Surgeons applied their own variable thresholds across clinical scenarios rather than a standard policy for professional interpreter use

Description #

In open-ended survey responses, surgeons described applying their own different thresholds for different clinical scenarios when deciding whether to request a professional interpreter, rather than following a standard policy — the second qualitative theme the study team identified. Surgeons calibrated interpreter use to task complexity (e.g., reserving a fluent interpreter for consent while getting by with their own skills for a history) and to their perception of whether ad-hoc communication was "working."

"never in situations where I am obtaining consent. My Spanish is good enough to get a decent [history and physical examination] and explain simple concepts, but I want someone fluent to help me gain consent." (Patel, 2016, p. 519)

"I think [using family or staff members as interpreters] is effective, the communication seems good and the patients seem to understand and seem pleased with the personal direct communication. Same for the staff at our hospital. If it is not working I backtrack and get more qualified help." (Patel, 2016, p. 520)

"Surgeons seemed to create their own thresholds for when they would request professional interpretation, instead of applying a standard policy." (Patel, 2016, p. 519)

Methods Context #

What? #ⓘ

The observable: surgeon-reported decision thresholds, drawn from open-ended responses, for when to request professional interpretation across clinical scenarios — coded to the theme of applying different thresholds rather than a standard policy.

"A second theme that emerged from responses involved applying different thresholds for different clinical scenarios." (Patel, 2016, p. 519)

How? #ⓘ

Free-text open-ended survey responses qualitatively analyzed for emerging themes using the constant comparative method by a subset of the research team, with coding disagreements resolved by consensus.

"Data analyses were performed by a subset of the research team (D.N.P., M.G., I.M., and L.D.). Disagreements in coding were discussed until a consensus was reached." (Patel, 2016, p. 516)

Who? #ⓘ

Surveyed surgeons across all surgical specialties at a single academic medical center in Boston, MA, who provided open-ended responses (drawn from 158 respondents; 33.1% response rate, 158 of 477).

"The survey had a 33.1% response rate (158 of 477)." (Patel, 2016, p. 516)

Other Notes #

The authors note this scenario-dependent thresholding is consistent with prior research on interpreter underuse (Patel, 2016, p. 520).

Caveats #

• Findings are surgeon self-report subject to selection bias so reported behavior may diverge from actual consent practice All findings are surgeons' self-reported behaviors, not directly observed consent encounters, and the sample may have been subject to selection bias favoring respondents with a particular interest in the LEP patient population. Such respondents may have given answers aligned with institutional policy rather than their actual practice, so the reported use of ad-hoc interpreters and own-language skills could differ from real behavior. The authors argue this bias likely leads to an understatement of the problem, since respondents still reported policy-contravening behavior (e.g., using minors).
• A single urban academic center with a low response rate and small sample limits representativeness of the surgeon survey The survey had a low response rate (33.1%) and small sample, limiting the strength of associations, and was conducted at a single urban academic medical center, which may not represent national physician and patient demographics or the behavior of surgeons at institutions with different interpreter resources and policies. Prevalence estimates and fluency subgroup comparisons should therefore be generalized cautiously.