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How Health Care Professionals Can Better Serve LEP Patients and Families

First impressions are key with all patients. And ensuring adequate language access for your Limited English Proficiency (LEP) patients can make a huge difference for your practice, both in patient safety and satisfaction. Your patients are more likely to receive improved quality in health care with fewer medical errors if they have access to the information they need in the language of their choice. This leads to a higher rate of patient satisfaction, and the individual is more likely to return to your practice/facility, if necessary, as long as they feel confident in the quality of care they received the first time.

Outside of just having access to the translated versions of key documents and medical interpreters for your patients, here are a few ways to better serve your LEP community and patients.

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Make sure your LEP community knows language access is available

Many LEP individuals may not even realize that they can receive care in their own language at your practice. This can result in a lack of preventative care, increasing their reliance on emergency room visits when the issues become more serious. This actually increases costs to the health care system, which could be alleviated by helping to inform your local LEP community that they can receive more basic or preventative care, even if they do not speak English. You can work with your Public Relations team to find ways to communicate this information to local groups. Social media channels, television appearances, direct mailers, or newspaper advertisements may be good places to start.

Translate discharge and medication instructions

Part of the reason that LEP patients have a greater chance of admission (or readmission) to the hospital after seeking care is that they do not fully understand their discharge instructions or how to properly take their medications. Having a qualified interpreter present during admission and discharge, as well as having the instructions translated into the patient’s preferred language, can result in a lower chance of patient confusion when they return home, lessening the need for the patient to return to your office or visit the ER later if their condition is not improving. If you are in doubt of the patient’s understanding, you can always use the “teach back” method to have the patient confirm what is expected of them when they leave.

Ensure proper training for your physicians and staff

You do not need a multilingual staff to be able to interact with your LEP patients. If your staff is trained to recognize cultural sensitivities and differences, as well as key indicators that your patients may need a professional medical interpreter, you can better serve your patients well when they come in for their appointments. Some patients will not request an interpreter, either because they do not know they can do so, or because they overestimate their English competency. Having a professional interpreter present or an over-the-phone interpreter available will help eliminate any language-specific issues that may arise during the visit.

If your practice has put anything in place that has helped deliver better care for your LEP patients, we’d love to hear more about it! Please let us know by leaving a comment!

Interpreting in health care: Why health care providers should skip the drive-thru method

Technology in the language services industry is in rapid growth mode. However, there seems to be a misunderstanding among the masses of ways technology will solve problems regarding language barriers in our society today. Perhaps it says something about the way we think and how we carry ourselves day to day. We've heard it referred to as a "drive-thru" society at times, i.e. we don't have time to stop the car, go inside and order our food. Rather, we'd prefer to sit in the comfort of our own vehicles and order at the window, assuming that service will be quicker and we can get on with our days a bit more easily. For anyone who has ever gone through a drive-thru more than once, you know that this may not be the case. You may end up sitting in line longer than it would have taken you to simply park the car, go inside and order your food to go. So how do our fast food society habits compare to language access and technology?

Recently, medical students at University of California, San Francisco (UCSF) created an application (app) for medical translation. An article published by UCSF in 2011 stated that a couple of medical students were frustrated at how long it took them to communicate with Limited English Proficient (LEP) individuals, especially at night and on the weekends. It also mentioned that the San Francisco General Hospital (SFGH), where they worked, "...offers assistance in more than 65 languages through a combination of staff medical interpreters, a telephone language line and a video medical interpretation system proving real-time access to providers and patients within four minutes." Four minutes! In most fields, access to an interpreter in that amount of time is incredibly fast. So, why the need for a translation app?

One of the students, Alex Blau said, “Ninety percent of diagnoses come from the patient’s self-reported medical history, so the ability to communicate is critical,” referring to nights and weekends. “Time is not an asset doctors or patients have. You need that information when you need it.” We would say it's safe to argue that most patients, whether they speak English natively or not, would rather their doctors slow down and take the time to talk with them (not to mention, in their own language).

In order to solve their dilemma, the students decided to create an app that would "translate" medical history questions into other languages. The article did not mention whether or not there was a feature that would "translate" the patients' responses. How would these students capture responses from patients or further explain if a patient does not understand the question, is illiterate or hard of hearing? Many professional interpreters know that when a patient is asked his or her name, at times, the patient may not even be able to spell it. An app certainly won't solve this issue.

The best choice is to have a professional, trained interpreter present in person, on the phone or available via video access. If a patient needs assistance via a professional interpreter, waiting the four minutes (and many times, less!) will give everyone peace of mind to know that the patients' concerns and medical information is interpreted accurately and efficiently. One more issue comes to mind when considering the features of the app in general. Although the creators have made it available in multiple languages with multiple questions about one's medical history, how does it really save time? It seems to only save a little time on the wait time (which, we have already established is really not that long), as patients have to take the time to read or listen to the questions and then respond. We would argue that medical interpreters are much more efficient in rendering the message accurately and interpreting the answers patients give, which tend to be explanations, rather than one- to two-word responses. Telephonic and remote video interpreters, as well as on-site interpreters, also work in the evenings and on weekends. So, availability is typically not an issue if the medical provider has a quality service provider.

Going to the doctor's office can be stressful enough, with filling out insurance forms, waiting for the doctor and feeling sick all at once. After waiting to see a doctor (which will certainly take more than four minutes), we'd like to think we can take the time we need to fully explain what we've been feeling or experiencing, without having to read or listen to an app, which may or may not contain the questions necessary to discuss our ailment. If we needed an interpreter, we would hope the doctor would take the four minutes or less to access one and read our charts while we wait. This seems like a much better use of technology and time.

Medical Translation and Interpreting: Saving Money, Saving Lives

Some professions can be very competitive and those who don't perform the same type of job duties may not understand why. Sometimes I think, "Why are these people being so competitive and cut-throat with their colleagues? It's not like they're saving lives!" However, in the field of medical translation and interpreting, we can say that yes, linguists often might be saving lives. Here are two examples of how medical translators and interpreters can save clients money while their work can save lives: The first example is found in an article posted in January 2009 in American Medical News from the American Medical Association. This case involved a New Jersey rheumatologist who refused to provide a sign language interpreter for a patient being treated for lupus. This patient consistently requested an interpreter, but claims that her requests were always denied. The physician's argument was that Medicare did not reimburse the entire cost of an interpreter for each visit. Instead, he passed written notes back and forth to the patient and her family.

Apparently, this was not enough for the patient to feel as though she understood what was happening at the medical visits and she transferred to another doctor. The patient sued the original physician, claiming violation of the federal Americans with Disabilities Act and the Rehabilitation Act, along with New Jersey's anti-discrimination law. The jury found the rheumatologist had indeed discriminated against the patient when failing to provide a sign language interpreter.

If a medical interpreter had been present at the child's visits with the rheumatologist, she might have felt differently about the care she received and would not have sued the physician, which will likely cost him more than an interpreter would have.

Then there is the story of Lia Lee, a child raised in California of Hmong refugees and the focus of Anne Fadiman's book, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. Lia was misdiagnosed twice as having had pneumonia, when in reality, she was epileptic from the time she was an infant. Lia's parents did not speak English well enough to communicate with the doctors who treated her, and they often misunderstood how to care for her at home. They did not know how to describe the child's seizures effectively to her physicians, as in their own culture, these episodes seemed to convey that her body was being overtaken by a spirit.

Misunderstandings continued between Lia's parents and her physicians, as both sides were unable to communicate effectively and understand each other's cultures. A New York Times article reported, "The seizures worsened; by the time Lia was 4 ½, she had made more than 100 outpatient visits to medical facilities and been admitted to the hospital 17 times. When she was not quite 3, in frustration at what he viewed as her parents’ refusal to administer her medication, Dr. Ernst (Lia's physician) had Lia legally removed from the family home." Lia was sent to live in foster care for one year, yet another blow to her parents. Her health worsened and the relationships between her parents and her physicians were strained, as neither side seemed to adequately comprehend the culture and language of the other. Lia died on August 31, 2012.

A medical interpreter at Lia's visits and proper translation of her prescriptions and care instructions could have allowed Lia to receive consistent and proper care for her condition, likely avoiding her placement in foster care. Needless to say, such services would have greatly improved her quality of life.

These are only two of the stories about how medical translation and interpretation can save lives and reduce costs by avoiding unnecessary tests, misdiagnoses, treatment errors and miscommunication. To ensure compliance with federal regulations as a health care provider, be sure to request professional interpreting and translation for patients and their families. It truly can save you money and continue to save lives.

“Obamacare” and LEPs: How does the law upheld by the Supreme Court affect the translation/interpretation industry?

What a week it’s been in politics! Now that the Health Care Law has finally gone before the Supreme Court, which upheld it on a 5 to 4 vote, those of us who work in medical translation and interpretation on a daily basis want to know: What does this mean for us?! For most Americans, the Health Care Law has been confusing from the start. However, imagine how confusing it could be for those millions of Americans who have limited English proficiency (LEP). This can be even more confusing for them. What are their rights? First, we have to look at what the rights have been so far for these individuals when it comes to language access in health care.

Title VI of the 1964 Civil Rights Act

Executive Order 13166, Title VI of the Civil Rights Act of 1964 states, “No person in the United States shall, on the ground of race, color, or national origin be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” (42 U.S.C. Section 2000d). In short, any organization, whether a clinic, hospital or other health care facility that receives federal funding must comply with this executive order by providing language access (free of charge) to LEP individuals. This is also true in areas of law and other fields, but for the sake of this post, we’ll stick to the health care issue at hand.

Unfortunately, many health care facilities will try to get around this law by asking patients to bring a friend or family member who is bilingual, or many times, they’ll have someone on staff come in to “interpret” for LEP patients. For those who work as interpreters and language agency owners or project managers, we know that this is a bigger problem, as those individuals are usually not trained in the medical terminology needed to carry out the appointment, nor are they trained in the fine skill of interpretation. Much of these attempts to weasel one’s way out of providing professional, quality service stems from the fact that these facilities have to foot the bill.

Don’t get us wrong. Many, many hospitals and doctors offices DO comply with Title VI;, however, many, many more do not. According to the National Center on Immigration Policy, LEP individuals accounted for 25.2 million (9%) of the population in 2010, although large concentrations of these demographics were attributed to states like California, Texas, New York, Florida, Hawaii, New Mexico and Massachusetts, among others. More and more states are seeing a rising number in minority populations whose first language is not English. In fact, although the Latino population has had steady growth in the past ten years, just recently, Asian Americans became the fastest-growing minority in the U.S.

So, what does all this have to do with language access in the health care debate?

One of the biggest issues in the political discussion on health care has been cutting costs and allowing all to receive health care and be insured. Although we may not see health care insurance covering the cost of language access for LEP patients anytime soon, we should see money saved by both insurance companies and health care facilities that provide professional language services to patients, as many more individuals will be able to go to the doctor and receive the care they need. Those who do not provide these services, but rather, rely on untrained individuals or (even more sadly) no one at all, will see their costs go up and possibly skyrocket, because miscommunications often lead to more doctor’s visits and adverse events that could have otherwise been avoided by providing proper language access to their LEP patients.

One section of the law discusses the implementation of effective approaches and specifically identifies “the ongoing, accurate, and timely collection and evaluation of data on health care disparities on the basis of race, ethnicity, sex, primary language, and disability status.” This data will be invaluable to many of us and it will be interesting to see if the information on patients’ primary languages affects the way that health care providers are reimbursed for offering professional language access services to patients.

Although up until now health care providers have not reimbursed by Medicare and Medicaid, we may see this change as a result of the passing of the Health Care Law. Provenzano argues, “Ultimately, one of the best arguments for Medicare reimbursement for language services is that the services themselves represent the linguistic equivalent of preventive care. By spending modestly up front to communicate effectively with LEP patients, Medicare—as well as Medicaid and private insurers—can save significantly through the prevention of costly errors.”

For those of us in the interpretation and translation industry, we will see a larger need from our clients who require on-site and telephonic oral interpretation, as well as the translation of vaccination records, consent forms, insurance policies, prescriptions, medical charts, etc. We’ll be on the edge of our seats to see what the next several years hold in store for all of us as Americans, especially LEP patients and we who provide professional language access to them every day.

For more information on LEP rights, please visit http://www.lep.gov/

CCHI announces the first group of CHI and AHI interpreters

The Certification Commission for Healthcare Interpreters (CCHI) announced the first group of Certified and Associate Healthcare Interpreters this week! This is quite a milestone in healthcare interpreting. In the past, the highest nationally recognized program for healthcare interpreter credentials was through a very well-known training program in the industry called Bridging the Gap. Although Bridging the Gap is still very much a valid and extensive training program with a successful turnout of well-trained healthcare interpreters, the new national certification through CCHI is expected to be the new bar set for interpreters to reach. CCHI launched the pilot exam in the late fall last year. Now, there is a list of 130 Certified and 105 Associate Healthcare Interpreters through this organization. By further allowing interpreters to gain education, training and certification, the Certification Commission is showing the nation that hiring an interpreter who is not really a trained interpreter, but rather, an employee's friend or family member, is not a good idea. In fact, many healthcare organizations are still allowing for patients to bring in family members or friends to interpret. Or, they look for the nurse that speaks Spanish to interpret for the Spanish-speaking patient who has an appointment today. This is not, and never should be, okay. For patient privacy purposes, a family member (unless already authorized to obtain the patient's medical information) should not be allowed to know something about the patient's medical condition before she/he does. A child should never have to interpret for his parent in a situation dealing with healthcare. Another healthcare specialist should also not be interpreting for a patient. He/she is not trained to be an interpreter. Sure, the nurse probably knows the terminology in English because she uses it every day, but this doesn't mean she knows it in the patient's language. Physicians should also be wary of the fact that some healthcare specialists (whether a nurse, a technician or another physician) may decide to tell the patient what they feel is best for his/her care instead of what the physician really stated.

Think about it. A patient comes in to see her general practitioner. She doesn't realize that she has a right to an interpreter according to the Title VI law and decides to bring her child with her. The woman's complaints lead the doctor to believe that she has a tumor. In what setting is it okay for a child to have to relay this message to his mother? Obviously, in this situation, without an interpreter present, the child has no choice. But how does the physician and his/her colleagues know that the child is using the proper terminology? How can one expect a child to do this? You'd be surprised. It happens all the time...although that doesn't make it right.

The Certification Commission should be commended for their endless hours of preparation for the national certification process. Hopefully, this is just the beginning of a long line of Certified and Associate Healthcare Interpreters to come!

For more information on CCHI's certification, please visit the CCHI website.