A Musing on Interpreters in the Pediatric Exam Room

When I practiced pediatrics as an Air Force officer, every one of my families spoke English. During residency rotations at Children's Hospital Oakland or University of California, Davis, I am certain that I made use of an interpreter as needed to conduct a history and physical exam, but I cannot specifically recall an encounter. It was not until I moved to Chester County, Pennsylvania, that I started to have more regular and memorable encounters that necessitated the use of interpreters.

Chester County is home to Kennett Square, the mushroom capital of the world, where over a million pounds of mushrooms are produced daily. The industry employs many farm workers, the majority of whom speak primarily Spanish. In my Children's Hospital of Philadelphia (CHOP) practice, I saw many a child brought in by a parent for whom English was a challenge, making conveying their questions and concerns difficult. Enter the interpreter.

Since a move to another practice in a different county, I hear Korean, Arabic, and Russian, with the occasional Spanish for good measure. At CHOP, we are very fortunate that for the vast majority of our encounters, we have live interpreters in the room. An alternative, interpretation over the phone, is certainly better than no interpreter at all, but it is devoid of nonverbal cues (which contributes to individuals speaking over or past one another) and complicated by poor-quality phone equipment.