You've got questions.
We've got solutions.


A BLOG FOR THOSE WITH VISION...


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.

Physician.png

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.