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 t hemselves and their patients and the physicians' perceptions of the av ailability 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 popu lation. Respondents were asked to estimate how many patients they saw per week, how many encounters they had per week with non-English-speak ing patients, and how often they used each of six interpretation metho ds. They were also asked to assess the availability and quality of int erpretation services. Results. Physicians reported that, on average, 2 1% 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 c ould 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 qua lity 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 interprete rs reported a significantly higher quality of patient-physician commun ication, the low rates of use of trained interpreters suggest that fac tors other than quality, such as costs, preclude greater use of these services.