Gaps in interpreter use for Asian patients during surgical consent

A new University of Auckland study conducted by medical student Samantha Turnwald has identified significant gaps in the use of professional interpreters during surgical consent processes for Asian patients with limited English proficiency.

The results raise concerns about patient safety, informed consent and equity in healthcare.

The research, supervised by psychiatrists David Menkes and Pablo Richly and published on 29 May in the New Zealand Medical Journal, analysed clinical data from 540 Asian patients who underwent surgery at Waikato Hospital in 2022 and 2023. Nearly one in three patients was found to have definite evidence of limited English proficiency, yet more than one in five of these patients did not receive a professional interpreter during consent discussions.

Menkes, Associate Professor of Psychiatry at the University of Auckland’s Waikato Clinical Campus, says the findings highlight a critical gap in surgical practice.

“Effective communication is fundamental to informed consent,” says Menkes. “If patients do not fully understand the risks, benefits and alternatives of surgery, we cannot be confident that consent is truly informed.”

The study found that 173/540 patients were classified as having definite limited English proficiency. Of these, 21.4 percent did not receive interpreter support during surgical consent. Also striking was the finding that none of the patients identified as having suspected language difficulties were provided with interpreters.

“This suggests that patients whose language needs are less obvious may be slipping through the cracks,” says Menkes. “If clinicians rely on subjective judgement alone, some patients who need support may not receive it.”

The research also uncovered disparities between ethnic groups. Among patients with limited English proficiency, Indian patients were significantly less likely to receive interpreter services compared with other groups. Interpreter use among Indian patients was around 57 percent, compared with higher rates for Chinese, Korean and Filipino patients.

“These differences raise important questions about equity,” says Menkes. “Healthcare services should be delivered according to need, but our findings suggest this not always happening in practice.”

The study also found that patients with limited English proficiency were typically older, with an average age of 65 years compared with 47 for English-proficient patients. This highlights a potentially vulnerable group who may already face additional barriers to understanding complex medical information.

Professional interpreters are recommended under New Zealand healthcare guidelines, and patients have a legal right to competent interpretation when needed. However, the study found that some patients relied on family members or friends to interpret, which can be problematic and introduce risks.

“Family members may unintentionally filter or misinterpret information,” says Menkes. “This can compromise patient autonomy and lead to misunderstandings that affect surgical consent and possibly other clinical decisions.”

The authors note that inconsistent documentation and a lack of standardised processes for identifying language needs may contribute to the problem. They suggest that more systematic approaches are needed, including better training for clinicians and clearer protocols for identifying when interpreters should be used.

“One practical step would be to require clinicians to formally assess and record language proficiency as part of the consent process,” says Menkes. “This would help ensure that interpreter needs are recognised early and consistently.”

The study also recommends that interpreter services be offered not only to patients with clearly identified language barriers, but also to those with suspected difficulties, to reduce the risk of miscommunication.

“Improving access to professional interpreters is not just a procedural issue, it is about patient safety and equity,” Menkes says.

The study points to the need to address the gaps, to support better outcomes and ensure all patients can participate meaningfully in decisions about their care.