What are three techniques you would use when communicating with a patient who has limited English speaking ability?

In all healtcare settings today, providers are seeing patients from such diverse cultural backgrounds that it is impossible to have staff capable of understanding all the languages of these patients. The culture of medical practice in the United States has its own very specific language. Care teams get used to communicating with one another, and they sometimes find it hard to simplify their way of speaking enough to be understood by patients and families — expeciallay those who are learning English as a second language. The key is being prepared to err on the side of over-simplifying. The tips that follow can be adapted to a broad range of non-native speakers.

TIP #1: English is a difficult language. 

We take for granted in the U.S. that much effort is made by people around the world learning our language. If English is your first language, you may not realize you were lucky to learn English without much conscious effort and it is hard to appreciate the struggle of those who have to put great effort into speaking and understanding it.

 Consider these examples:

 If the word through is pronounced “throo” then why is enough pronounced “ee-nuff?” Why isn’t the word cough pronounced “coo?” Why is threw sometimes spelled through, and why do these two words that sound exactly the same mean two completely different things?

 It’s also very difficult to learn which syllable gets the accent in English words –  beginning (DEN-ver), middle (col-o-RAD-o), or end (cor-TEZ). In many other languages the accents are equal or they are indicated in the spelling of the word like Còmo està. Also consider the strange spelling of English words like science and since not to mention the illogical trio their, there, and they’re.

TIP #2: Keep It Simple. 

Basic words such as good, give, take, more, and less will be better choices than positive, administer, increase, decrease. Keep sentences simple as well. Avoid run-on sentences. Americans tend to be uncomfortable with silence, so we ramble on if there’s a break in conversation. As we ramble, we tend towards more complex ideas rather than simpler ones. Try to allow some silence between simpler phrases and pause after asking a question. The other person my need a moment to consider their best answer.

TIP #3: Give and Seek Feedback. 

 Even if you are using simpler words and shorter sentences, you can’t be certain there has been communication until the receiver acknowledges it with feedback. Remember, head nodding does not count as feedback with people from many different cultures. Even with Americans, and definitely with children, head nodding is often a sign of partial comprehension. So you must ask clarifying questions.

TIP #4: Mis-undderstanding. 

 You may say to a person, “I want to help you,” but she may hear “I won’t help you.” She may be perplexed that this is your response, but she may be very inclined to accept the word of a healthcare professional who is in a position of authority. She may perceive you as being uncaring, but certainly won’t say so. Many MISunderstandings go unnoticed by both parties. Asking clarifying questions is crucial.

TIP #5: Speak More Slowly not loudly. 

Often when people don’t understand our language, we treat them as if they are deaf or “slow” without realizing we are doing so. Articulate your words in shorter phrases rather than just speaking more loudly.

TIP #6: Repeat…reapeat 

Much of what we gain from a conversation is in the context or general content of the discussion. Our brains constantly fill in the missing information. If we don’t actually hear every word, we compensate. For example, if I say, “I left you a message on your______” you will almost automatically fill in the blank with cell phone, phone, or voicemail. Non-native speakers will struggle to do this. So repeat key phrases and summarize key points. 

TIP #7: avoid acronyms and idioms. 

The medical culture has a language of its own that includes many acronyms like NSAIDs and ED. Using acronyms shows poor awareness of communication skills that improve pateint engagement. Common expressions and idioms can also block communication. Imagine how confusing an expression such as “we can kill two birds with one stone” might sound in the context of a follow-up appointment. 

TIP #8: offer written information. 

Written material with detailed information about medications and treatments should always be offered. These instruction should be used to support a thorough explanation in the doctor’s office. Offering hand outs even if you only have an English version is worthwhile. Written materials that can be taken away and read at a leisurely pace are sometimes greatly appreciated. The patient may have a family member or friend who can translate. Note than these eight tips are also useful when working with limited literacy patients and those who have low health literacy.

 Communicating with limited English proficiency patients is one of the greatest challenges for healthcare professionals. Having a fluent speaker on hand who is either a trained interpreter, a staff member, or adult family member is ideal, but not always possible. Hopefully, the eight practical tips covered here will prove helpful.

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