1. Medical interpreter role grows By Joann Loviglio / Associated Press November 22, 2004 http://www.detnews.com/2004/health/0411/23/A05-12062.htm

2. Language Issues PHILADELPHIA -- Romualdo Rivera arrives at the emergency room with what seems to be a complaint of chest pain. But it's hard to be sure -- he doesn't speak English. He's a pale but solidly built man with thinning gray hair, and his face reddens as his shirt is removed, his pant legs are pushed up and electrodes are attached to his calves and chest. As nurses and technicians come and go from the small curtained examination area, his eyes dart from one person to the next, hoping for a familiar phrase, even a word. Unlike TV portrayals of frenzied big-city emergency rooms, the scene slows in real-life hospitals when a doctor and patient can't communicate. It becomes like a game of charades, as one doctor put it, with lots of pointing and gesturing.

3. At Temple University Nationwide, the approach to care for non-English- speaking patients is hit-or-miss. Fewer than a fourth of U.S. hospitals have professionally trained interpreters, a study found. In some places, hospital employees with no medical training are called in to interpret. In others, relatives, neighbors or acquaintances do the job. In the worst cases, the patient's problem gets lost in translation. Hospital officials realize they need interpreters, but most haven't figured out how to pay for them. The Temple University Health System took action when two hospitals had a surge of Spanish-speaking patients. Now, Temple and nine other medical institutions nationwide are taking part in a program that could show why hospitals can't afford to be without formally trained medical interpreters.

4. Interpreters Last spring, Temple hired four interpreters with an $850,000 grant from the Robert Wood Johnson Foundation and began sending them to medical classes. Temple and the other hospitals getting grants must develop a comprehensive medical interpreting program. Health care advocates are convinced that having no interpreters means longer stays, unnecessary tests, more repeat visits and even medical mistakes. Hospitals have long relied on friends or relatives of patients to help translate, but it's an arrangement that comes with risks. Patients sometimes hide details from children or friends filling in as translators. And sometimes family members want to shield patients from unwelcome news from their doctors, said Marbella Sala, who manages medical interpreting services at the University of California-Davis.

5. Several Economic Issues Information – How do you get the right information? (Related) Cultural customs – These include appropriate examinations (sometimes race, ethnicity, or culturally related). Compliance – If it’s hard to communicate initially, how can provider be sure of compliance with diagnoses and prescriptions?