Eyeworld

July 2017 • Ophthalmology Business 21 education, notification, or informed consent; some also target a specific healthcare setting, medical condi- tion, or language." Chen et al. said that improving and increasing language access has occurred mostly at the state level. For example, some states have required that emergency rooms and others provide professional interpreters when needed, while others have expanded this to include all private managed care plans and individual and group health insurers. But even when an official interpreter is an option, patients might opt for family members, and the situation can get dicey. Take the example presented by Glenn Flores, MD, in a perspective published in the New England Journal of Medicine. 9 A 12-year-old boy came to the emer- gency room in Boston with dizziness and headache. His mother spoke no English and his was limited. Yet he acted as the interpreter between the physician and his mother. The moth- er, in Spanish, described how her son had been dizzy for a week with no fever and how his father's side had a history of diabetes. The physician, after hearing the mother's speech in Spanish, asked the child patient if his mother was saying he looked yellow. The boy re- peated the question in Spanish to his mother, and from there, confusion ensued. The mother said he looked dizzy and pale; the son repeated in English that she said he was "para- lyzed, something like that." The boy, according to Dr. Flores, was treated inappropriately for his condition as a result of this miscommunication. Language barriers can often lead to misinformation about how to follow medical instructions. A small study published in 2003 recorded 13 patient encounters in a 7-month period, resulting in 474 pages of tran- scripts. 10 Interpreters in the encoun- ters included professional hospital in- terpreters and "ad hoc" interpreters, such as nurses, social workers, and family members. The study authors found that 63% of errors resulted due to issues with medical interpretation, which could have had clinical conse- quences. These included not asking about drug allergies, not asking about dosage and other instructions for antibiotics and fluids, not explaining that a hydrocortisone cream had to be applied all over instead of only to the rash, and a mother who thought she was told to put amoxicillin in the patient's ears rather than administer- ing it orally. Ad hoc interpreters were more likely to have errors that could result in clinical consequences. If a doctor is concerned he or she and the patient are not on the same page due to a language barrier, despite an interpreter, Ms. McGaffigan recommended asking the interpreter to ask the patient what they've heard, what they need to do, and why it's important, and having the interpreter translate that back to the provider in a teach-back method. That could at least help identify if a misinterpretation occurred before treatment proceeds. "I would try to use that third person as a guidepost to validate and verify what the patient knows," Ms. McGaffigan said. With big medical decisions, Ms. McGaffigan advised, "Having experienced translators is essential for shared decision-making, espe- cially with respect to understanding what matters to the patient, making informed decisions, and determining plans of care." Ranya Habash, MD, assistant professor of ophthalmology, Bas- com Palmer Eye Institute, Miami, said Bascom Palmer uses InDemand Interpreting services, which created a mobile app that physicians can use to reach specialized interpreters with dozens of different languages avail- able. Dr. Habash said she recently had a patient who spoke only Creole. She used the app, and while the patient did not speak English, after communicating with her through the interpreter on the app, he said, "good technology!" OB References 1. Beckman HB, et al. The effect of physician behavior on the collection of data. Ann Intern Med. 1984;101:692–6. 2. Marvel MK, et al. Soliciting the pa- tient's agenda: have we improved? JAMA. 1999;281:283–7. 3. Langewitz W, et al. Spontaneous talking time at start of consultation in outpatient clinic: cohort study. BMJ. 2002;325:682–3. 4. Kutner M, et al. The health literacy of Amer- ica's adults: results from the 2003 National Assessment of Adult Literacy. National Center for Education Statistics, U.S. Department of Education. 2006 Sept. 5. Medical Library Association. What Did My Doctor Say? www.mlanet.org/p/cm/ld/fid=580. Accessed April 12, 2017. 6. Bittner A, et al. Translating medical doc- uments improves students' communication skills in simulated physician-patient encoun- ters. BMC Med Educ. 2016;16:72. 7. Ryan C. Language Use in the United States: 2011. American Community Survey Reports. U.S. Census Bureau. www.census.gov/prod/ 2013pubs/acs-22.pdf. Accessed April 13, 2017. 8. Chen AH, et al. The legal framework for language access in healthcare settings: title VI and beyond. J Gen Intern Med. 2007; 22 Suppl 2:362–7. 9. Flores G. Language barriers to health care in the United States. N Engl J Med. 2006;355:229–31. 10. Flores G, et al. Errors in medical inter- pretation and their potential clinical conse- quences in pediatric encounters. Pediatrics. 2003;111:6–14. Editors' note: The sources have no finan- cial interests related to their comments. Contact information Braga-Mele: rbragamele@rogers.com Galor: AGalor@med.miami.edu Habash: ranya@hipaachat.com Marks: markshcconsulting@gmail.com McGaffigan: pmcgaffigan@ihi.org

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