Maggie Eisner, May 2011. May 10 th Introduction Exercises – consulting with limited language...
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Transcript of Maggie Eisner, May 2011. May 10 th Introduction Exercises – consulting with limited language...
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