In Compliance, Interpreting

The Joint Commission’s vision is for all people to experience the safest, highest quality, best-value healthcare. Of course, effective communication from registration through after-care instructions is key to achieving this goal. Although this concept might seem simple, let’s dive a little deeper into what “effective communication” really means. After all, there is no one answer to “What is effective communication?” Healthcare providers must communicate health information to patients “in a manner tailored to the patient’s age, language, and ability to understand.” The Joint Commission also directs healthcare providers to be culturally competent, ensuring that communication takes each patient’s unique cultural background into consideration. So, “effective communication” varies from patient to patient. Let’s take a look at the communication of a single point of information to two very different patients to further explore how this works in action.

The Goal:

Effectively communicate to the patient that she has Alice in Wonderland syndrome (AIWS). AIWS is a neurological condition often associated with migraine headaches. AIWS patients see humans, parts of humans, animals, and inanimate objects as much smaller than in reality. For example, the family dog may appear to be the size of a kitten or a mansion may look like a dollhouse. There is no known cure, but treatments are available and there is no risk of death or bodily harm.

The Roadblock:

Alice in Wonderland is a beloved tale in the United States, popularized by cartoons, movies, and children’s stories. For patients who grew up with the famous tale, the connection between the condition and tale is easy to understand: Alice grows and shrinks throughout the story.  However, in some cultures and countries around the world, Alice in Wonderland is unknown or even reviled. Discussion of the name alone can cause concern and panic.

Patient #1

Maliha is a 24-year-old, Palestinian woman whose preferred language is Arabic. Palestinian culture has extremely negative views on Alice in Wonderland. Although she has never read or seen Alice in Wonderland, Maliha knows it is a controversial tale.

  • Challenge: “Alice in Wonderland” will mean nothing to Maliha. Maliha will not understand the reference and will probably be confused or even upset by the name of the disorder. To properly assess Maliha’s ability to understand, both the doctor and the interpreter will have to be sensitive to Maliha’s culture.
  • Plan of Action: To successfully explain AIWS to Maliha, the doctor may want to explain the symptoms and the connection to migraine headaches first, before explaining the name of the syndrome. Once mentioning the name of the condition, the doctor must be prepared to answer questions about Alice in Wonderland without showing any cultural bias. Saying, “I can’t believe you’ve never heard of Alice in Wonderland!” would demonstrate cultural insensitivity. The interpreter may need to assist the doctor in understanding Maliha’s culture and lack of knowledge of Alice’s story.

Patient #2

Roberta is a six-year-old little girl hailing from Mexico. She and her mother, Maria, moved to the United States only a year ago. They both speak Spanish. They both love Alice in Wonderland. In fact, Roberta was Alice for Halloween!

  • Challenge: The challenge here is that Roberta may not understand how something she loves is causing her so many problems. In fact, when she first hears AIWS, she might think it is something great or exciting. The doctor could potentially use the “eat me/drink me” reference from the tale. (Alice drinks a potion with “drink me” on its label that shrinks her to just 10 inches tall. A magic cake with “eat me” on it has the opposite effect). This might help little Roberta understand her condition better. But for her mom, the reference to “eat me/drink me” may make her think that the consumption of food or beverage caused her daughter’s condition.
  • Plan of Action: To successfully explain AIWS to Maria and Roberta, the doctor will need to be sensitive to Roberta’s age and ability to understand. Because AIWS doesn’t cause any physical harm, the doctor may want to use the “eat me/drink me” references from Alice in Wonderland to help explain to Roberta what is happening to her, so she can understand and won’t be afraid of her condition. On the other hand, the doctor needs Maria to understand that nothing Roberta ate or drank actually caused the problems, but instead there is a disconnect between what Roberta’s eyes take in and how her brain processes the information. The interpreter needs to choose his or her language choices carefully, using a child-level vocabulary for Roberta and an adult-level vocabulary for Maria.

The difference in the two examples above demonstrates the difficulty healthcare providers and interpreters can face in day-to-day care for limited English proficient (LEP) patients. Explaining the same disorder in very different ways based on the age, language and culture of each patient is the best method for achieving effective communication. This example showcases how vital it is to utilize a qualified medical interpreter when communicating with LEP individuals, rather than a close family member, friend, or bilingual staff.

Vocalink ensures that its interpreters are well-versed in medical terminology and culture to help healthcare providers meet the Joint Commission requirements of effective communication, cultural competence, and patient-and-family-centered care. Medical interpreting adds a whole new layer to ensuring your patients are both heard and understood.

Connect with us today to learn more about the interpreting services Vocalink Global can offer you and your organization.

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