Navigating the Health Care System

Tool Helps Hospital Staff Improve Communications for Patients with Limited English Skills

By Carolyn M. Clancy, M.D.

November 9, 2012

If you're sick or need emergency care, being unable to communicate effectively can be a serious, even life-threatening, situation.

Take the tragic case of Willie Ramirez, a healthy, Spanish-speaking 18 year old who developed a sudden and intense headache.

Willie, in a coma, was taken to a hospital. His Spanish-speaking family members told the emergency room doctor that they thought he was “intoxicado.” Among Cubans, that word can mean a person feels ill because of something they ate or drank. Willie had gone to a fast-food restaurant earlier that day.

However, the ER doctor assumed “intoxicado” meant that Willie had overdosed on drugs. Based on that information and on a physical exam, he treated Willie for an overdose.

The family didn't believe that Willie's illness was brought on by drugs, as the ER doctor did. In fact, Willie was an athlete, and his family knew he didn't use drugs. But they were reluctant to challenge an authority figure's opinion and did not do so.

They did not ask for an interpreter because some information was being provided to the doctor in English by Willie's 15-year-old girlfriend.

In fact, Willie had not suffered from a drug overdose or food poisoning, but he had experienced serious bleeding in his brain (a stroke). As a result of getting the wrong treatment, Willie suffered severe brain damage that left him unable to use his arms or legs.

This tragedy occurred in 1980. But it continues to hold valuable lessons that doctors, nurses, and patients can use to prevent a similar event from taking place.

The United States has a growing number of people with limited English skills. About 25 million people, or nearly 9 percent of the U.S. population, have limited proficiency in English, meaning they speak English “less than very well,” according to the U.S. Census.

Research has shown that patients with limited English proficiency are more likely to be harmed by adverse events in the hospital than patients who speak English very well. Further, this harm is likely to be more severe compared with errors that affect English-speaking patients.

To help address this issue, AHRQ has developed a new training module that teaches hospital staff how to work more effectively as a team to reduce the risk for communication errors. The module uses a scientifically tested teamwork system that has been show to improve communication among hospital staff and reduce adverse events.

If you or a loved one do not speak or understand English very well, you can play an important role in making sure that you are being fully understood. You should —

• Ask for a professional interpreter. Hospitals may have interpreters on staff. Interpreter services should be available by telephone or video. You will not be charged for this service.
• Don't rely on a friend or family member to translate medical information. It is difficult and stressful to interpret for someone else. Research shows that professional interpreters are less likely to make important mistakes than people who have not been trained to interpret. Even if a friend or family member has good English skills, he or she may still be unfamiliar with certain medical terms. Never ask a child to interpret.
• Take it in stride if your doctor uses an interpreter. Don't be offended. Your doctor wants to make sure that he or she can get all the needed information and can answer all of your questions completely.
• Ask questions about your follow-up care. Errors due to poor communication can also happen when you go home from the hospital. Make sure you ask questions about how to take your medicines, when you need to come back for follow-up appointments, and other issues. You can find a handy list of 10 questions you should ask here, available in English and Spanish.

Communicating so you're understood is an essential part of safer, better health care. Working together, patients and health providers can make that happen.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
TeamSTEPPS® Enhancing Safety for Patients with Limited English Proficiency Module
http://www.ahrq.gov/teamsteppstools/lep/

AHRQ Publication No. 12-0041. Improving Patient Safety Systems for Patients with Limited English Proficiency: A Guide for Hospitals. September 2012
http://www.ahrq.gov/populations/lepguide/lepguidefig3.htm

Questions for Your Health Care Provider (Questions are the Answer):
http://www.ahrq.gov/questions/tenquestions.htm

Health Affairs Blog. Language, Culture and Medical Tragedy: The Case of Willie Ramirez.
http://healthaffairs.org/blog/2008/11/19/language-culture-and-medical-tragedy-the-case-of-willie-ramirez/

Current as of November 2012

Internet Citation:

Tool Helps Hospital Staff Improve Communications for Patients with Limited English Skills . Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, November 9, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc110912.htm