Patient centeredness in medical encounters requiring an interpreter

PURPOSE: Patient-centered interviewing is associated with greater patient s atisfaction and better medical outcomes than traditional encounters, but ac tively seeking patients' views of their illnesses and encouraging patients to express expectations, thoughts, and feelings is difficult in encounters that require an interpreter. We sought to examine physicians' use of the pa tient-centered approach with patients who required the assistance of an int erpreter. SUBJECTS AND METHODS: A cross-sectional sample of patients was videorecorde d during visits with physicians at a multi-ethnic, university-affiliated, p rimary care clinic. Nineteen medical encounters of Spanish-speaking patient s who required an interpreter and 19 matched English-speaking encounters we re coded for frequency that patients mentioned symptoms, feelings, expectat ions, and thoughts (collectively called "offers"). Physicians' responses we re coded as ignoring, closed, open, or facilitative of further discussion. RESULTS: English-speaking patients made a mean (+/- SD) of 20 +/- 11 offers , compared with 7 +/- 4 for Spanish-speaking patients (P = 0.001). Spanish- speaking patients also were less likely to receive facilitation from their physicians and were more likely to have their comments ignored (P < 0.005). English-speaking patients usually received an answer or acknowledgment to their questions even if the physicians did not encourage further discussion on the topic. CONCLUSION: Spanish-speaking patients are at a double disadvantage in encou nters with English-speaking physicians: these patients make fewer comments, and the ones they do make are more likely to be ignored. The communication difficulties may result in lower adherence rates and poorer medical outcom es among Spanish-speaking patients. (C) 2000 by Excerpta Medica, Inc.