Download Consulting through Interpreters

Consulting through Interpreters:
Training Medical Students
Aim
• To improve medical students ability to provide care for patients with Limited English Proficiency
•
Objectives
• To use role-play of interpreted scenarios using bilingual actors to given them exposure to the
process
• To foster an understanding of the challenges of triadic interpreted consultations.
Learning Outcomes
• Students recognise the importance of using a professional interpreter in patients with Limited English
Proficiency
• Students are able to employ the various techniques which help optimise the use of an interpreter in a
triadic consultation (e.g. positioning, language, maintaining eye contact with patient)
• Students recognise the importance of a patient-centred approach and awareness of cultural
influences on ideas, concerns and expectations
Why teach this?
1.
Evidence of Heath Inequalities for patients with Limited English Proficiency (LEP)
– Lower clinical contacts, lower preventative care uptake
• Jacobs, E. A et al. 2001. ‘‘Impact of Interpreter Services on Delivery of Health Care to
Limited-English-Proficient Patients.’’ Journal of General Internal Medicine 16:468–74.
– Less information giving to patient with LEP.
• Crane, J. A. 1997. ‘‘Patient Comprehension of Doctor–Patient Communication on Discharge
from the Emergency Department.’’ Journal of Emergency Medicine 15:1–7.
–
Poorer adherence to treatment and follow up, decreased satisfaction with care and
increased complications
• Gandhi, T. K. et.al. 2000. ‘‘Drug Complications in Outpatients.’’ Journal of General Internal
Medicine 15:149-154
• Manson, A. 1988. ‘‘Language Concordance as a Determinant of Patient Compliance and
Emergency Room Use in Patients with Asthma.’’ Medical Care 26: 1119–28
2.
Evidence that professional interpreters improve care for patients with LEP to approach or
equal that for patients without language barriers. Also studies show professional interpreters
improve communication (errors and comprehension), utilization, clinical outcomes and
satisfaction with care
•
Karliner, L. S., E. A. Jacobs, A. H. Chen & S. Mutha (2007) Do professional interpreters improve
clinical care for patients with limited English proficiency? A systematic review of the literature.
Health Services Research, 42, 727-754.
3.
Evidence that clinicians who receive training on how to work with interpreters
– More likely to use professional interpreters
– Both patients and clinicians more satisfied with consultation and clinicians more respectful
– Even 1.5 hour intervention improved knowledge, skills and attitudes of medical students.
- Bischoff, A., T. V. Perneger, P. A. Bovier, L. Loutan & H. Stalder (2003) Improving
communication between physicians and patients who speak a foreign language. British Journal
of General Practice, 53, 541-546.
- Jacobs, E. A., L. C. Diamond & L. Stevak (2010) The importance of teaching clinicians when
and how to work with interpreters. Patient Education and Counselling, 78, 149-153.
4.
Tomorrow’s Doctors 2009 (GMC)
– Graduate will be able to communicate sensitively and effectively with individuals and groups
regardless of their age, social, cultural or ethnic backgrounds or their disabilities, including
when English is not the patient’s first language
– Students are responsible for ensuring patient safety
– Interpret findings from the history, physical examination and mental-state examination,
appreciating the importance of clinical, psychological, spiritual, religious, social and cultural
factors.
– Students are responsible for ensuring patient safety
– Interpret findings from the history, physical examination and mental-state examination,
appreciating the importance of clinical, psychological, spiritual, religious, social and cultural
factors.
5.
Not covered elsewhere in curriculum
Evidence looking at Family Interpreters
6.
7.
8.
9.
More major errors in interpreting (Prince and Nelson 1995, Flores 2003)
Clinicians and patients less satisfied with quality (Hornberger 1997, Kuo and Fagan 1999, Lee 2002)
Patients preferred professional interpreters over family members due to issues of accuracy and
control (Ngo-Metzger et al. 2003)
Family members act mainly as a third participant often speaking as themselves. Professional
interpreters act mainly to ensure information transfer (Leanza et al. 2008)
Message: not always wrong to use family member – may be patient choice and advocacy may be welcome.
However, they need to be aware of potential problems. Rarely acceptable to use a child.