Everyone is familiar with the childhood rhyme, “Sticks and stones may break my bones, but words can never hurt me.” Whatever the wisdom of this statement, it most certainly isn’t true in hospitals and clinics across America — words can hurt, and not just emotionally. A multitude of recent studies examining how poor physician-patient communication can lead to poor patient outcomes have elucidated the critical role of language in optimizing patient care. Two interesting examples are medical interpreting and end-of-life care conversations.
Improper medical interpreter access is a significant problem for many Americans. Over 25 million Americans have limited English proficiency, leading to a strong demand for medical interpreters in hospitals and doctor’s offices. However, cost poses a significant obstacle for care providers, as in-person translators can cost up to $150 per hour1. For most doctor-patient interactions, amateur interpreters and bilingual family members are more commonly translators. In one study, 84% of resident physicians reported that they used “ad hoc” interpretation by adult family members and friends2, but these amateur interpreters can provide incorrect information to clinicians and feed miscommunication. In one case, a Spanish-speaking Florida teenager presented as “intoxicado” at a clinic and was treated for a drug overdose. Days later, doctors realized his true diagnosis: a brain hemorrhage. However, even with the proper diagnosis, it was too late to prevent the teen from becoming quadraplegic for life3. Amateur translators tend to make these devastating mistakes, with the error rate of “ad hoc” interpreters being 11 times higher than experienced interpreters3. Unfortunately, improving medical interpretation remains a difficult issue. The obvious solution seems to be hiring more professional interpreters, but for many offices this is simply too expensive.
Possible alternative solutions to the interpreter problem have come from a variety of sources, including modern technology. Some patients have reported that traditional technology, like interpreting over the phone, cannot fully facilitate physician-patient communication. But the advent of video conferencing platforms has some healthcare professionals excited, because it provides the “closest approximation to face-to-face interpretation while offering the productivity of remote interpretation” [4]. These video-based interpretation services have proven to be especially helpful for patients that communicate via American Sign Language. Though there are drawbacks, such as high initial cost, video conferencing seems to be a solution with great potential.
There are other promising options as well, including some emerging internally. Loyola University Chicago Stritch School of Medicine is testing a new program in which Spanish-speaking medical students are trained and certified as professional interpreters. There are hopes that it will help create more “well-trained, culturally competent” physicians [5]. Since medical students populate clinics in great numbers, and will one day treat their own patients as physicians, this program helps improve the availability of interpreter services. However, it remains to be seen if these medical student interpreters can fully replace professional interpreters.
As previously discussed, the other area of great concern is end-of-life conversation. Many doctors have trouble holding meaningful conversations with dying patients and their families. In fact, less than a third of families remember having end-of-life conversations with their loved one’s physician. Most doctors hesitate because they feel as though are draining their patients of hope. End-of-life conversations are indicative of a greater phenomenon: doctors are not fully comfortable with death. In fact, 99% of clinicians deem it necessary to have difficult conversations with patients, yet only 14% have them8. As a result, the patient suffers.
Many companies are working to alleviate this issue, including VitalTalk. VitalTalk is an innovative healthcare communication company founded by a team of doctors with the idea that “effective, empathic, and honest conversations” between clinicians, patients, and families comprise the foundation of patient-centered care9. The company offers a free guide to the public outlining proper delivery of devastating news as a clinician. The guide reduces the process to a five-step process: organizing the situation, understanding the patient’s current knowledge, delivering important information, demonstrating empathy, and explaining the next steps9. With specific regard to end-of-life conversations, studies have shown that better and more-frequent end-of-life conversations leads to better pain and symptom management [10]. Hopefully, VitalTalk can help physicians become more comfortable with these conversations and everyone can benefit.
Communication in medicine plays a crucial role in providing optimal patient care. Fortunately, new answers are emerging from a variety of different sources: private companies, medical schools, and modern technology. In the future, hopefully these options can minimize communication challenges between doctors and their patients so that physician words only heal and never hurt.
References:
Jacobs, B., Ryan, A. M., Henrichs, K. S., & Weiss, B. D. (2018). Medical Interpreters in Outpatient Practice. Annals of family medicine, 16(1), 70–76. doi:10.1370/afm.2154 Lee, K. C., Winickoff, J. P., Kim, M. K., Campbell, E. G., Betancourt, J. R., Park, E. R., … Weissman, J. S. (2006). Resident Physicians Use of Professional and Nonprofessional Interpreters: A National Survey. Journal of the American Medical Association, 296(9), 1049–1054. doi: 10.1001/jama.296.9.1050
Foden-Vencil, K. (2014, October 27). In The Hospital, A Bad Translation Can Destroy A Life. Retrieved October 18, 2019, from https://www.npr.org/sections/health-shots/2014/10/27/358055673/in-the-hospital-a-bad-translation-can-destroy-a-life.
Masland, M. C., Lou, C., & Snowden, L. (2010). Use of communication technologies to cost-effectively increase the availability of interpretation services in healthcare settings. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 16(6), 739–745. doi:10.1089/tmj.2009.0186
Aitken, G. (2019). Medical Students as Certified Interpreters. AMA Journal of Ethics, 21(3), 232–238. doi: 10.1001/amajethics.2019.232
Bailey, M. (2018, February 12). Doctors Learn How To Talk To Patients About Dying. Retrieved October 18, 2018, from https://khn.org/news/doctors-learn-how-to-talk-to-patients-about-dying/.
Beck, E.R., McIlfatrick, S., Hasson, F., Leavey, G. (2017). Health care professionals' perspectives of advance care planning for people with dementia living in long-term care settings: A narrative review of the literature. Dementia. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26378123
Serious News. (n.d.). Retrieved October 18, 2019, from https://www.vitaltalk.org/guides/serious-news/.
Job Description. (n.d.). Retrieved from https://www.vitaltalk.org/wp-content/uploads/VitalTalk_CEO_JobDescription.pdf
Wright, A. A., Zhang, B., Ray, A., Mack, J. W., Trice, E., Balboni, T., … Prigerson, H. G. (2008). Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA, 300(14), 1665–1673. doi:10.1001/jama.300.14.1665
Health Care Insider: Approaching End-Of-Life Conversations as A Physician. (2017, March 31). Retrieved from https://healthcare.utah.edu/the-scope/shows.php?shows=0_mhwopdne