Provider Language Proficiency and Decision-Making When Caring for Limited English Proficiency Children and Families.

OBJECTIVE: To examine associations between self-assessed language ability and provision of clinical care without professional interpretation.

METHODS: We conducted an anonymous web-based survey of pediatric residents at a large pediatric training program. Respondents self-rated their language ability, and then reported on their willingness to deliver clinical care without professional interpretation in standardized clinical scenarios.

RESULTS: All pediatric residents completed the survey (n=81; 100%). Many residents (58 of the total sample) indicated at least rudimentary skills in a second language, and seven (9%) indicated they were proficient in Spanish. Eight-five percent had sometimes relied upon friends or family to communicate with parents. Most (69%) reported occasional use of Spanish-language skills to take a history or provide medical advice without the use of a professional interpreter. In contrast, in clinical scenarios where a child was believed to have a complex medical history, few residents (2.5%) felt comfortable using their language skills in the clinical encounter. Residents were willing to have their language ability assessed.

CONCLUSIONS: Residents still face circumstances in which care proceeds without an interpreter. Discomfort with providing care in a second language grows with the perceived complexity of care, and yet a complex condition may not be apparent when communication barriers exist. Overcoming barriers to the use of professional interpretation may improve care for LEP children.