How Do You Say, “Do you speak English?”
We have all seen it or done it – trying to communicate with someone who does not speak your Language. Struggling through gestures, pointing, talking slowly, over enunciating, throwing in a random word you remember from your high school class, or adding an “o” to the end of a work and crossing your fingers. It can be frustrating, embarrassing, and only occasionally successful. It is fine if you are trying to find the café or bathroom in a foreign country, but not great if you are trying to provide high quality healthcare to your patients.
Our current healthcare system is filled with patients who have Limited English Proficiency, that is, they have decreased ability to speak, understand, read, or write English. Per the PEW Research Center, in California, New York, New Jersey, and Florida, one in five people are foreign born. According with Migration Policy Institute in 2014, about one-fourth of foreign-born immigrants are from Mexico; India, China and the Philippines follow with about five percent each. Depending on where you live, you may have a larger population of immigrants from other areas in the world like Bosnia, Somalia, Burma, El Salvador, Korea, or Syria.
Thanks to Title VI of the Civil Rights Act in 1964, all patients who have limited English proficiency require an interpreter. Failure to do so is illegal and discriminatory, and can also be dangerous. Read this article for an example: http://www.npr.org/sections/health-shots/2014/10/27/358055673/in-the-hospital-a-bad-translation-can-destroy-a-life
So, for those of us who are not fluent, make sure to offer the use of an interpreter to effectively communicate with patients and families.
Here are some common mistakes made when encountering families or patients with limited English proficiency:
- Don’t assume, because the patient or family is nodding along, that they understand. They may be able to speak some English and understand basic conversation, but that doesn’t mean they understand the complexity of medical language. Even if you spoke another language, wouldn’t you prefer to make critical decisions in your native language?
- Don’t let the family translate. Would you want your child to be responsible for sharing all that is necessary about making a medical decision for you or have a private conversation between you and the doctor…and your neighbor or uncle?
- Don’t assume because they understand spoken English that you can give out written education in English. Make sure to allow for all education to be in the language they understand most, for each method of delivery.
- Don’t talk to the interpreter; talk to the patient! Use first person language, sentence-by- sentence, and focus on your patient. Don’t dumb down the language, but do avoid use of idioms. Make sure to verify that your patient understands.
- Don’t forget to take into account cultural differences. Use your resources of medical interpreters, social workers, and the rest of your team to make sure you are not missing anything in translation. Make sure to communicate what you learn with everyone involved in their care, so you can know about their beliefs in healthcare, prayer schedules, diet restrictions, or anything else that could impact their care.
Hopefully, these tips will help make your next experience a little better – for both you and your patient! ¡Hasta luego!
References:
http://www.aafp.org/afp/2014/1001/p476.html
http://www.pewresearch.org/fact-tank/2014/05/14/15-states-with-the-highest-share-of-immigrants-in-their-population/
http://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states#Current%20and%20Historical%20Numbers%20and%20Shares
