Lost in Translation; Conference Addresses Ways to Overcome Language Barriers in Health Care

In today’s hospitals and clinics, vital health information is often lost in translation as English-speaking doctors struggle to effectively communicate with their non-English-speaking patients.

Misunderstood or poorly communicated medical information can result in undesirable treatment outcomes, frustration for both patients and doctors and contribute to health disparities.

To address the problem, the CT-RI Public Health Training Center at the Yale School of Public Health co-hosted a daylong conference earlier this month with the International Medical Interpreters Association, CT Multicultural Health Partnership and Connecticut Department of Public Health that drew more than 100 health care professionals interested in the new standards for Culturally and Linguistically Appropriate Services in Healthcare (CLAS) due to be released by the U.S. Department of Health and Human Services (HHS) this month.  

Medical school is worthless, noted Dr. Raul Pino, director of health at the Hartford Department of Human Services, if doctors are unable to translate vital health information to their patients. A native of Cuba, Pino recalled the relief of both patients and their physicians when he was called from his former duties as a nursing aid to translate.

The symposium, “Connecting Cultures: Promoting Equal Access to Healthcare,” was held at Yale’s West Campus and focused on promoting access to care for patients with limited or no English proficiency.

The 2012 CLAS standards broaden the definition of culture and health, said C. Godfrey Jacobs, a program manager with SRA International and a member of the HHS CLAS standards committee in his keynote address.  The standards aim to eliminate disparities by building rapport, developing trust, personalizing care and increasing patient satisfaction. “CLAS ought to be a way of doing business,” he said.

The CLAS standards were first published in 2000 as a strategy to address health inequities. The Affordable Care Act also has 62 provisions specifically addressing race, ethnicity and language barriers to health care.

At Boston City Hospital, 70 full-time staff members provide medical translation. In addition, treatment rooms are equipped with two-way telephones that can connect within minutes to interpreters of 150 languages. During the last fiscal year the hospital used medical interpreters 205,000 times.

“Language barriers cost money. At $17.77 per request [for an interpreter], this is a bargain,” said Eric Hardt, M.D., associate professor at the Boston University School of Medicine and a physician at the hospital. People with limited English proficiency are administered more unnecessary tests and treatments, have longer hospital stays, more return visits to emergency departments and poor adherence to post discharge instructions. “If you think of medical interpretation as ordering a test or treatment, it’s cheap,” he said.

Manual Rodriguez Davalos, M.D., a liver transplant surgeon at Yale New Haven Hospital and assistant professor at the Yale School of Medicine, argued that medical interpreters are an essential part of the team. Even when he uses his native Spanish to speak to a patient or family, the rest of the team needs to understand what is being communicated between the patient and physician.

In addition to issues surrounding translation, CLAS standards also call for other culturally appropriate services. In an era when African-Americans are affected at higher rates than whites in every single disease category, regardless of income and education, unequal treatment is a result of social, environmental, health systems and policy factors. The CLAS standards also now include religion and spirituality, said Ellen Boynton, president of ESB Consulting and Training Associates. Providers need to understand their own biases in order to make patients with different backgrounds feel comfortable and supported.

The CT-RI Public Health Training Center at the Yale School of Public Health is placing priority on cross cultural communications training for all sectors of the public health workforce and will soon announce a new initiative to be lead by Elaine O’Keefe and Dr. Rafael Perez-Escamilla of the Office of Community Health where the PHTC is based. 

This article was submitted by Denise L Meyer on November 13, 2012.

Eric Hardt, M.D., associate professor at the Boston University School of Medicine and a geriatrician at Boston City Hospital

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