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Narrowing the Language Gap in Medical Tourism: Communications Guidelines for Physicians
Part 1: When You and Your Patient Speak Different Languages and Come from Different Cultures
How do you insure good communication when you are a native speaker of one language but your patient is a native speaker of another? Even if you speak the patient’s language “more or less” well, and/or your patient speaks your language—possibly a little less well than you speak his/hers, communication issues will arise that may impact the success of the surgery or medical treatment for which he/she has come.
In which language do you communicate? Do you try to make the patient feel more comfortable (but yourself less comfortable) by conducting the medical exam in his/her native language? Do you speak in your native language and thereby risk the patient’s leaving out or miscommunicating symptoms, medical history, or the reason(s) for which he/she is seeking treatment abroad because of lack of fluency in yours? What do you do when neither you nor your patient share fluency in any common language?
Today’s climate of “cross-border” health care and medical tourism has made the issue of clear patient/physician communication a number one concern in assuring quality and success in healthcare delivery.
Unlike care of patients who live permanently in the country in which your practice is located, medical tourists only visit your hospital/practice and your country for a limited amount of time. They come to you with either a diagnosis given by a physician in their home country or because they have made a personal decision to have a specific elective procedure performed. Often they have supplied you with their medical records and/or the home physician’s diagnosis and procedural advice prior to their arrival. Still, it’s important for you to conduct a medical interview, check that medical history personally and examine the patient prior to starting treatment or performing the medical procedure for which they have come.
Whether or not you consider yourself quite fluent in the patient’s language and/or the patient speaks your language well, the possibilities of medical error due to omission or miscommunication of information are greatly increased by differences in your languages and cultures. Language differences hinder physician/patient communication and thus medical outcomes has nothing to do with either your expertise as a physician or the technology your hospital or practice has to offer. However it is an issue that the entire medical tourism industry needs to address. You, as a physician engaged in the care of medical tourists, also need to address the difficulties that may arise in communicating with patients of different language and cultural backgrounds because it impacts both your efforts to offer the highest quality of care to these patients and your medical success rate.
Communication, in this new atmosphere of global health care is filled with “land-mines”—both visible and invisible. For example, can the patient adequately communicate his/her expectations regarding exactly what treatment/procedure he/she wants done or the outcome expected from that treatment? Are these expectations realistic? Has he or she consciously or unconsciously omitted or skewed pertinent information in the wish to have you perform this procedure? How will your own “cultural biases and rules” impact your understanding of what he/she has said or how you communicate your conclusions? If the patient is following the diagnosis and treatment plan made by a physician in his or her home country, do you agree with that assessment? Can you adequately communicate your medical views and/or explain any risks that may be involved and the outcome the patient should expect?
Most physicians are trained in “patient-speak” in medical school and know how to obtain from and present information to patients who come from the same linguistic and cultural background as they do. Most are practiced in reading the body language of these patients to gather non-verbalized information. However, the advent of medical tourism has made it necessary for physicians and their staff to learn to apply these skills in an entirely new environment and in a manner that is both accessible and acceptable to someone who does not share either their language or cultural background. Time is also of the essence, since the patient will usually want the treatment or procedure done almost immediately upon his/her arrival in your country and will plan to return home as quickly as possible after it is completed.[/vc_column_text][/vc_column][vc_column width=”1/3″][vc_column_text]This article is part of a series by Dr. Suzanne Salimbene, a senior consultant with the Mercury Advisory Group. Dr Salimbene’s book, What Langauge Does Your Patient Hurt In? is currently being revised for 3rd edition release later this year.
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Learn more about culturally Competent Care with the US Department of Health and Human Services Office of Minority Health.
In April 2013, the National CLAS Standards were re-released after undergoing a two-year enhancement initiative. This program, along with others featured on TCH, is scheduled to be under annual review for accreditation purposes and will be updated to reflect the National CLAS Standards enhancements.
To assist you during this transition, we recommend that you reference this crosswalk (PDF – 115 KB) and fact sheet (PDF – 59 KB) which will assist in understanding the numbering and organization of the re-released National CLAS Standards.
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