Felisha Rohan-Minjares, MD
Assistant Professor, FCM
Director of Cultural Competency
Curriculum Development
Office of Diversity
At the end of today’s session,
residents will be able to:
 Explain the importance of language
access and why interpreters should
be utilized when needed
 Explain best techniques of how to
utilize medical interpreters
A set of congruent behaviors,
attitudes, and policies that come
together in a system, agency, or
among professionals that
enables effective work in crosscultural situations.
Cross, T L et al. Towards a Culturally Competent System of Care:
A Monograph on Effective Services for Minority Children,
National Center for Cultural Competence, Georgetown
University, 1989.
No one provider can or should be expected to know
about every type of culture they might encounter. What
is important is that they learn to listen respectfully and
learn and respect that patients bring their own health
beliefs and value systems into each encounter.
 Health care organizations must
offer and provide language
assistance services, including
bilingual staff and interpreter
services, at no cost to each
patient/consumer with limited
English proficiency at all points of
contact, in a timely manner during
all hours of operation.
 Required of all health organizations
receiving federal funds.
 Translator
a person who takes a written document in one language and converts it to
another language
 Interpreter
a person who takes a spoken language and converts it to another language.
 Cultural Broker
 Resident physicians recognized
that they underused professional
interpreters, and described this
phenomenon as "getting by”
 Resident physicians made
decisions about interpreter use by
weighing the perceived value of
communication in clinical decision
making against their own time
constraints
. Journal of Gen
Int Med.
 The decision to call an interpreter
could be preempted by the
convenience of using family
members or the resident
physician's use of his/her own
second language skills
 Resident physicians normalized the
underuse of professional
interpreters, despite recognition
that patients with LEP are not
receiving equal care.

Chance Interpreters – Family,
Friends

Bilingual Support Staff –
Untrained

Bilingual Support Staff – Trained

Professional Medical Interpreters
– in person, via video, via
telephone
 Omit questions or instructions
 Leave out or instruct patients
not to answer personal
questions
 Try to influence the patient’s
decisions
 Summarize the message
instead of relaying it exactly
 Answer questions on their own
 Spanish, Vietnamese,
Navajo & American Sign
Language in house
 Services available in
person, video, and via
telephone
 Contracted Language
Services Provider
Pacific Interpreters for
over 200 languages
 Find the best interpreter
available.
 Never use a child.
 If it all possible, avoid family
members interpreting.
 Avoid the Triangle.
 Introduce yourself to the
interpreter.
 You may briefly tell the
interpreter about the patient
and the case if you are familiar
with the patient.
 Speak in the 1st person and
make eye contact with the
patient while speaking, not the
interpreter
 Speak clearly and in your
normal tone of voice. Speak at
a normal to slow-normal pace.
 Use short sentences.
 Be aware that many concepts
you express have no linguistic
or conceptual equivalent in
other languages. Don’t use
idioms. (i.e., “It’s a long shot”,
“kill two birds with one stone”)
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Education
Socioeconomic status
Role in family
Role in community
Bias
Immigration history
Etc.
Language
Cultural Background
Religion
Spirituality
Family Structure
Historical Trauma
Familiarity with and
acceptance of western
medicine
21 yo Vietnamese female
patient accompanied by
her husband. Husband tell
you that he wants to
interpret for her
WHAT WOULD YOU DO?
65 yo Swahili speaking
man comes in to the clinic
at 4:45pm on Friday with
chest pain. He is
accompanied by his 16 yo
grandson
WHAT WOULD YOU DO?
You saw a 72 yo Iraqi man
yesterday. Today you are
reviewing his labs from the
hospital and find that his
sodium is 118.
WHAT WOULD YOU DO?
You are doing your rural rotation
in Santa Rosa. A 16 year old
Spanish-speaking patient is
accompanied by her aunt who
knows English and is serving as
interpreter. You are ready to ask
the questions about risk behaviors
including sexual history and drug
and alcohol use. You don’t speak
Spanish and there are no trained
interpreters at the clinic. Several
clinic staff members speak
Spanish.
WHAT WOULD YOU DO?
Thanks for your attention.
Please call an interpreter when you need to!