Alterations in medical interpretation during routine primary care.

BACKGROUND: Increasing numbers of patients require medical interpretation, yet few studies have examined its accuracy or effect on health outcomes. OBJECTIVE: To understand how alterations in medical interpretation affect health care delivery to patients with limited English proficiency (LEP), we aimed to determine the frequency, type, and clinical significance of alterations. We focused on best-case encounters that involved trained, experienced interpreters interacting with established patients. DESIGN: We audio-recorded routine outpatient clinic visits in which a medical interpreter participated. Audiotapes were transcribed and translated into English. We identified and characterized alterations in interpretation and calculated their prevalence. PARTICIPANTS: In total, 38 patients, 16 interpreters, and 5 providers took part. Patients spoke Cantonese, Mandarin, Somali, Spanish, and Vietnamese, and received care for common chronic health conditions. MEASURES: Unlike previous methods that report numbers of alterations per interpreted encounter, we focused on alterations per utterance, which we defined as the unit of spoken content given to the interpreter to interpret. All alteration rates were calculated by dividing the number of alterations made during the encounter by the number of utterances for that encounter. We defined clinically significant changes as those with potential consequences for evaluation and treatment. KEY RESULTS: We found that 31% of all utterances during a routine clinical encounter contained an alteration. Only 5% of alterations were clinically significant, with 1% having a positive effect and 4% having a negative effect on the clinical encounter. CONCLUSION: Even in a best case scenario, the rate of alteration remains substantial. Training interpreters and clinicians to address common patterns of alteration will markedly improve the quality of communication between providers and LEP patients.

Klinefelter syndrome presenting as behavioral problems in a young adult.

BACKGROUND: An 18-year-old Somali man presented to a primary care clinic to investigate a potential pathophysiological reason for behavioral problems at school that had arisen in the past 1-2 years. A previous physical examination at school revealed the patient to have small, firm testicles which prompted further testing. INVESTIGATION: Thyroid function and levels of prolactin, total testosterone, follicle-stimulating hormone and luteinizing hormone were determined. Testes were measured. Chromosome analysis testing was performed to determine the patient's karyotype. DIAGNOSIS: Klinefelter syndrome with a 47,XXY karyotype. MANAGEMENT: Testosterone replacement therapy was recommended, but the patient declined treatment.

Case report: Revisiting celiac disease.

Celiac disease (CD) is an autoimmune disorder that causes varying degrees of villous atrophy and chronic malabsorption in genetically predisposed persons. Once considered a rare disease affecting children, younger adults, and persons of European ancestry, CD is increasingly recognized in all demographic groups with a prevalence rate in the United States of almost 1%. We offer an overview of the evaluation and management of CD vis-à-vis the case of a 41-year-old man who was hospitalized after presenting with the classic symptoms of chronic abdominal complaints, diarrhea, iron-deficiency anemia, and weight loss. Celiac disease remains an underdiagnosed condition in the United States, which is unfortunate given the potential treatment with a gluten-free diet.