Tuesday, November 24, 2015

Weekly Tidbit #8 -- Richness of Communication

by Chris Moreland
Hi Everyone,
Our weekly Tidbit this week is from Chris Moreland, a hospitalist attending physician in San Antonio. Chris wrote recently about collaborative care with a patient whose primary language is Spanish. 
His note is interesting and prompts thoughts about all of the ways that people communicate, the importance of respect-filled interactions, and the richness of communication that is possible in collaborative care.
Chris wrote:
            Hi, all:

            Health disparities are well documented among people who speak a language other than English. I wanted to share a particularly striking experience during my last week of collaborative care in September, when our team took advantage of opportunities to work with our Spanish-speaking patients on their own terms (figuratively and literally).

            On Tuesday that week, we scheduled UH's staff Spanish interpreter, Irene Jiminez, to join us while visiting one of those patients. Before we entered the room, she laid out some crystal clear ground rules (eg, speak directly to the patient). During our discussion, the patient and his family members ended up switching between both languages, so she interpreted when needed and monitored the discussion otherwise. While it was a bit chaotic with 15 team members and varying levels of Spanish usage, it was nice to see our focus switch from our favored English more toward their primary language.

            Later in the week, we spoke with our non-interactive patient's mother, who spoke only Spanish. We decided beforehand that her primary intern, Jose, and Tiffani (who all speak Spanish) would manage the collaborative care conversation with her, while the rest of us observed. Todd wrote notes on the paper in Spanish and summarized for us. (See the attached photo.)

            On Friday, we were unable to secure an in-person interpreter, so we communicated through an over-the-phone interpreter, with Jose scribing and summarizing. While the phone protocol took a while, it did force us to stay on-message and limit tangential comments.

            The literature on communicating with limited-English proficient patients often addresses three methods: in-person interpretation, over-the-phone interpretation, and language-concordant providers. I'm proud to say that the team successfully used all three methods during collaborative care rounds, inching ever closer to true patient-centered care.



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