On interpreters: the ethics of interpreter use in general practice.

In the absence of language congruency between patient and general practitioner (GP), the use of an interpreter is essential for a safe and effective clinical consultation. A substantial proportion of individuals living in the UK lack sufficient command of the English language to allow direct communication with their GP. Interpreters in UK general practice can be classified into three major categories: Casual, professional in-person and professional telephone interpreters. The use of casual interpreters threatens the safety and quality of care provided in interpreted consultations, increases the potential for safeguarding concerns to go unrecognised by the GP, poses a potential legal risk to the GP and is burdensome for and potentially harmful to the relatives, friends and carers who act as such interpreters. The use of professional in-person interpreters greatly improves the safety and quality of care above that of casually interpreted consultations, increases the probability that safeguarding concerns will be recognised by the GP, avoids the legal risk inherent to casually interpreted consultations, is neither burdensome nor potentially harmful to accompanying relatives, friends and carers or the interpreter and permits interpreter continuity while generating a small non-clinical opportunity cost borne by administrative staff. The use of professional telephone interpreters shares the same advantages as the use of professional in-person interpreters but prevents interpreter continuity and generates a large clinical opportunity cost borne by other patients. The paper also explores ethical challenges that are common to the use of all major categories of interpreter and offers four policy recommendations in light of the analysis.