Life is about connections.
Our family, social, work and on line connections make us happier and healthier. The outcomes of trials hinge on connections. I work with my clients on ways to connect with the jury, because without that connection we’re unlikely to win the case. Medicine is probably the profession most dependent on connections. The patient and the healthcare team are just that–a team. If they don’t communicate in such a way that they understand each other and form a strong relationship, the health of the team suffers.
But how do you forge connections when you don’t speak the same language?
It can be close to impossible. I tried a case where the patient spoke primarily Chinese. During her medical care the doctors had used an interpreting line to communicate with her. This is a device where the doctors and nurses dial up a number on a phone, indicate they need a specific language interpretation, and then they say what they want to communicate to the patient–only into the phone. Then the patient takes the phone and the faceless voice on the other end interprets that information. With that, they are trying to build a connection. Can that ever work?
During the trial, we had an Chinese interpreter there live in person. This was fraught with challenges. Our first interpreter didn’t speak the same dialect as the patient, so he had to leave and then we waited hours for one who did. When she arrived she noted that the patient would often switch dialects, but they could still communicate. Often, the interpreter was late because she was so busy with other jobs. At trial we had the luxury of waiting up to 45 minutes before we started testimony to ensure the interpreter was there. Doctors don’t always have that luxury. They have to make treatment decisions quickly, and they want their patients to understand those treatment decisions. They also want to create connections.
Can you really create connections through an interpreter, on the phone?
As of 2014, one in five U.S. residents spoke a foreign language at home. In speaking with my doctor friends in the U.K, I know this is a challenge there as well, especially in light of the refugee crisis. This means more and more doctors will be using translator lines. The U.S government has recognized this has the potential to be a real problem for these patients. Under Section 1557 of the Affordable Care Act, on Nondiscrimination in Health Programs and Activities, each covered entity must post taglines in the top 15 non-English languages spoken in the state. That tagline has to inform patients they have access to an interpreter. Super-a tagline. Taglines don’t create access to empathy, humor, education and the exchange of opinions. And we know that’s what it takes to provide good care. It’s also what it takes to avoid lawsuits.
Creating these types of connections takes takes eye contact, a personal touch, and a meeting of the minds.
Those are hard to come by via an interpreter on the telephone. And a language barrier can lead to mistakes. It can be a barrier to comprehension and increase the risk of adverse medication reactions. In one reported case, there was an incorrect operation performed on the patient’s hand due, in part, to a language barrier during the time out process. Part of that process includes confirming with the patient what type of surgery they’re having. It’s a great idea that may not work if the patient doesn’t speak the same language as the person asking the question.
Until we have answers to this problem, there are things that both doctors and patients can do.
Doctors can determine whether they need a translator available before the visit so that they and their staff can be prepared. They can take the time to ensure all questions are answered, and document the interaction well. Providing the patients access to their notes will allow them to have them interpreted and more quickly recognize any misunderstandings. For patients, while it’s always helpful to bring an advocate, it becomes even more so in these circumstances. Work to ensure that you do understand what’s been explained, and take the time to review materials that your healthcare team provides.
The current push towards technology in health care should find a way to help with this issue. My mantra in response to this push has always been that technology without humanity doesn’t win hearts or minds. Doctors have to find a way to overcome the translator, the telephone, and the language barrier to find some connection with the non-English speaking patients. Patients have to do the same.
If we can’t connect with a common tongue, hearts and minds have to pick up the slack.