The American College of Obstetricians and Gynecologists (ACOG) awarded the 2007 Wyeth Pharmaceuticals Section Award to California Section V in District IX for its efforts in establishing a Limited English Proficiency (LEP) program that improves communication with patients who have limited or no English language skills. The $5,000 award, presented during ACOG's 56th Annual Clinical Meeting, was accepted for Section V by Elizabeth G. Lyster, MD, of Laguna Niguel, CA, who initiated the program. ACOG's CA Section V represents the Beverly Hills and Pasadena areas.

Forty percent of Californians speak a language other than English at home, with Spanish spoken by 26%. Census data show that 11 million California households are "linguistically isolated." The impact of language differences between doctors and patients is associated with lower levels of patient understanding of health care information, lower levels of satisfaction with health care services, lower access rates to primary and preventive services, more costly health care encounters, and lower quality of care overall.

In 2004, ACOG's California Section V began its LEP project, supported by a grant from the California Endowment Program, to explore how its member ob-gyns communicated with their patients who speak little or no English. It conducted focus groups of physicians and patients and issued a survey of District IX's (California state) membership to determine how doctors dealt with foreign-speaking patients. It then set up an advisory panel to review the findings and to develop practice and policy recommendations.

According to Sharon A. Winer, MD, chair, ACOG California Section V, "This project is a valuable contribution to the doctor-patient relationship because communication is such a critical element. The information generated from the LEP project is relevant and practical and can be implemented in any medical setting with different languages."

Survey results from District IX found that physicians relied heavily on bilingual office staff and their own language skills to communicate with patients who speak little or no English. Other frequent approaches included relying on interpretation by patients' family members, patients' children, or professional interpreters.

Numerous studies and anecdotal reports have shown the limitations of and harm that frequently results from the use of untrained interpreters. Many immigrants use their children, other family members, or friends as translators at doctor visits, which violates doctor-patient confidentiality and often results in inaccurate and incomplete interpretations.

After reviewing the LEP project results, the advisory panel made the following recommendations to promote and ensure accurate interpretation, confidentiality, and adherence to medical ethics standards, while discouraging the use of inappropriate methods:

- eliminate the use of children as interpreters;
- strongly discourage the use of family members as interpreters except in emergencies or if the patient insists against the physician's advice;
- assess language skills of bilingual physicians;
- validate language and interpreting skills of bilingual staff who serve as interpreters;
- and provide interpreter training for bilingual staff and for physicians who work with interpreters.

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

American College of Obstetricians and Gynecologists