A successful clinician-interpreter collaboration can lead to improved health outcomes for patients, writes Rachel Showstack. However, Kansas health care professionals receive minimal training on basic interpreting protocols. (Getty Images)
The Kansas Reflector welcomes opinion pieces from writers who share our goal of widening the conversation about how public policies affect the day-to-day lives of people throughout our state. Rachel Showstack is associate professor of Spanish at Wichita State university and founder of Alce su voz, an organization that supports health equity for Spanish speakers in Kansas.
This September, at a safety net health clinic that provides care for uninsured individuals in Wichita, a doctor neglected to follow the standard protocol of briefing the interpreter on the upcoming visit, walked directly into the exam room with the interpreter following him, and told his Spanish-speaking patient in English that it was time to make preparations for the end of her life.
The interpreter, who was completing a practicum for Wichita State University’s graduate certificate program in Spanish for the professions, had no opportunity to prepare herself emotionally for the interaction or think about the type of language needed for this context. A pre-session is considered the best practice for communicating through an interpreter, but in a recent e-mail the clinic’s volunteer coordinator maintained that providers are only there to do their jobs and “do not see their role as trying to accommodate interpreters’ needs.”
The clinic’s staff failed to understand that practices for provider-interpreter collaboration are not primarily designed to accommodate interpreters’ needs. Rather, they are important for reducing liability, increasing patient adherence to providers’ recommendations, and assuring effective communication between the provider and the patient.
A successful clinician-interpreter collaboration can lead to improved health outcomes for the patient. However, health care professionals in Kansas receive minimal training on basic interpreting protocols, and health care institutions do little to ensure that best practices are followed.
As indicated by Pilar Ortega and Tiffany Shin in an article published in Health Affairs, health care providers should receive training on how to apply language-appropriate health policies to ensure equitable care for patients who need language assistance. If providers at the Wichita health clinic were to receive such training, they would be able to identify patients with non-English language needs and determine the most appropriate way to use the patient’s preferred language when providing care. They would also understand that the provider and patient are expected to direct their gaze toward each other during an interpreted interaction (not toward the interpreter).
Yet over the years, my students have described situations in which clinicians at the clinic were unable to follow these basic guidelines.
Health care providers should receive training on how to apply language-appropriate health policies to ensure equitable care for patients who need language assistance. If providers at the Wichita health clinic were to receive such training, they would be able to identify patients with non-English language needs and determine the most appropriate way to use the patient’s preferred language when providing care. – Rachel Showstack
Health care providers should receive training on how to apply language-appropriate health policies to ensure equitable care for patients who need language assistance. If providers at the Wichita health clinic were to receive such training, they would be able to identify patients with non-English language needs and determine the most appropriate way to use the patient’s preferred language when providing care.
– Rachel Showstack
As interpreting services are increasingly offered remotely, using over-the-phone or video-remote interpreting systems, providers must also receive training on how to use such systems and how to determine when they should or should not be used. A member of Kansas’s deaf and hard of hearing community explained to me that while VRI can work for American Sign Language interpreting, there are some situations, such as when a patient is visually impaired, that make communication through VRI impossible. Without providers trained to use the VRI system, patients can be left waiting for care and in some cases may be required to reschedule their appointment.
When providers and health care facilities depend on remote interpreters and are not able to use them, they risk violating civil rights and antidiscrimination legislation and facing lawsuits. Worse, delayed care could have a detrimental effect on a patient’s health.
While interpreting services are the most common method of providing language access for patients who require care in a language other than English, physician language concordance is the most equitable way to care for such patients. Language concordance describes a situation in which a provider speaks the patient’s preferred language and is trained and certified to provide care in that language. This practice may not be feasible for many less commonly spoken languages in Kansas, but the objective of preparing Kansas’s bilingual health care providers to care for patients in Spanish appears much more reasonable as the state’s Latino population grows.
One challenge to this objective is that professional programs, such as Wichita State University’s undergraduate nursing program, must adhere to curriculum requirements set forth by their accreditation bodies, leaving some majors without elective credit hours. However, other majors allow more flexibility and could be supplemented with Spanish courses, and summer courses are also an option.
Health professions students who already speak Spanish could take advanced Spanish language courses designed for health professionals in specific fields, while students with limited background in the language could learn basic vocabulary that would allow them to build rapport and better understand their patients with the assistance of an interpreter.
Preparing future health professionals to communicate with Spanish-speaking patients can start before college. North High School’s bio-med program, which is designed to prepare students for health-related careers, could include medical Spanish classes, for example. Lack of resources to hire the appropriate teachers can appear to be an insurmountable challenge, until cross-disciplinary collaborations are developed and faculty begin to think outside of the box.
There are promising signs that educators and administrators in Kansas’s health professions programs are making progress toward preparing students to work with patients who need language assistance.
In 2018, the Wichita State School of Nursing began a collaboration with the Spanish program to engage nursing and Spanish students in patient care simulations involving interpreter scenarios. The University of Kansas offers a Spanish course for health care workers, which pre-med students take, and at Wichita State an increasing number of students have shown interest in taking our Spanish for the Health Professions course. In addition, a few educators in health professions programs at both Wichita State and KU have hosted guest classroom lectures on best practices for collaborating with interpreters.
However, much more needs to be done to prepare Kansas providers to care for patients who need language assistance in a state that is becoming increasingly diverse and continues to suffer glaring health disparities.
Through its opinion section, the Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.
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