Margarita Ruiz, 33, says she relies on office staff to interpret during visits to her children’s doctor.

Ana B. Ibarra / California Healthline

When Margarita Ruiz takes her children to the doctor’s office, she has no choice but to trust that nurses and front desk staff are translating medical orders accurately. She doesn’t speak English, and her children’s pediatrician speaks little Spanish.

Ruiz, of Rosemead, California, says she feels grateful that staff members at the office of her children’s current doctor are usually available to translate. In the past, in a different doctor’s office, her oldest son, 14, translated for her. “It wasn’t ideal, but I didn’t have much of a choice,” says the 33-year-old homemaker.

Healthcare experts say it is not advisable to use untrained interpreters, whether they are medical office staff members or family members.

Ruiz says the language barrier has not discouraged her from taking her four sons, aged 2 to 14, to medical appointments, but she wishes she could communicate more effectively with their doctor.

Latino parents who speak only Spanish are less likely to report having a satisfactory experience with their children’s doctors than Latino parents who speak only English, or at least some English, a new analysis of California data shows.

According to the study, published 5 January in Academic Pediatrics, parents who speak only Spanish are half as likely as English-only Latinos to think that their children’s doctor listens to them.

The study compared the experiences of Latinos divided into three different groups based on the language they speak at home: people who reported speaking only Spanish, those who speak only English, and others who speak a mix of the two.

The study also showed that Spanish-only parents are 70 percent less likely than those who speak only English to communicate with their children’s doctors over the phone or via email. And parents who speak a mix of the two languages are 25 percent less likely than exclusively English-speaking Latinos to feel they are listened to by their children’s providers, according to the analysis, which is based on 2011-2012 data from the California Health Interview Survey.

The findings may suggest that a 2009 state law establishing the right to a medical interpreter is either not being fully enforced or is not being promoted widely enough, says Alex Ortega, professor of health policy at the Dornsife School of Public Health at Drexel University in Philadelphia, who led the study.

Ruiz, whose children are enrolled in Medi-Cal, says she has never called her health plan requesting an interpreter because she didn’t know it was an option.

Lost in translation:

In California, the Healthcare Language Assistance Act requires that health plans provide a qualified interpreter when requested, either in person or via telephone or video conference.

At the federal level, Title VI of the 1964 Civil Rights Act mandates that medical providers receiving federal funds through Medicaid and Medicare, including hospitals, provide language assistance for their patients.

Ortega says it is important to evaluate the communication barrier between doctors and parents because of the impact it could have on children’s health.

“If parents don’t understand their providers, they are less likely to properly manage problems at home,” Ortega says. “This is particularly problematic for kids with chronic [diseases] such as obesity, asthma and childhood diabetes, which are big issues in Latino communities.”

In 2016, about one-third of practicing physicians in the state reported being proficient in Spanish, according to the Office of Statewide Health Planning and Development.

That’s actually higher than the proportion of proficient Spanish speakers in the state’s overall population. But Spanish-speaking doctors may be more concentrated in some areas than others, and families may not always know where to find them.

Ruiz, for example, says her priority is to find doctors closest to her.

The experience of Latino families in medical settings has been the subject of many studies, but the new analysis shows serious disparities in healthcare communication within the same ethnic community, Ortega notes.

Yet the study does not show delays in care for families facing language barriers. “Access was about the same for all Latino children,” Ortega says. “That’s the good news.”

Untrained interpreters:

Alicia Fernandez, professor of clinical medicine at the University of California, San Francisco and a physician at San Francisco General Hospital, says that using untrained interpreters — such as family members or office staff — can lead to clinically significant errors.

For example, medical vocabulary may not be easily understood by a layperson, especially a child, she says.

Asking a child to translate also distorts the family dynamic, Fernandez says. “When parents don’t speak English and the child does, the child prematurely takes on an adult role in the family.”

Even with a qualified interpreter on hand, communication can be a challenge. That’s because physicians are not necessarily trained to work through interpreters, Fernandez says. When using an interpreter, doctors often dominate the conversation, making it harder for the patient to raise questions and concerns, she says.

Fernandez says many of her patients want to learn English but were poorly educated in their country of origin, which might make it more difficult for them to learn a second language. They may also face obstacles such as long work hours and not being able to afford classes.

“In the meantime, they or their kids get sick and the healthcare system has to deal with it,” Fernandez says.

In California, some 29 percent of immigrants live in households where no one older than age 13 speaks English “very well,” according to the California Public Policy Institute. Nationally, the percentage is similar, at 28 percent.

Ruiz continues to rely on the nurses and front desk personnel for language assistance, and has to wait until Spanish-speaking staff are available to interpret.

“There have been times I’ve had to wait hours,” she says. “It can be frustrating.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation. It has been slightly modified to reflect Spectrum’s style.