malpractice risk.