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Curbside Consultation

When a Patient Declines Interpreter Services

Maniraj Jeyaraju, MD
Jaime Russell, CT, CHI
Rana Alkhaldi, MD

American Family Physician. 2026;114(1):86-88.

Author disclosure: No relevant financial relationships

CASE SCENARIO

JS, a 45-year-old patient, comes to establish care at my office. JS primarily speaks Spanish but can converse in and understand conversational English. I do not speak Spanish. My medical assistant offers the use of a Spanish interpreter, but JS declines. After starting JS's visit without an interpreter, I sense that JS does not clearly understand my questions and that some nuances are being missed. Additionally, I am not sure whether JS understands the medical terms I am using. How can I best help my patient who declines the use of an interpreter when I believe that one is necessary to help us communicate?

COMMENTARY

Inadequate resources, including insufficient time, undertrained personnel, and cost, are commonly cited as barriers in communicating with patients who are not proficient in English. Occasionally, however, patients refuse such services even when the services are readily available. Possible reasons include medical privacy issues or shame relating to insufficient language skills. This commentary offers an approach to care to help mitigate patients' concerns about involving a third-party interpreter.

Rationale and Requirements for Interpreter Services

Clinician Performance and Patient Safety. Optimal medical care relies on accurate bidirectional communication between patients and clinicians. A patient who does not understand the clinician may respond incorrectly to questions and inadvertently make decisions harmful to their care (eg, responding incorrectly to a question about medication allergy, which could lead to anaphylaxis). A clinician who does not understand the patient may ask misleading follow-up questions, which can lead to diagnostic and treatment errors. A qualified interpreter can help a clinician accurately communicate with the patient. Studies have shown that using unqualified interpreters can harm patients and increase health care costs.1,2

Patient Rights. Health care organizations cannot require patients to provide their own interpreter or charge for interpretation services.3 During language-discordant care (ie, patient and health care staff lack proficiency in the same language), patients may choose to not use an interpreter and communicate as they are able; bring their own interpreter (eg, family, local language navigation service), whether that person is qualified or not; or use a qualified interpreter provided by the organization.4,5

It is essential to understand why patients may choose not to use an organization-provided interpreter. Reasons may include worry of additional incurred cost, lack of privacy, and sense of discomfort or mistrust.6,7 These valid concerns should be addressed with the patient. Table 1 provides suggestions for physicians whose patients who decline interpreter services.

TABLE 1. Suggestions for Physicians With Patients Who Decline
Interpreter Services

Understand the patient's reason
Ask why the patient prefers to decline interpreter services, which could help open communication surrounding reasons for not using the service (eg, prior bad experience, concern about cost or privacy, incorrect language variant requested)
Reminder of patients' rights
Ensure that patients understand their rights and inform them that interpreter services are legally required to be free and that access to health care in their requested language is their fundamental right
When a family member is interpreting
Communicate with the patient that private medical information can be difficult for a family member to interpret (eg, “Sometimes our team has to communicate sensitive medical topics that might be uncomfortable for a family member to interpret. Some new terms or concepts may be introduced that your family member might have trouble interpreting correctly. We recommend having an interpreter on standby. Your family member is welcome to stay with you, even if we need the interpreter's help. Is that okay?”)
When the physician and patient are having trouble understanding each other
Explain to the patient that medical concepts can be complicated to interpret and that it is important for the patient to understand the physician and to be able to fully communicate concerns with the physician (eg, “We want you and your family to have the best experience at our clinic. Having a trained interpreter allows us to communicate complex medical concepts that might be hard to understand and allow our team to best understand your concerns. Is it okay to have an interpreter available [even if only on standby] for the visit?”).
When the patient continues to decline interpreter services
The patient decides which language is used during the visit. If, after further inquiry and discussion, they continue to opt out of proceeding with interpreter services, it is imperative that the clinician respects their autonomy, which includes effective communication.
Speak clearly and use shorter utterances
Avoid overly technical terms and idiomatic expressions
Understand that a patient nodding may not always equate to understanding
Ask the patient to repeat back (teach-back) the message to confirm understanding
Highlight key elements on the after-visit summary

MANIRAJ JEYARAJU, MD, University of North Carolina, Chapel Hill

JAIME RUSSELL, CT, CHI, Amethyst Language Solutions, Chapel Hill, North Carolina

RANA ALKHALDI, MD, University of North Carolina, Chapel Hill

Address correspondence to Maniraj Jeyaraju, MD, at mjeyaraju.work@gmail.com.

Author disclosure: No relevant financial relationships

  1. 1.Karliner LS, Pérez-Stable EJ, Gregorich SE. Convenient access to professional interpreters in the hospital decreases readmission rates and estimated hospital expenditures for patients with limited English proficiency. Med Care. 2017;55(3):199-206.
  2. 2.Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255-299.
  3. 3.US Department of Justice Civil Rights Division. Title VI of the Civil Rights Act of 1964. Updated March 24, 2025. Accessed September 13, 2025. https://www.justice.gov/crt/fcs/TitleVI
  4. 4.Hornberger J, Itakura H, Wilson SR. Bridging language and cultural barriers between physicians and patients. Public Health Rep. 1997;112(5):410-417.
  5. 5.Lee LJ, Batal HA, Maselli JH, et al. Effect of Spanish interpretation method on patient satisfaction in an urban walk-in clinic. J Gen Intern Med. 2002;17(8):641-645.
  6. 6.Schwei RJ, Schroeder M, Ejebe I, et al. Limited English proficient patients' perceptions of when interpreters are needed and how the decision to utilize interpreters is made. Health Commun. 2018;33(12):1503-1508.
  7. 7.Brisset C, Leanza Y, Laforest K. Working with interpreters in health care: a systematic review and meta-ethnography of qualitative studies. Patient Educ Couns. 2013;91(2):131-140.
  8. 8.US Department of Health and Human Services. Civil Rights: Section 1557: ensuring meaningful access for individuals with limited English proficiency. August 25, 2016. Accessed December 8, 2025. https://www.hhs.gov/civil-rights/for-individuals/section-1557/fs-limited-english-proficiency/index.html
  9. 9.US Department of Health and Human Services. CLAS Standards: think cultural health. Accessed September 13, 2025. https://thinkculturalhealth.hhs.gov/clas/standards
  10. 10.Chen AH, Youdelman MK, Brooks J. The legal framework for language access in healthcare settings: Title VI and beyond. J Gen Intern Med. 2007;22:362-367.
  11. 11.Diamond LC, Schenker Y, Curry L, et al. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2009;24(2):256-262.
  12. 12.Diamond LC, Luft HS, Chung S, et al. “Does this doctor speak my language?” Improving the characterization of physician non-English language skills. Health Serv Res. 2012;47(1):556-569.
  13. 13.Heath M, Hvass AMF, Wejse CM. Interpreter services and effect on healthcare—a systematic review of the impact of different types of interpreters on patient outcome. J Migr Health. 2023;7:100162.
  14. 14.Jacobs EA, Shepard DS, Suaya JA, et al. Overcoming language barriers in health care: costs and benefits of interpreter services. Am J Public Health. 2004;94(5):866-869.
  15. 15.Fagan MJ, Diaz JA, Reinert SE, et al. Impact of interpretation method on clinic visit length. J Gen Intern Med. 2003;18(8):634-638.
  16. 16.Centers for Medicare and Medicaid Services. Guide to developing a language access plan. August 2023. Accessed December 8, 2025. https://www.cms.gov/about-cms/agency-information/omh/downloads/language-access-plan.pdf

Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to afpjournal@aafp.org. Materials are edited to retain confidentiality.

This series is coordinated by Caroline Wellbery, MD, associate deputy editor.

A collection of Curbside Consultation published in AFP is available at https://www.aafp.org/afp/curbside.

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