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

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