Key Points
- The Royal Australian College of General Practitioners says it's "more important than ever" to boost uptake of interpreters.
- But there are concerns about what support is offered for patients from diverse backgrounds under Medicare.
Interpreters are being "underutilised" in general practice healthcare for diverse communities, leading to some avoiding help, a peak body says.
Culturally and linguistically diverse patients have been particularly impacted by the COVID-19 pandemic, according to the Royal Australian College of General Practitioners (RACGP).
It said boosting the uptake of interpreters is "more important than ever", as the latest Census revealed .
"Unfortunately, we know that interpreters are underutilised in general practice care due to a number of disincentives and barriers, sometimes resulting in this cohort avoiding healthcare," RACGP president Professor Karen Price said on Monday.
“So, boosting uptake of interpreters in general practice is more important than ever to reduce health inequality and minimise the impact of the [COVID-19] pandemic on vulnerable communities."
The 2021 Census, released last week by the Australian Bureau of Statistics (ABS), showed more than half of Australians are now first or second-generation migrants.
The number of people who used a language other than English at home has increased by nearly 800,000, rising to over 5.5 million people.
As the country's multicultural community has risen, so has the demand for services such as healthcare.
The RACGP's Dr Bruce Willett said there was strong demand for telephone interpreter services during consultations with family doctors.
"Of the 20 per cent of people who speak another language in Australia, there's 400 other languages, so a telephone-based service is really the only practical way to do that," he told SBS News.
He said not all medical practices use interpreters, with families frequently taking their place.
"Often relatives are used to interpret, and while that can work really well, [it] has severe limitations in terms of if someone has something that's private or confidential. They may not feel comfortable discussing things like that, or even just things in intimate detail."
A 2017 report from the Cultural and Indigenous Research Centre Australia (CIRA) found differences in how and when people from diverse backgrounds present for treatment for particular conditions, and the issues they faced in accessing health services.
This included English language proficiency, lack of access to skills and resources to access certain health information and differences in cultural perceptions of health.
Dr Astrid Perry from Settlement Services International, a community organisation that supports newly arrived people from multicultural backgrounds, said people can be misdiagnosed or misunderstood.
"Sometimes, it's interpreted wrongly as to what the person means ... particularly in the area of mental health - around the level of seriousness, whether it's a figure of speech rather than illness-related and so on," Dr Perry said.
"So there's a lack of understanding as to whether they mean they want to go home or whether they mean they're not well enough or - because in many cultures you use a synonym rather than saying straight out how you're feeling."
Dr Willett said bilingual GPs can often help to bridge the gap, when "there's that feeling of understanding as well as the language".
"Those doctors can not only interpret the language but they can also help interpret the system for patients from a different culture, and help those patients navigate what can be quite a foreign and different system than what they're used to," he said.
But Dr Perry said these GPs tend to be concentrated in cities, or a few language groups.
"We do have some language GPs in regional areas because sometimes it's a condition of their visa that they work in regional areas first before they can come back to a metropolitan area. But this is often not the language that the local populations speak in those country towns," she said.
Experts said cost is also a barrier, as for patients who are refugees and on temporary visas, finding a doctor who speaks their language or has access to interpreters does not mean they can afford to see one.
"Some of them do if they have Medicare. There's a number of temporary visas that actually have Medicare and then they have to pay the gap like everyone else - if there is a gap," Dr Perry said.
"For those who don't have Medicare, like students for example, they're supposed to have their own insurance that caters for their health care. But we do know that they don't always have it as they're on a very stretched budget already."
For those who are fully covered by Medicare, there are concerns about what support the scheme offers patients from diverse backgrounds.
There is no item in the Medicare Benefits Schedule (MBS) that caters specifically for patients who require translators.
"It takes some extra time to ... get interpreter services in place. But of course, it also takes some extra time for the person doing interpreting to explain to the patient, and then the patient to give their answer to the interpreter and then that to go back to the doctors," Dr Willett said.
But the federal Department of Health has recently released resources clarifying how GPs should bill when translation services require an extended consultation, which have been welcomed by the RACGP.
Professor Price said she wrote to the department last December recommending a change to MBS item descriptors to reflect the additional time required for GP consultations when an interpreter is used.
"The department responded that descriptors could not be amended; however, the new fact sheet confirms that GPs are billing correctly when a longer consultation item is required due to the extended nature of consultations involving interpreters," she said.
“Every patient matters and when language barriers exist, we do need to take extra time to make sure we are communicating effectively with our patients."
CIRCA's study found that patients from diverse backgrounds consistently reported feeling they were not given the time in an appointment to fully understand what was being said or to ask questions.
"GPs have been squeezed," Dr Willett said.
"They either have to see patients more quickly to try and make ends meet - which of course makes things like treating people who have English as a second language or don't speak English at all more difficult in that time - or GPs are forced to abandon bulk billing."
Additional reporting by Emma Brancatisano.
