9 Tips for Communicating With Non-English Speaking Patients
Key takeaways:
For many Americans, English is not their primary language. But, unfortunately, limited English proficiency (LEP) can cause language barriers that contribute to poor health outcomes.
It’s tempting to use family members or apps to help translate, but those approaches come with additional challenges. Using a medical interpreter is the best way to ensure optimal communication with patients who have LEP.
Even when working with an interpreter, healthcare providers (HCPs) can improve communication using basic techniques to enhance understanding.
In our global society, more people than ever move around the world for work, for educational opportunities, and because of war and civil conflict. Healthcare providers (HCPs) must continue to be mindful that English is not always patients’ primary language. A language other than English is spoken in approximately 1 out of every 5 households in the U.S., and over 25 million Americans have limited English proficiency (LEP).
Unfortunately, LEP contributes to poor health outcomes because of communication barriers. But there are things that HCPs can do, including working with a medical interpreter, to overcome those obstacles.
Why is it important to overcome language barriers in healthcare?
Language barriers in healthcare frequently lead to miscommunication between HCPs and patients. And, when there’s miscommunication, both patients and HCPs experience dissatisfaction, and the quality of care and patient safety are affected.
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Negative patient outcomes that result from language barriers in healthcare settings include:
Delays in surgery
Fewer preventative screenings
Higher rate of central line infections
Increased fall rate
Less access to the healthcare system
Longer hospital stays
Medication management problems related to adherence and understanding of discharge instructions
More frequent hospital readmission
More surgical site infections
Higher risk of pressure injuries
Under Title IV of the Civil Rights Act of 1964, Medicaid and other federally funded programs are required to provide language assistance to people with LEP. Even so, less than 70% of all U.S. hospitals provide language services for patients. And less than 30% of outpatient providers report regularly using the services of professional interpreters.
In addition to helping avoid miscommunication, interpreters can bridge cultural differences, as they relate information in a way that is both technically accurate and culturally specific. In one study of Latino patients with diabetes, participants who switched from a solely English-speaking primary care provider to a Spanish-speaking provider saw a significant improvement in glycemic control compared to those who switched from one solely English-speaking provider to another.
Tips for communicating with non-English speaking patients
When treating patients with LEP, providers often rely on bilingual staff and patients’ family members to help interpret. Some also use smartphone apps for translation. But the best practice is to involve a trained medical interpreter.
Family members should only be relied on to interpret in urgent situations, as there’s a higher risk for medical errors and incorrect translation, as well as a potential for patient confidentiality being violated, when this option is used. Also, family members may not be comfortable relaying sensitive information on topics like sexual health, substance abuse, and terminal illness.
Translation apps are often not HIPAA-compliant and don’t have the complexity to accurately interpret in medical situations. If you do use a translation app, you should only use one that’s been evaluated and approved by your employer.
Even when working with a medical interpreter, HCPs can take steps to help ensure that they are communicating clearly and accurately. Use the nine tips below to improve your communication when you’re treating a patient with LEP.
1. Keep sentences short and simple
Shorter sentences that are worded simply are easier for the interpreter to keep up with, which improves the accuracy of their translation.
2. Maintain appropriate eye contact
Speak directly to the patient, making eye contact with them. Avoid looking at and speaking to the interpreter unless you are asking them for clarification. This will allow both you and your patient to pick up on physical cues.
3. Speak slowly
Allow the interpreter time to translate and phrase information clearly for the patient. Also, avoid interrupting the interpreter to guess the patient’s reply because it can come across as rude.
4. Don’t use slang
Avoid using slang and medical jargon. These kinds of terms may not be able to be translated accurately, resulting in miscommunication.
5. Be mindful of your body language
Use body language that shows you are engaged and interested, such as leaning toward the patient. If you’re wearing a mask, be aware of how it may affect the patient’s ability to understand you. And interact in person when possible, as telemedicine can make it difficult to build rapport with patients.
6. Be culturally competent
Showing cultural competence means incorporating cultural beliefs, behaviors, and needs into a patient’s healthcare plan. Culturally competent care increases the quality of services and improves outcomes.
7. Engage with the interpreter
Check in with both the patient and the interpreter to ensure you are being understood. Before the visit, introduce yourself to the interpreter and summarize your needs and the patient’s medical history. At the end of the visit, check back in with the interpreter to ensure you both ended the encounter with the same understanding.
8. Be patient and repeat what you said if there is a misunderstanding
If the interpreter seems confused with something you’ve said, ask them if you need to restate or clarify anything. Be patient if the interpreter seems to take a long time to translate things, as they may be working out the phrasing. On the other hand, if the interpreter gives a brief answer to something that took a long time to translate, it may be because of a lack of understanding. Make sure that the patient’s responses are being translated completely; don’t simply accept a yes or no answer if there seems to have been more said.
9. Use teach-back techniques
Asking the patient to demonstrate a technique or teach you back information ensures that they have understood what you were saying.
What if an interpreter is not available?
Some healthcare facilities have access to interpreters over the phone. Wearable communication technology, such as the Vocera badge, allows HCPs to contact language assistance directly from a HIPAA-compliant, hands-free device.
Some facilities successfully use online translation tools like Google Translate and MediBabble. Just remember that not all translation tools are HIPAA-compliant, so make sure your organization has evaluated and approved any program that you use.
In an emergency or other extenuating circumstance, a patient’s family member can act as an interpreter. But this is the least preferred option.
The bottom line
Limited English proficiency (LEP) affects a large proportion of people living in the U.S. When treating patients with LEP, there is an increased risk of miscommunication, which leads to poor outcomes. So it’s important to ensure that you are communicating clearly with these patients by working with a medical interpreter.
Even when you’re working with an interpreter, you can improve communication with simple techniques like verifying that information has been received and understood.
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