Best Hospitals 2007
Bridging the Language Gap
Some hospitals make non-English-speaking patients feel right at home
That neutrality is perhaps the hardest part of the job, says Heather Cazarin, one of AnMed's Spanish interpreters. "You see people not getting it, and it's real tempting to add more explanation," she says. "I'm not a doctor, I'm not a radiation technician, and I should not be explaining medicine or radiation." Cazarin had to explain the difference between a bacterial and viral infection to Lucia Lau, mother of a 15-day-old girl, Britani, who was admitted with a fever. "I came to the U.S. five years ago, from Peru," says Lau, through Cazarin. "I know some English but don't understand everything the doctors say to me." Doctors had to tell Lau they had ruled out a bacterial infection but needed to keep Britani on antivirals for a while until some tests came back.
Cazarin has to deal with cultural disconnects as well. In some very traditional Hispanic cultures, for instance, a wife tends to defer to her husband in medical matters or the husband insists on interpreting for the wife. "I can hear the husband editing the wife's answers," says Cazarin, "and I have to tell him--politely--to let her speak for herself."
Medical staff needs to be sensitive, too. "A lot of times, if there are children in the room, even grown children, patients will minimize symptoms," says Wong of St. Vincent's Chinese patients. "It's part of the culture not to trouble your children." These dynamics change as the parent ages, as they will tell the doctor to let the son or daughter decide on treatment. "That makes it hard to know if you are really getting informed consent," says Wong.
Talk easily. Mon Lam, a 58-year-old man on 15 East with a bleeding gastrointestinal tract, hasn't relied on his children as much as he has on Faith Zhao, the physician assigned to the floor. "It's very good to be in a place like this," says Lam. "I can talk easily to the doctors and nurses." It turned out he had a malformed junction of an artery and vein near his stomach. In a relatively simple procedure, doctors sealed off the junction, and Zhao, speaking in Lam's native Cantonese, tells him he's OK to go home but to stay on soft foods for a while.
St. Vincent's also has patients who are Hispanics, western Europeans, Indians, or Hasidic Jews who speak Hebrew. There are bedside cards in Chinese telling patients about language services but not in many of the other languages. And while Ellen Gayama, the language coordinator, uses five full-time interpreters plus 120 members on the hospital staff who speak 30 foreign languages--from Albanian to Yiddish--only 30 of them have, so far, been through the hospital's 32-hour certification course covering medical terminology and ethics. (More classes are scheduled.) "This is a work in progress for us," says Dennis Greenbaum, chair of St. Vincent's department of medicine. "We don't have the resources to do everyone at once."
At least the hospital is aware there are cultural differences. "Some hospitals around the country say there are no disparities and they treat everyone equally," says Amy Wilson-Stronks, a health services researcher at the Joint Commission on Accreditation of Healthcare Organizations. Wilson-Stronks is in the middle of a project evaluating language and culture service at 60 hospitals. "There's definitely a learning curve, and hospitals are on different points of that curve."
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