By Courtney Case, OD
August 16, 2017
Communities in the U.S. are becoming more diverse, with influxes of Hispanic and Asian immigrants, among others. As an attending optometrist at two hospitals, one in Long Island, NY, and the other in Brooklyn, NY, I’ve seen these demographic changes first-hand, and know the impact being able to communicate with patients in their native tongue can make.
You Don’t Have to Be Fluent
Practitioners who can converse, carry out an exam, and perform services, in a foreign language, are at an advantage in providing care to communities in need. Fortunately, being fluent is not a necessity.
I started off with high school Spanish. I did not use it for many years, until I began practicing in the Bronx. It was a mostly Latino patient base, and I quickly reacquainted myself with the basics. Over time, those basics have expanded into comprehensive dialogue. My patients feel a sense of connection and ease when the language barrier is removed.
I also am learning French to better serve the Haitian Creole population. I am not fluent, but I have learned enough of the language to conduct an exam. Patients light up when I attempt to speak in their language. I instantly feel them relax, which is so important in patient care.
Start With Spanish
Regardless of location, doctors should have the ability to conduct an exam in Spanish. According to the 2012 U.S. Census, the Hispanic population accounts for nearly 20 percent of the population. This number is likely higher as it does not account for undeclared immigrants. The regions most populated with Hispanics include the Southwest, Southeast and areas of the Northwest. This expanding population is prone to high cylinder on refraction and a systemic history of diabetes. So, these are patients in need of good eyecare.
It also is in an OD’s own interest to be proficient in Spanish, aiding the OD’s marketability both as a practice owner and as an employed OD.
I started listening to Spanish radio on my drive home and watching telenovellas (Spanish soap operas) to expand my skill level. Another helpful resource came from speaking and practicing with friends who speak Spanish, and most recently, French. This is important as they can provide feedback on pronunciation. Even when you clearly state the word, if the pronunciation is wrong, the patient won’t be able to understand what is being communicated. This is especially true in the Latino community where pronunciation varies significantly depending on the country of origin.
At times, I still need to use a translator, or apps on my phone for translation. An excellent app is Google Translate. Click HERE to download the app for use on an iPhone and HERE to download the app for use on an Android device. You can speak in English, and it speaks back in Spanish and other languages. Another option is to use a professional service to provide over-the-phone interpretation. The service I use is Languageline, but there are other similar companies that you can choose from.
The greatest challenge in optometric care, when provider and patient do not speak the same language, is performance of subjective refraction. Having an accurate retinoscopy finding, or an auto-refractor, are starting points, but refinement occurs with subjective evaluation. Opto-types of numbers, or tumbling E, are valuable resources to aide in refraction, but nothing replaces understanding patient feedback.
In addition, getting an accurate case history, and educating the patient about your findings and diagnosis, are much harder when practitioner and patient don’t speak the same language.
An important element of patient education is the review of medication use. Without proper communication, mistakes could easily be made in the dosage and duration of application. These errors are easily avoided when the doctor is able to at least conduct an exam in the patient’s first language.
A Translator Isn’t Equal to a Bilingual Doctor
Doctors often feel relief when family members are present in the exam room to provide translation. This can be a great help, but proceed with caution. This is especially true when patients have their children present. Some patients may not feel comfortable with their child having knowledge of their health concerns. And when the child serving as translator is young, they may not convey the information to you accurately.
Even adult family members serving as translators can have a high rate of translation errors, including omission, substitution and the addition of information that didn’t come from the patient, as well as editorializing based on their own feelings, rather than those of the patient.
Offer Patient Education Materials in Patient’s First Language
Most electronic health record systems have educational material that can be printed in both English and other foreign languages. Patients find the information in their first language helpful, and it reassures me that they are able to take home accurate information.
I like to print educational material in the patient’s own language, and allow them to read it while dilating (as much as time allows before they are too blurry). As I finish the exam, I can then follow-up and ask if they have questions.
Another great resource is the American Optometric Association Marketplace. There are several brochures, and materials in other languages, that can be printed and handed out to patients. The information is comprehensive, and covers a range of topics from refractive error to ocular and systemic disease.
There also is information for doctors on how to best communicate with Spanish-speaking patients.
Another resource is from Transitions. They offer “My Multicultural Toolkit“ as part of their Cultural Connections program. It offers a wealth of information and strategies for promoting cultural competency.
Do you have many patients who don’t speak English? Have you learned to conduct exams in other languages? What resources can you recommend for learning foreign languages, and helping ODs to conduct exams in other languages?
Courtney L. Case, OD, FAAO, RYT, is an attending optometrist for Long Island Federally Qualified Health Centers, a division of Nassau University Medical Center in East Meadow, NY., and Bedford Stuyvesant Community Health Center in Brooklyn, NY. To contact: firstname.lastname@example.org