Communication

Overcoming language barriers

Even if you don’t speak your patient’s language, knowing how to communicate is vital.

BY SUMÁYA RODRÍGUEZ, COA, OSC, ABO-AC, FNAO, USN RET.

At the beginning of my career as an ophthalmology technician, I was assigned to observe an experienced technician take chief complaints and medical histories along with visual assessments at clinic. Eventually, a young Spanish-speaking patient sat in our examination chair.

Since I speak Spanish, I offered the technician my services as a Spanish-to-English translator, but the technician roundly declined. Instead, the technician attempted to take a history with very little knowledge of the Spanish language, and what Spanish was attempted was ill-used. The young patient answered in a heavily accented English, but soon became nervous and gradually responded less to the questions.

By the visual assessment portion of the exam, the patient was flustered and began to read the Snellen visual chart from top to bottom rather than left to right. The technician became agitated and used the word “arriba” — while it translates from Spanish to English as “top” or “above,” the expression “Arriba! Arriba!” is an aggressive form of motivation to most Spanish-speaking persons. This caused more nervousness and grief, and neither the history taking nor visual assessment was successfully recorded.

In the same way that you tend to the needs of a patient who has low vision or a handicap, you must take all reasonable efforts to tend to non-English speaking patients.

Communication is crucial

Outside of seeking to learn every language spoken in your office’s region, you can resolve language barriers by exploring innovative and alternative methods for your patients’ communication needs.

Consider it an investment that will increase patients’ loyalty to your clinic as well as their dedication to their health care. Patients have been known to travel far and flock to the clinic that tends to their complete — and sometimes complex — overall needs. Also, patients are more willing to listen to and adhere to the recommendations of a medical staff that clearly communicates with them.

Exhibit that your clinic is willing to grow, modernize, or at least attempt to bridge cultural gaps. Attend to the language-limited speaking patient in the same way you attend to other patients’ needs.

Break down the barriers

To resolve language barriers, consider the following:

• Seek employees with second-language skills.

• Employ translators. Patients can request that on-staff, certified translators of various languages, including sign language, accompany them during their appointments. If using an in-office translator, all HIPAA rules must apply, and strict professionalism should be upheld at all times. Translators should adhere to remaining strictly translators, and never an interpreter of the physician’s or patient’s words. Make sure patients and physicians keep attention and eye contact with each other during the medical appointment — a translator’s voice only need be acknowledged as a bridge between the two parties. Conversations between patient and translator that require further explanation or patient education should always be translated to the physician. The physician must be privy to all conversations during the appointment.

• Prepare for the exam. Ask patients to have someone help them write their medical concerns or questions before an appointment (in English if you don’t have a translator). Also, encourage patients to bring a translator to their appointments, This step can increase the patient’s comfort level in addition to helping communication. One caveat: Not all family and friends are qualified to interpret medical information that is frequently new and outside of the interpreter’s knowledge. A patient’s eye care cannot be left to even the remote chance that patient instruction and education might be lost in translation.

• Create patient education materials. Provide instructions and informational signage on clinic walls in different languages according to the demographics of your location.

• Add technology. Although some technology can be financially out of reach for the average ophthalmic practice, many clinics and their patients can benefit from modern advancements in communications. Language translation apps and over-the-phone or video-screen translators afford medical professionals and patients the opportunity for better communication. Also, consider mobile, virtual presence devices that transmit voice and/or video translations — as well as consults from physicians — in remote locations. Just like the development of clinical skills, training communication technologies must become commonplace to become part of the clinic’s modern culture, so you must effectively train staff to use these technologies within the clinic.

Costs of translation

Human translators are probably the most sought after form of translation service. Only another human can add to the translation the inflection, tone and spirit of the doctor’s and staff member’s instructions. The need for personalized, face-to-face translation services, including those for sign language, is clear in cases where facial expressions are just as important as the sound of the human voice (for example, when the doctor instructs the patient how to instill glaucoma drops or properly patch a child’s eye).

The costs of a human translator services can vary widely depending on the language, the level of education and experience of the translator, the certification level of the translator, and the length of time the translator’s services will be used (usually calculated by the hour). Some well-certified translators expect to receive anywhere from $30 to $60 per hour, not including travel time to the office. Also, if the patient cannot keep the appointment, the assigned translator must still be remunerated at some level for time lost. For these reasons, human translators or their agencies are usually under contract in order to keep expectations of services and payments clear.

Over-the-phone and video-screen translators are a more cost-effective option, but they can present potential HIPAA regulations if speaker volume is too loud. Preparing your practice with digital equipment and quality speakers and microphones can be expensive as well, but you can cut costs by using your current computer hardware.

The “phone” conversations may take longer to complete as all voice communications must be spoken — and listened to — at least twice. Video communication is preferred to a faceless voice over a speaker. Putting a face to a voice can be done inexpensively with computer software, or more expensively with sophisticated programs that allow the translator to appear on an office computer or tablet.

Alternatively, translation apps for smartphones and tablets can eliminate the need of a translator. These can be obtained for free or at nominal prices, while more sophisticated computer translation programs can cost upwards of hundreds of dollars. Also, although virtual presence devices represent the most advanced and recent form of translation services, costs for these devices start at about $2,500.

Conclusion

As our clinics continue to see more patients who speak different languages, communication and technology must improve.

Increased diversity may add to the challenge of providing the custom care that patients need and expect from the ophthalmic clinic, but they also richly add to the constantly growing communication spectrum of the ophthalmic experience. OP