Risk Management _ __________________________________________________________________________
ENHANCING THE PATIENT-PHYSICIAN RELATIONSHIP
Introduce yourself to new patients. Listen attentively, without interrupting. Avoid acting rushed, and provide adequate time to talk to each patient. Explain plans for treatment and follow-up. Use language the patient can understand—avoid jargon and provide interpreter services, if necessary. Apologize for any delays in the office schedule. Remain within your scope of care and competence, providing timely referrals if necessary. Encourage patients to write down their questions before they come to the office. Do not guarantee the outcome of a treatment. Provide educational resources for patients, asking them their preference for media format. Ask the patient about his or her preferred level of involvement in decision making (and document this in the
patient’s record). Source: [36; 92; 97]
Table 3
is English-speaking) [103]. In addition, physicians should ask what language patients prefer for their medical care informa- tion, as some prefer their native language even though they have said they can understand and discuss symptoms in English [103]. Physicians should use plain language in their discussions with patients who have low literacy or limited English proficiency. They should ask them to repeat pertinent information in their own words to confirm understanding [104]. Reinforcement with the use of low-literacy or translated written educational materials is helpful. “Ad hoc” interpreters, such as family members, friends, and bilingual staff members, are often used instead of professional interpreters for a variety of reasons, including convenience and cost. Physicians should check with their state’s health officials about the use of ad hoc interpreters, as several states have laws about who can interpret medical information for a patient [105]. Even when allowed by law, the use of a patient’s family member or friend as an interpreter should be avoided, as the patient may not be as forthcoming with information and the family member or friend may not remain objective [105]. Children should especially be avoided as interpreters, as their understanding of medical language is limited and they may filter information to protect their parents or other adult family members [105]. Individuals with limited English language skills have actually indicated a preference for profes- sional interpreters rather than family members [106]. Most important, perhaps, is the fact that clinical consequences are more likely with ad hoc interpreters than with professional interpreters [107]. A systematic review of the literature showed that the use of professional interpreters facilitates a broader understanding and leads to better clinical care than the use of ad hoc interpreters, and many studies have demonstrated
that the lack of an interpreter for patients with limited English proficiency compromises the quality of care and that the use of professional interpreters improves communication, utiliza- tion, clinical outcomes, and patient satisfaction with care [108; 109]. The importance of professional interpreters to effective communication and patient safety has been recognized by the development of The National Board of Certification for Medical Interpreters, founded in 2010 by the International Medical Interpreters Association [110]. When professional interpreters are not feasible or available, bilingual staff members may be used, and their adherence to several principles can enhance their effectiveness [105]: • Use the universal form of the language when possible • Avoid assuming the role of interviewer or decision- maker • Allow the patient to lead the discussion • Translate everything (without additions, deletions, or changes to meaning) • Translate in a way to convey the patient’s cultural context • Meet the patient before the interaction to be translated • Meet with the physician before the visit, to develop a structure to the interaction • Seek continuing education to improve interpretation skills Physicians should encourage their bilingual staff members to enhance their interpretation skills. Resources for such train- ing include the Cross Cultural Health Care Program and the National Council on Interpreting in Health Care.
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