Maggie Eisner, May 2011

May 10th

IntroductionExercises – consulting with limited languageInteractive presentation – your experiences of

limited language consultations and how to improve them

DVDs of limited language consultationsBriefing for next week

May 17th – practising skills: simulated consultations in facilitated small groups

your experiences of consultations with patients who speak little or no English

Non verbal signals – body language, gestures Sign language Paraverbal – loudness, tone, manner of speaking Simplified language (‘basic English’) Drawings and diagrams (prepared, or drawn by

either doctor or patient) Leaflets in other languages Internet resources

Asylum seekers’ health portal http://www.harpweb.org.uk Translated leaflets - http://www.patient.co.uk

http://www.mind.org.uk/Information/BT.htm, http://www.healthinfotranslations.com

Interpreters – telephone or face to face; professional, informal or ad hoc

Basic EnglishWith interpreter in the room

Professional Family memberFriend Practice staff member

With telephone interpreter…..All need extra time…..

Speak clearly, slowly, calmly (don’t shout)Simplify English

Avoid idioms and colloquialisms Avoid jargon and technical terms Simplify grammar - short, simple sentences

Leave gaps for patient to process what you’ve said and compose reply

Simplify consultation structure More closed questions But offer alternatives to check that Yes means Yes (is the pain

worse when you sit? Or when you walk?)Consider

using pictures using mime (but some gestures aren’t universal and some may

offend)Remember your own expressions and body

languageTry to check understandingDon’t overload (unlike this slide ...)

Raise the same issues as other 3 way consultations

Who is in control?Risk of it becoming 2 way, someone gets

excluded (usually the patient but may be the doctor)

Always try and look directly at the patient and address your questions to them

May be the only option, or may be patient’s preference

May be planned or arranged at short noticeConfidentiality issues - with relative or with

member of same communityOr just embarrassmentInterpreter may have poor language skillsInterpreter may not understand their roleComplex – like having a relative in a same-

language consultationCan be hard for the friend or relative too

Introductions – who are they? What is their relationship?

Are they both comfortable with the situation?Assess translator’s level of English – may need to use

‘basic English’ tips with translator

Be directive with interpreter Explain what you want to happen and why Ask for direct translation

Acknowledge dual role of family member – possibly ask things twice – ask for pt’s view and then relative’s (and they should translate theirs back to patient)

Consider offering appt with alternative interpreter

May not have had any training May not understand roleMay not be comfortable with role; may feel

pressurised Variable level of language skillsPatient may not understand confidentiality

General points Very accessible, 100 languages Interpreter may not be in UK Expensive

Differences from face-to-face Feels unfamiliar May make sensitive issues harder – or easier Harder to use diagrams Hard to have help while examining

Before starting consultation Introduce self to interpreter Check language/dialect is correct Explain your context

Be aware of nonverbals (yours and the patient’s)

Doctor Rushed? Jargon or complex English? Complicated or multiple sentences? Rapport with patient or interpreter?

Interpreter Language skills Acceptability to patient Inhibiting patient? Not translating fully and/or adding own spin?

Patient Lack of trust of interpreter Lack of trust of doctor Embarrassment or taboo subject

Styles of greeting and addressFormality/informality; politenessRespect for doctorsPatients may not expect

Patient-centred approach Psychosocial questions

Confidentiality