Today, many sections of the country are experiencing an increase in population segments where English is not the primary language. The resulting language barriers and cultural miscommunications often prevent patients from seeking the care they need. Effective communication among dentists, staff, and patients is the heart of a dental practice. Dentists are responsible for ensuring the patient has a full comprehension of the diagnosis, procedure, treatment instructions, and plans for follow-up care.
Providers who are unable to effectively communicate with patients for whom English is a second language often order additional tests and other costly, and sometimes invasive, procedures to compensate for the ineffective communication. This can also create legal implications when unaddressed language barriers lead to poor treatment outcome, false expectations, or unequal access to care.
Dentists and other health care providers often utilize interpreters to respond to the challenges of serving culturally diverse populations. They employ bilingual-bicultural staff (including partner/associate dentists), hire trained interpreters, and use patients’ family members or friends. There are advantages and disadvantages to using these types of interpreters.
A bilingual-bicultural staff member is considered by most medical and dental providers as the ideal interpreter because he or she is fluent both in the patient’s language and culture. The advantages of using bilingual-bicultural staff are convenience, knowledge of dentistry, and they may be viewed as trustworthy by the patient.
Hiring trained interpreters who have a good working knowledge of dental terminology can be costly, and it can be difficult scheduling the interpreter and the patient to come on the same day. However, these interpreters understand the importance of confidentiality, and patients generally trust them.
The advantages of using a patient’s family member or friend are convenience and the fact that the patient may prefer that person over someone they do not know. However, there are many potential disadvantages to this approach. They often make errors in interpretation due to language limitation. For example, in the Hmong language there is no word for “cancer”, or even a concept of it. When trying to explain “radiation”, a friend or family member would translate this as “we’re going to put fire in you,” which obviously would deter the patient from consenting to treatment. A trained interpreter would be a better choice in this instance because of his or her understanding of medical and dental terminology.
Additionally, patients may not share information they do not want their family member or friend to know, such as prior drug or alcohol abuse. It can also strain family relations by burdening a minor child with the responsibility of communicating for a parent. Children do not have the vocabulary in either language to handle dental-related conversations, and often become bewildered by the content being discussed and by their lack the maturity to deal effectively with what they hear.
If the patient decides to use a family member or a friend for interpreting purposes, all involved must be aware of patient confidentiality. Ask the interpreter to explain to the patient that personal information will be discussed and ensure that it is all right to speak on those topics with the family member or friend present. The patient should sign an agreement stating that he or she understands and agrees to allow the family member or friend to be involved in the overall discussion. The agreement has to be either in their native language or translated by the interpreter. If a document such as an informed consent form is presented to a non-English-speaking patient in English, the interpreter translating the document should also sign and date the document next to a phrase that states, “the foregoing has been read to [patient’s name] in [language].”
One of the best tools for facilitating conversations is to have key documents translated into the most common languages of a dentist’s patient population. Informed consent, medical history, prescriptions, and many other forms must be understood by the patient to help ensure effective communication.**
Trying to explain the location of pain or complications related to dental treatment can be a tremendous communication hurdle for both patient and dentist. Ensuring dentists are communicating clearly to patients in a language they understand is one of the many cultural variables that may lead to a misunderstanding.
It is important to know where patients are “coming from” to lead them to successful oral health and treatment.
**TDIC offers informed consent and other forms in English, Spanish, Korean, and Chinese. The forms can be downloaded from the Risk Management section of the TDIC web site at thedentists.com.
*Mr. Keene is a risk management analyst for TDIC, Sacramento, California.