Language and Communication Resource
Communication: is the transmission of information or ideas from one person to another. The medical encounter relies heavily on communication through verbal and written language as well as body language. Title VI of the Civil Rights Act of 1964 requires that physicians make the best attempt at communicating with patients. For more information on Title VI see the section titled “Legal Requirements” below.
Language: English is the dominant language in the United States, but, according to the 2000 Census, approximately 45 million people in the United States speak a language other than English at home, and approximately 19 million have limited English proficiency (LEP). More than 176 different languages are spoken in the US, with Spanish, Chinese, French and German rounding out the top five in addition to English. American Sign Language (ASL) is also considered a “foreign” language and requires the same consideration as any other language. For more on languages in the US and information about where various languages are spoken, visit: http://www.census.gov/prod/2003pubs/c2kbr-29.pdfInterpretation vs. Translation:
• Translation: the conversion of written text from one language into another,
• Interpretation: the act of receiving a message in one language and sending exactly the same message in another language through a verbal exchange.
When evaluating an individual who is not a native English speaker, proper interpretation is key to obtaining the medical history, performing a physical exam, and explaining the illness and course of treatment to a patient. For more on how to use an interpreter see (HL: Toolbox card – How to use and Interpreter). Properly translated written materials are also critical to ensure effective communication in the case of obtaining informed consent, establishing advanced directives, and issuing discharge instructions and prescriptions. For written materials available in other languages, see "Culturally Specific Patient Information" at: http://www.dartmouth.edu/~biomed/resources.htmld/culturalcomp.shtml.
Even when the physician and patient both speak the same language, it is important to remember that medicine has its own language that may be unintelligible to those without medical training. Terms that are part of day-to-day medical language often are confusing to patients. For example, a patient may understand that he or she has a blood clotting disorder, but not understand the term “coagulopathy.” A simple way to ensure a patient’s comprehension is to have him or her repeat back to you his or her understanding of the conversation. Also, know the reading level of your pamphlets and handouts. The average reading level of parents of young children in the US was approximately 7th-8th grade in 1994. For more on comprehension, reading level and language, see: http://www.informatics-review.com/FAQ/reading.html.
Non-verbal Communication:
Body language is the unspoken communication that goes on in every face-to-face encounter with another person. Between 60-80% of the message is communicated through body language, only 7-10% is attributable to the actual words of a conversation. The position, gestures, and motion of the body can be interpreted differently depending on the culture. The use of hands is a method of nonverbal communication. A firm handshake may be a gesture of goodwill in the Anglo-American culture, but some other cultures prefer only a light touch, while others avoid such contact. Many cultures use handshakes more frequently than do most Americans, some even as a greeting between husband and wife. Standing with hands on hips may imply anger to some participants. Pointing or beckoning with a finger may appear disrespectful to some cultures. When unsure about what body language is appropriate within a cultural group it is best to use body language sparingly. Observe actions and interactions for clues, or ask an interpreter for advice.
Legal Requirements:
The Title VI of the Civil Rights Act of 1964 requires that physicians make the best attempt at communicating with patients. Additionally, the federal government requires any health care provider who receives federal funding from the Department of Health and Human Services to communicate with patients effectively or risk losing funding. These are referred to as the Culturally and Linguistically Appropriate Services (CLAS) standards. The standards that pertain to language are as follows:
1. Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
2. Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.
3. Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/ consumer).
4. Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.
Descriptions of the various laws governing communication can be found on the web site of The Office of Minority Health: http://www.omhrc.gov/templates/browse.aspx?lvl=3&lvlid=18.
Resources:Culturally Specific Patient Information: http://www.dartmouth.edu/~biomed/resources.htmld/culturalcomp.shtml
The Informatics Review. Comprehension and Reading Level. http://www.informatics-review.com/FAQ/reading.htmlThe Office of Minority Health, U.S. Department of Health and Human Services. http://www.omhrc.gov/
U.S. Census 2000. http://www.census.gov/