Bilingual Physicians in California: When do you need an interpreter?

Background: Little is known about how and when partially bilingual clinicians use their language skills in communicating with patients and when they use an interpreter. Understanding the opportunities and challenges of using one's language skills in patient care is timely given the national focus on reducing disparities. The California Endowment funded a joint initiative between George Washington University and the American Medical Association to work with leading medical organizations and bilingual physicians to better understand and guide physicians' use of their second language skills in patient care. This study represents an initial step in this process. Methods: We consulted with a physician advisory group to develop clinical scenarios illustrating reasons patients seek care, with variations in levels of risk for miscommunication affecting patient outcomes and physician's proficiency in a second language. We interviewed bilingual physicians around the country, including 30 in California, comprising the primary data source for this paper, and asked them to evaluate the clinical scenarios to determine when it would be appropriate to use one's own language skills and when it would be more appropriate to engage an interpreter. We analyzed interview data using thematic content analysis. We used an iterative process to reach consensus on themes and subthemes that emerged in the interview data, allowing us to create an index of themes. Based on the index, we coded the interview data using NVivo qualitative data analysis software. Results: We identified themes around physician language proficiency, patient proficiency in English, clinical risk of miscommunication, and challenges using interpreter services. Bicultural physicians indicated the greatest sense of ease moving across languages in the clinical environment, whereas physicians who are bilingual with less understanding of cultural context expressed less comfort, especially in higher-risk situations. Many pointed to a lack of practical guidance or explicit protocols for determining which clinical interactions can be safely navigated with one's own, limited, language skills. Conclusions: Partially bilingual physicians frequently make decisions about whether to communicate directly with patients or use an interpreter, directly affecting the quality of care. Providing physician-driven guidance and standardized clinical tools to aid in this decision-making process could heighten awareness among bilingual physicians about the adequacy of their own secondary language skills and the need for appropriate use of interpreters in specific clinical situations.