Around 18% of people aged five and older in the United States speak a language other than English at home. Nearly half of these report that they speak English less than “very well.” When these people with limited English-proficiency go to see their doctor, appropriate interpreter services and Non-English written patient education materials are crucial to help them communicate with their doctor and understand their conditions and their care. In fact, Title VI of the Civil Rights Act states that health care providers who treat patients with public insurance (such as Medicare, Medicaid, and the State Children’s Health Insurance Program -- SCHIP) have an obligation to provide interpreter services to those patients who are not proficient in English.

A new report suggests, however, that “nearly half of U. S. physicians identify language or cultural communication barriers as obstacles to providing high-quality care, and physician adoption of practices to overcome such barriers is modest and uneven.” The report is based on a national survey of 4,700 doctors that provide at least 20 hours of direct patient care per week. It asked them, among other questions, whether their practice provides inter­preter services and whether their practice provides patient-education materials in languages other than English.

While less than 5% of doctors considered diffi­culty communicating with patients because of language or cultural barriers as a minor problem, around half of them (48.6%) considered it at least a minor problem. Nearly all doctors reported having at least some non-English speaking patients. However, only 56% of them are in practices that provide interpreter services. Of those that do, 44% offer interpretation in only one language, 16% offer interpretation in two languages, and 40% provide interpretation in three or more languages, including tel­ephonic translation services. And only 40% of doctors reported practicing in an organization that provides patient-education materials in languages other than English.

The concerning finding is that having interpreter services in and itself does not solve the language barrier. In fact, among doctors with patients who speak different languages, those in practices providing interpreter services were more likely to report com­munication difficulties with their patients than those without access to interpreter services. This suggests that interpreter services are not always readily available or are inadequate: Around 19% of doctors reported being unable to obtain inter­preter services that were medically necessary.

But even when interpreters are available, the benefit to the patient can be uncertain, since doctors sometimes rely on patients’ relatives and untrained bilingual staff. The report notes that “little policy atten­tion has been given to clarifying the legal framework governing interpreter services and establishing uniform standards for inter­preter services.” A good first step is the establishment of national training standards for health care interpreters by a new group called the Certification Commission for Healthcare Interpreters.