Two Sides to Every Conversation: Communication Strategies and Appropriate Interpreter Utilization in Pediatric Orthopaedics

Abstract

Marginalized patients including those with limited English proficiency (LEP) are at risk of seeing graver health outcomes across many specialties. Communication barriers contribute to impaired shared-decision making and missed education opportunities. Tools are available to clinicians to allow for more accurate and effective education and to facilitate shared decision-making. This article reviews existing guidelines for utilization of professional interpreters. A framework is provided for pre-visit planning, facilitating appropriate introductions, and setting up a clinic room to optimize workflow. Suggestions are provided for utilizing professional interpreters efficiently and prioritizing patient autonomy, respect, and mutual understanding. Pediatric orthopaedic surgeons and providers can promote health equity by utilizing professional interpreters and using other strategies to communicate effectively with patients and families from diverse backgrounds and/or those who have LEP. Key Concepts•Pediatric orthopaedic surgeons can take a leading role in exemplifying the delivery of equitable care, investing in appropriate educational resources in a wider variety of languages and connecting with community resources to improve access for underrepresented communities.•The use of non-professional interpreters such as relatives, friends, children, or bilingual staff is a breach of the duty of care owed to the patient with potential legal ramifications.•Professional interpreters work under established standards of practice and ethical guidelines to guide interactions with clear priorities of maintaining accuracy, confidentiality, impartiality, and respect.•Avoid the temptation to look at the interpreter during a clinic visit rather than the patient or caregiver-remember that they are sharing your words with the patient.•Language access alone will not erase existing health disparities, but it is a critical step toward optimizing patient outcomes.

Figure 1

Set up your clinic room for success. Here, the physician is seated close to the patient, facing him and his caregiver. The professional interpreter is present via video and is positioned adjacent to the physician, facing the patient and caregiver as well. The clinician should make eye contact with the individual they are addressing, not the interpreter.

Figure 2

Diagram of room setup suggestions for in-person, video, and phone interpreters. The left diagram shows a parallel seating arrangement: the clinician faces the patient and caregiver, speaking to them directly. The interpreter is positioned so as to speak directly to the patient and caregiver, parallel with the clinician or slightly set back behind the clinician allowing unimpeded face-to-face conversation between the clinician and patient/caregiver. The right diagram shows a triradic interview arrangement: the phone is positioned between the provider and the patient/caregiver so that all parties face each other and can easily hear the interpreter’s voice.