Interpreter Use, Code-Switching, and Patient Outcomes in U.S. Clinics: A Narrative Review for Graduate Medical Education

Ruth Ese Otaigboria, Department of Anthropology, Northern Illinois University, DeKalb, Illinois, USAFollow
Kenneth Anaeto Nwankwo, Department of Pharmacology, Therapeutics and Toxicology, Faculty of Basic Medical Science, College of Medicine, University of Lagos, Lagos, NigeriaFollow
Mishael Ifeanyi Nonyelum, Medical Library, College of Medicine, University of Nigeria, Nsukka, NigeriaFollow
Ayodele Blessing Ayo-ige, School of Public Health, Yale University, New Haven, Connecticut, USAFollow
Aliaa Mohammed Soliman, Mental Health Cooperative, Nashville, Tennessee, USAFollow
Tumoe Heni, Department of Anthropology, Northern Illinois University, DeKalb, Illinois, USAFollow

Abstract

Language discordance between clinicians and patients in U.S. clinics is a recognized driver of communication-sensitive adverse events, yet the synthesis linking specific linguistic practices to clinical outcomes remains incomplete, and graduate medical education programs lack a unified evidence base on which to build interpreter-mediated competencies. This narrative review evaluates whether interpreter use, translanguaging, and code-switching constitute an interactional pathway through which cultural and explanatory models shape outcomes for limited-English-proficient (LEP) patients, and derives recommendations for graduate medical education. Searches across MEDLINE/PubMed, Embase, CINAHL, PsycINFO, and Scopus covered January 2000–September 2025 and prioritized U.S. immigrant and LEP encounters that linked language practices to assessment, medication decisions, referrals, revisits, adherence, satisfaction, or safety; the Mixed Methods Appraisal Tool informed quality stratification. Across studies, professional interpretation reduced clinically consequential errors (12% vs 22% with ad hoc interpreters; 2% with ≥ 100 training hours). LEP adverse events showed more physical harm than English-proficient events (49.1% vs 29.5%). Verified interpreter coverage at admission and discharge shortened length of stay and lowered 30-day readmissions; chronic conditions reliant on transitional communication showed higher readmissions for LEP patients (heart failure RR 1.29; COPD RR 1.51), while protocolized conditions did not. In-person interpretation was most consistently associated with patient-reported satisfaction and rapport, with video and telephone modalities calibrated to encounter complexity. Reliable, qualified interpretation operates as a patient-safety lever; bundling verified coverage with closed-loop communication at transitions merits programmatic adoption in graduate medical education.

Recommended Citation

Otaigboria R, Nwankwo K, Nonyelum M, Ayo-ige A, Soliman A, Heni T. Interpreter Use, Code-Switching, and Patient Outcomes in U.S. Clinics: A Narrative Review for Graduate Medical Education. Patient Experience Journal. ; 13(3):324-330. doi: 10.35680/2372-0247.2179.