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Can You Communicate With This Patient?



You are serving at the international immigrant health clinic in Dallas. At the door of the waiting room a scene like the United Nations opens before you: Somalis, Iraqis, Hmong, Burmese – many wearing traditional dress. You call aloud the name of your next patient, “Sunita Bajracharya please.” A middle-aged lady gets to her feet, speaks to children around her who all sit back down, and approaches you with a greeting, “Namastae doctor, ma khushi meet Lae timi Chaa.” She smiles as if you clearly understand. You do, don’t you?


Moments later you both take a seat across from one another. Ms. Bajracharya looks at you expectantly, rubs the side of her neck, and exclaims, “mero Ghatee Lae pani mero pachadi Dukha ma Cheen.” You reply, “Could you please speak English with me?” Ms. Bajracharya gives you a questioning expression.


At this point you should choose which ONE of the following actions?


A. Go invite one of the children with Ms. Bajracharya to interpret.
B. Instruct an assistant to ask in the waiting room for someone who speaks both Nepali and English.
C. Inquire at the clinic’s human resources department about who among the staff speaks Nepali.
D. Delay the appointment while locating a professional interpreter.


Think carefully and then select the best response. The correct answer is D. Untrained interpreters ― friends, family members, untrained staff ― are prone to omissions, additions, substitutions and volunteered opinions. They may also be unfamiliar with the particular terminology, or may be tempted to informally mediate rather than simply interpret information. Use of children as interpreters is particularly hazardous. They may be uncomfortable with bodily functions, adult situations and interpersonal conflicts. Use of children as interpreters also undermines patient confidentiality, can cause friction within the family structure, and may cause children to take on burdens and responsibilities for which they are unprepared.


You recognize that quality healthcare is quite dependent upon accurate communication, and that the field of language interpretation is rapidly growing in recognition and professionalism. Your patience is rewarded a short time later with the arrival of a certified interpreter. But communication through an interpreter also requires certain skills.


Each of the following guidelines should be followed when speaking through an interpreter EXCEPT which ONE?


A. Humor is a universal language and translates across cultures.
B. Allow adequate time for interpretation.
C. First-person speech is preferred.
D. Periodically affirm that the listener understands.


Try your hand at this question. What answer did you select? The correct answer is A. Humor rarely translates effectively from one language and culture to another, so it should be avoided. Similarly, not all gestures have the same meaning from one culture to the next, and seemingly innocent gestures can cause great offense. Speaking through an interpreter greatly slows the exchange of information, so adequate time must be allowed. An extremely useful technique known as teach back involves asking the listener to explain back to the speaker what was said and what it means. In the process of doing so, the speaker can both affirm the accuracy of the original communication and also correct any misunderstandings.


The book The Spirit Catches You and You Fall Down is one of the most tragic and well-documented cases of cross-cultural misunderstanding in American healthcare. Please join INMED on October 9th to welcome Spirit author Anne Fadiman as she addresses the 2012 INMED Cross-Cultural Healthcare Symposium on behalf of the immigrants and refugees among us like Ms. Bajracharya.

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