Eyeworld

20 Ophthalmology Business • July 2017 continued from page 19 "I was on a stretcher in a hallway for 9 hours, and then a nurse came to me after a shift change and asked me to sign my discharge instructions. I said I hadn't even had a conversa- tion with the healthcare team about my status and didn't know what the discharge instructions were, given that no one had spoken to me yet," Ms. McGaffigan recalled, noting that she also didn't have her glasses at the time and yet the nurse pressed her to sign. "There is a lot of production pressure that I think is causing our healthcare industry to forget about taking a moment to understand what's happening with patients and family members," she continued. "I hadn't even been informed at that time about what the results of my test were. I'm someone who knows how to advocate for myself, but I couldn't get the synapses of the system to recognize the fact that no one was clearly communicating with me about what was happening despite my requests for information and updates. It wasn't so much that it was medspeak, per se, it was no speak. When there is 'speak,' it's important to keep in mind there are many situations where providers are speaking far beyond the capabilities of a patient's and family's under- standing, and that increases the risk of healthcare-related harm." Dr. Braga-Mele said she's found the baby boomer and younger, Internet-savvy populations seem to be coming in well informed of their ocular conditions and treatment op- tions. However, she added, if patients are recent immigrants and English is not their first language, or if they come from a lower socioeconomic class, they can have less of an un- derstanding of ophthalmology and medicine because they don't have the language capabilities or facilities to research the topic on their own. "That's where you have to communicate on a different level with those patients, ask if they have someone they want to bring along to better understand what's going on, specifically if there is a language barrier," Dr. Braga-Mele said. When an actual language barrier exists Ms. McGaffigan, during that same visit to the emergency room, wit- nessed how a language barrier— where the patient and his or her caregivers do not speak the same language as the physician and other healthcare personnel—can impact care. "There was an elderly patient oc- cupying a hallway stretcher for many hours. She and her husband spoke Russian and her care could not pro- ceed until the translator arrived, and there was a time delay in the trans- lator's ability to get to her bedside," Ms. McGaffigan said, pointing out how one could see how critical that role was to understand the patient's history, symptoms, and complaints, and communicate all of the options. According to the 2011 American Community Survey, 60.6 million people (21% of the population age 5 and older) speak a primary lan- guage other than English at home. 7 Of those, 7% spoke no English at all (58% spoke English very well, 15% spoke English but not well). The Department of Health and Human Services issued guidance in 2000, un- der the directive of Executive Order 13166, to improve access to services to people with limited English. The legality of how to improve access or provide translation services, and who incurs that expense, varies from state to state. "In aggregate these laws provide additional protection for [limited English proficient] patients," said Chen et al. 8 "However, individual laws vary tremendously in scope and impact, and together leave many important areas unprotected. Many focus exclusively on patient Tips for effective physician- patient communication • Ask patients if they have any questions before they leave the office. • To assess how well patients understood something, ask them how they'd relay this information to a spouse or other family member. • Ask patients to tell you why they might think a certain thing to engage patients for more information and their perspective. • Watch patients' body language. Does it look like they're following what you're saying? • When it comes to recommended care, ask patients if the treatment plan is something they would be able to adhere to. • Consider having the patient bring a family member to act as a transla- tor or use a professional translator or translation service to help bridge language and cultural barriers. • Maintain an open-door policy so patients feel comfortable phoning or meeting with any follow-up questions. • Use certified decision aids to ensure that decision tools meet the criteria for health literacy and comprehensiveness.

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