To the Editor:

I enjoyed reading “Achieving a More Minority-Friendly Practice” [June 2002, page 39]. As a physician who is often called on to translate, I wish we could do a better job of making translation available. However, it's not that simple. It's not right to hire staff members based on their ethnicity and language abilities when they may not be the best-qualified candidates. This can actually hurt patient care for everyone, including minority patients. How can a private practice afford to provide professional translation when its cost far exceeds the reimbursement for the visit? Medicine is a business; if we spend more on translation than we can recoup for the visit, we will be out of business! Unless there is a life-threatening emergency, adult patients need to be empowered to take responsibility for their medical care.

Author's response:

I sympathize with the physician's need to negotiate good patient care with limited resources for interpretation and translation in patients' native languages. However, many health care organizations have found that the relatively small investment of a few extra dollars to improve the flow of communication on the front end can add up to thousands in savings in the long run. Clear communication can actually shorten patient visits, eliminate extra diagnostic work and strengthen the physician-patient relationship in a powerful way, leading to improved compliance and outcomes. A proactive approach also reduces liability –an even greater expense than interpretation and translation. If hiring qualified and competent staff who are bilingual is not feasible, telephone interpretation services are a cost-efficient option. The Office of Civil Rights recognizes telephone interpretation services as evidence that a practice has made a reasonable effort to accommodate limited English proficiency patients to comply with Title XI of the Civil Rights Act of 1964.