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Asian patients at Waikato Hospital with limited English proficiency have been left without language support at one of the most critical moments in healthcare – consenting to surgery.
Research published in the New Zealand Medical Journal on Friday found that about one in five Asian patients at the hospital who needed an interpreter did not receive one when asked to sign surgical consent forms.
Indian patients were significantly less likely than other Asian patients to receive language support, the analysis found.
The researchers reviewed records of more than 500 Asian patients treated at Waikato Hospital in 2022 and 2023 to examine whether those with limited English proficiency were provided with interpreters before surgery.
The analysis defined surgical consent as a critical moment when patients were expected to understand the risks, benefits and alternatives of a procedure.
Of the 540 patients, 173 (32 percent) were classified as having limited English proficiency, while 14 (2.6 percent) were suspected of having some difficulty.
Of those with limited English proficiency, 136 patients (79 percent) received interpreter services, while 37 (21 percent) did not.
None of the patients suspected of having limited English proficiency received an interpreter.
Researchers found that Indian patients were particularly disadvantaged, being less likely to receive interpreter support than other Asian patients.
Patients with limited English proficiency were also older, with an average age of 65.4, compared with 47.4 for patients who were proficient in English, making them a potentially more vulnerable group.
The researchers said limited English proficiency was a significant barrier for migrant populations, particularly the growing Asian communities in regions such as Waikato.
The analysis showed that patients could struggle to understand medical information without appropriate language support, leading to increased anxiety, misinterpretation and potential breaches of informed consent.
Professional interpreters played an important role in addressing communication barriers and meeting ethical and legal requirements, the researchers said.
New Zealand’s Code of Health & Disability Services Consumers’ Rights gives patients the right to a competent interpreter when needed.
Despite that requirement, previous research has found inconsistencies in the use of interpreters in healthcare settings.
Family members and friends are often used instead of professional interpreters, raising concerns about miscommunication, loss of patient autonomy and potentially compromised clinical outcomes.
Researchers said Indian ethnicity was associated with significantly lower interpreter service use, indicating a failure to provide equitable healthcare.
“This disparity may be influenced by factors such as lower recognition of language needs by clinicians, patient reluctance, cultural differences or systemic barriers in interpreter access,” the analysis said.
The findings come as New Zealand’s older Asian population is expected to grow sharply.
According to Stats NZ’s 2023 Census, 34,308 Chinese and 18,720 Indian residents are aged 65 and older.
The Asian population in this age group is projected to grow from 72,900 in 2023 to 299,800 by 2048 – a fourfold increase.
The cohort is forecast to include 120,700 Chinese and 80,500 Indian individuals.
Researchers noted that a significant proportion of Chinese and Indian patients were classified as having definite limited English proficiency.
They said targeted efforts were needed to ensure these groups had adequate access to interpreters, with particular priority given to older patients.
“Addressing these challenges requires systemic changes, including enhanced clinician training, structured protocols for identifying LEP patients and improved interpreter service access,” the analysis said.
“To ensure patient-centred care and uphold ethical principles, hospitals should implement policies mandating interpreter use for all patients with suspected as well as definite [limited English proficiency], reducing reliance on clinician discretion.”
Titled “Interpreter use during surgical consent for Asian patients with limited English proficiency”, the analysis was conducted by Pablo Ritchly, a consultation-liaison psychiatrist at Waikato Hospital in Hamilton, Samantha Turnwald of the University of Auckland’s Faculty of Medical and Health Sciences and David Menkes of the university’s Department of Psychological Medicine.