When a healthcare professional has an encounter with a non-English speaking patient - there would usually be an interpreter, oftentimes remote interpreter. The payment for the service is by the minute including the inherent periods of silence.

In every encounter there are “communication parts” where provider and patient exchange information, questions and there are “silent parts” - usually where the provider is doing a “brain work” for example, going over charts etc.

One example of “silent part” is working on the EHR system - one US-based study¹ found, that on outpatient encounters - “Physicians spent an average of 16 minutes and 14 seconds per encounter using EHRs, with chart review (33%), documentation (24%), and ordering (17%) functions accounting for most of the time.”

Let's examine another Turkish-based study², also in outpatient settings, that measured steps and general duration as an example (we've ignored the variation).

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According to this study, out of 22.7 minutes of encounter, 10.3 minutes don't require interpreter communication. This means that 45% of the meeting is paid for the silence time.‍

Side note - it seems like in the US, physicians spend more time on EMR (16:14 min) than in Turkey (10:30 min).

Even if the numbers could vary, medical encounters, from their nature, include non-verbal clinic time. However, the current workflow can't overcome that - there is an attached remote interpreter following the encounter until the patient is released from the room.

In our interviews with providers, we've asked about this topic. Two interesting stories were:

1. One MD from an inpatient hospital in NY told us: "If I don't say anything for 15 min, after 15 min they'll hang up. I have to request it. Yes, I have to request every 15 min for them to stay on the line."
2. In another case, an MD from an optometry clinic health center told us: "We call an interpreter over the phone for the beginning part of the visit, but since that service charges by the minute, we can't have the interpreter on the phone for the whole time." In optometry, the typical exam is most of the encounter - in their case, for their own reasons they decided the interpreter would be present only for the first part of medical history taking.

To summarize, there is "waste" when using remote interpreters, reflected by silence time in medical encounters. It is an overlooked subject that is inherent to the current labor-based medical interpreting process.

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Resources:

¹ _{https://pubmed.ncbi.nlm.nih.gov/31931523/}
² _{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541965/}