Bilingual medical professionals

These individuals are health care professionals who are able to speak and understand another language other than the main language spoken in the country. They can be either health care providers or other members of medical staff.

3.2.1. Bilingual providers

There are instances where the health care provider is also able to speak the patient’s language. These dual-role providers are usually first or second-generation immigrants with knowledge of both languages (Moreno et al., 2007). They communicate directly with the patient, eliminating the need for an interpreter. From a more practical point of view, bilingual providers seem to reduce the costs of unaddressed language barriers in hospitals, and the management of allophone patients by bilingual providers was found to be similar to their management of non-allophone patients (Moreno et al.).

Another practical advantage of this category is the protection they provide to the hospital (or clinic) against liabilities that may arise from unsolved or poorly tackled communication barriers (Golley, 2018).

Hsieh states that their medical expertise, availability, and institutional roles set them apart as a distinct category. The presence of bilingual doctors and other highly trained members of the medical staff can be highly beneficial, thanks to their knowledge of both technical terminology and the institution where they work. These two highly valuable features make bilingual providers a real, but rare, asset for hospitals; they are perceived as the “gold standard” of cross-cultural care (Hsieh, 2016, p. 100).

The use of bilingual providers, as well as the use of professional interpreters, is considered by several studies to be the best solution for overcoming language barriers (Hampers & McNulty, 2002; Flores, 2005; van der Rijken, Bijlsma, Wilpert, van Horn, van Geffen, & van Busschbach, 2015) . Bilingual

health care providers positively affect client satisfaction, quality of care, and health outcomes (Flores, 2005). The risk of communication errors is reduced, patients seem to be more comfortable, and they pay more attention to their providers and to the explanation of their treatment (Hampers & McNulty, 2002).

The importance of language competency has been highlighted in mental health studies as one of the main issues around bilingual providers. Indeed, while providers may believe themselves to be highly proficient and knowledgeable of another language and/or culture, in reality their level may not be as high as they think. Without any long-term professional training in bilingual health care, or a language fluency assessment, the risk of miscommunication is still present. This is especially true for providers who are not truly bilingual, having learnt another language during a different time of their lives.

Keeping up a second language at a very high level is a real challenge, an activity which requires time and energy. It is therefore possible that not all bilingual providers – with an already heavy workload – would be able to maintain such linguistic competencies over time (Bourhis & Montreuil, 2016).

Like for other types of interpreter, the sensitivity of mental health interactions adds another level of complexity to the analysis. The existing literature holds that only fluent therapists with strong linguistic skills should conduct therapy in the minority language (Office of Minority Health, 2005), as it would be wrong to assume that all licensed clinicians claiming to be bilingual are able to conduct a mental health consultation in two languages (van der Rijken et al., 2015). Appropriate assessment of bilingual staff would avoid misunderstandings and miscommunications, or the awkward situation where a patient faced with a therapist with a low level of language competency feels too uncomfortable to ask for an interpreter (Moreno et al., 2007). It is possible that the rarity of bilingual providers and the advantages that they present may lead hospitals to overlook these potential problems.

Bilingual mental health providers will not be further discussed in this work. Although interesting from a social and medical point of view, the presence of a bilingual provider eliminates the need for interpretation, limiting the relevance of such an instance for this project. It is, however, important to take their work into consideration, because it provides yet another example of an allophone interaction in health care. Moreover, the literature available shows that while bilingual providers are considered to be one of the best solutions for allophone patients, cultural and linguistic barriers may still arise with bilingual providers, thus showing once again the importance of addressing these issues in bilingual health care.

3.2.2. Bilingual medical staff

Bilingual physicians, nurses and other medical employees are classed by Hsieh as bilingual members of medical staff. Because of their higher availability, bilingual staff are (along with family interpreters) one of the most frequently used types of interpreter. Monolingual clinicians often rely on their bilingual colleagues for language assistance. The difference between the previously explored category of bilingual providers and the present category is that bilingual staff are a third party in the interaction between the provider and the allophone patient. These individuals play a dual-role, and may be called away from their assigned job to interpret for their colleagues when needed.

Just like any other category of untrained interpreter, bilingual medical staff usually have no training in medical interpreting, but happen to know another language for reasons relating to their background or upbringing (for example, they may be first or second generation migrants, or may have studied abroad). This is worth stressing once again because being capable of speaking two languages perfectly is not enough to be able to interpret successfully. Indeed, the literature shows that while interpreters of this category generally appear well qualified, taking their competencies for granted would be a mistake. Indeed, Moreno et al.’s 2007 study shows that as many as one in five dual-role

licensed clinicians do not have the necessary skills to act as medical interpreters, even compared to other kinds of untrained interpreter who do not share their medical background (Moreno et al., 2007).

While they may be able to interpret correctly from one language to the other, bilingual members of staff may fail to act as cultural brokers because they may lack knowledge about specific cultural differences or appropriate language choices. Like chance interpreters, it is possible that they may not know how to behave and share information correctly. Health care institutions that rely heavily on dual-role staff as interpreters may consider assessing their language skills. This, however, happens rarely: these interpreters, who are sometimes simply referred to as “bilingual colleagues”, are usually fully trusted by the providers for whom they interpret. However, it is interesting to note that their value as interpreters, as well as the trust that they enjoy, is often based on their knowledge and familiarity with the medical field rather than their language skills (Hsieh, Ju, & Kong, 2010).

Another issue lies in the fact that two mental health care professionals are, in this instance, effectively assigned to the same patient. The dual-role activity of a bilingual provider may thus be problematic for the main therapist, who must rely on another provider and potentially deal with an imbalance of power and control between themselves – the main therapist – and the other bilingual provider (Hsieh, 2015b). However, this specific element remains little researched, and further studies are needed to gain a better understanding of this specific topic.

Notwithstanding, bilingual employees are generally considered to be very beneficial to the session, unlike the more mixed results of family interpreters. Their knowledge of technical terminology and the institution where they work sets them apart from other “untrained” categories. When asked about their highly valued bilingual colleagues, a monolingual health care provider stated that “if there is a medical personnel, either on my team or right there in the unit, who speaks the language, we grab them” (Hsieh, 2015b, p. 78).

The importance of bilingual staff members in hospitals (and how often they are called to cover the role of interpreter as well as their job as medical professionals) is directly related to one negative aspects of this group of interpreters: time management. Bilingual medical staff often struggle to balance the workload of their dual-role job. Time constraints are therefore a problem for these individuals, who find themselves assuming two different roles at the same time. This is particularly true for mental health departments: an interpreted initial mental health evaluation can last for more than 45 minutes. A second health professional, nurse or overworked skilled staff member will rarely find the time during their shift to interpret for its whole duration (Hsieh, 2015b).

Unfortunately, the literature available does not give a better insight on the work of bilingual providers in mental health, and further studies are needed to grasp a better understanding on this specific topic.