Bridging language and cultural barriers between physicians and patients.

OBJECTIVE: This study explored a group of primary care physicians' use of various methods to bridge language and cultural barriers between themselves and their patients and the physicians' perceptions of the availability and quality of these methods.
METHODS: The authors mailed a questionnaire to 495 primary care physicians in the Greater Bay Area of northern California, an area chosen for its ethnically diverse population. Respondents were asked to estimate how many patients they saw per week, how many encounters they had per week with non-English-speaking patients, and how often they used each of six interpretation methods. They were also asked to assess the availability and quality of interpretation services.
RESULTS: Physicians reported that, on average, 21% of visits were with non-English-speaking patients. Trained medical interpreters or the AT&T Language Line were used, on average, in fewer than 6% of these encounters, and no interpreters were used in 11%. In 27% of encounters with non-English-speaking patients, the physician could speak the patient's language, in 20% interpretation was done by a staff member who had no formal interpretation training, and in 36% a family member or companion of the patient interpreted. Physicians who had access to trained interpreters reported a significantly higher quality of patient-physician communication than physicians who used other methods (P < 0.0001).
CONCLUSIONS: In an area of great ethnic diversity where physicians who had access to the services of trained interpreters reported a significantly higher quality of patient-physician communication, the low rates of use of trained interpreters suggest that factors other than quality, such as costs, preclude greater use of these services.