How Do We Modify Clinical Care For Non-English Speaking Patients?

Question

Answer

• Options for interpreters:
  • Official hospital interpreter
  • Language line
• Not speaking English ≠ hard of hearing!
• Shouting does not make someone magically gain English fluency OR hearing ability
• “Ad-hoc interpreters”: family, friends, support staff, strangers in waiting rooms
• What is the risk of using ad-hoc interpreters? Benefit?

As a respiratory therapist, you are often in live or die situations. You need to make sure people and family understand what you say if you do not speak their language. How do we modify our clinical care? An official hospital interpreter is someone that you can call either on a language line, a video call, or in person. Language lines can be very frustrating. I have had patients on a ventilator trying to talk through a language line, which is virtually impossible. However, we have to try.

Non-English speaking does not equal hard of hearing. They do not understand English, so stop shouting at them. People, unfortunately, make that mistake all the time. Shouting does not make someone magically gain English fluency or hearing ability.

Ad hoc interpreters are family, friends, support staff, or strangers in waiting rooms. However, there are some risks with using ad hoc interpreters. The person may not be as fluent as you think, or there can be a family dynamic that you are not unaware. What is the benefit? In an emergency, it can be conducive, even life-saving. However, you cannot do it just because you do not want to call the interpreter. This option should only be used in an emergency.

Non-English Speaking Patients

• Patients have the right to a translator
• Make handouts in several languages OR with only images
  • Ask for help with translation
    • Translating service
    • High school/college language professors
    • Language graduate students
    • Bilingual family members
• Non-English speakers are less likely to return for follow-up appointments
• Higher rates of drug complications and hospitalizations
• Keep in mind that when using a translator, facts can get lost in translation

https://www.npr.org/sections/health-shots/2014/10/27/358055673/in-the-hospital-a-bad-translation-can-destroy-a-life

Again, patients have a legal right to a translator. You can make handouts in several languages or with only images. Ask for help with translation or provide translating services. In terms of your handouts, you may be able to get assistance from high school or college language professors or graduate students. You have to get them approved by your clinic or hospital, but this would be a great project for someone to do. Bilingual family members or bilingual friends are also great resources. Find someone whose native language is Spanish first. There is always going to be someone that can help with translation for things like handouts. However, you cannot just call anybody into the exam room with you.

Non-English-speakers are less likely to return for follow-up appointments. Higher rates of drug complications and hospitalizations. Keep in mind that when using a translator, facts can get lost in translation. I have provided a link to an NPR article about translators in the hospital, showing how things can go very wrong. Pause this recording and take a moment to read this. Hopefully, this helps you to understand why we need to have translators in our clinics. This article shows that it can be life-saving to have a translator. And, as respiratory therapists, you are in charge of life-saving techniques that a language barrier can severely impact.

This Ask the Expert is an edited excerpt from the course, Cultural Awareness and Implicit Bias in Healthcare, presented by Sara Pullen, PT, DPT, MPH, CHES.