Practice Strategies

Bridging the Cultural Divide in Your Practice

As the country becomes more ethnically and linguistically diverse, the challenges facing physicians in delivering quality care to all patients, regardless of cultural background, are mounting. Differences in language, cultural values, and attitudes toward illness and medical care can lead to a potentially dangerous breakdown in communication between the physician and the patient. Unlike large hospitals, small practices often lack the resources and interpreters to assist them in their interactions with immigrant patients. If your practice is providing care to patients from a variety of ethnic backgrounds, there are strategies you can use to ensure that the needs of these patients are met—even when the doctor and the patient do not speak the same language.

The potential for misunderstanding is considerable in treating patients with limited English proficiency (LEP), especially when patients are from countries with non-Western medical traditions. Because of communication difficulties, it may take longer for physicians to diagnose and treat these patients. Even when the patient speaks sufficient English to communicate on a basic level, the doctor may have to take additional time to explain the diagnosis and to issue specific instructions on how to adhere to the recommended course of treatment.

When presented with a patient who speaks little or no English, some practices rely on family members of the patient or staff members with some knowledge of the language to interpret. While adequate in some instances, this improvised approach to translation can lead to serious mistakes, especially when the language skills of the interpreter are limited.

Family members usually lack the medical knowledge necessary to be effective communicators in these situations, and staff members may not have a firm grasp of the language or sufficient experience in translation to do the job well. It is, therefore, advisable not to rely on family members to interpret, except when no other option is available. If your practice has a staff member who is charged with providing interpreting services on a regular basis, make sure the employee not only has strong language skills, but also has been trained to act as a medical interpreter.

If no staff member is available to interpret for an LEP patient, you can use a telephone-based language line to assist in translation. These services typically offer interpretation for a wide range of languages. It may also be possible to bundle appointments for patients who speak a particular language and have an interpreter on-site for certain days only. If your practice frequently serves members of a particular language group, you may want to order informational materials in that language to distribute to patients.

The federal government at one time required all health care providers to hire interpreters for all appointments with LEP patients covered by Medicaid or Medicare. The revised guidelines issued by the U.S. Department of Health and Human Services (HHS) in August 2003 allow for greater flexibility for smaller practices: While recipients of federal funds are, according to the guidelines, “required to take reasonable steps to ensure meaningful access” to their services, the amount of language support each practice is obliged to provide may be related to the number or proportion of LEP patients from a particular language group the practice serves, the size and resources of the practice, and the nature and importance of the services provided. But even if LEP individuals access services from a provider on an unpredictable or infrequent basis, the guidelines advise providers to consider using telephonic interpretation services or sharing a contract interpreter with other small practices.

While language barriers alone can pose significant difficulties in treating LEP patients, physicians are also called upon to develop “cultural competency” in their interactions with members of diverse ethnic groups. Patients may bring to the examining room fears about certain medical technologies or practices, spiritual beliefs that could affect their approach to illness, or a desire to have their own traditional remedies integrated into their course of treatment. Without stigmatizing the patient, physicians should ask questions about any cultural practices or home remedies that could be relevant to the patient’s condition or treatment.

Whenever possible, physicians should strive to be respectful of their patients’ belief systems, acknowledging their individual perspectives and attempting to work with them to create a course of treatment acceptable within their own cultural context.

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Maxine Lawyer, Director of Healthcare Services at 972.448.6905.

The articles in this newsletter are general in nature and are not a substitute for accounting, legal, or other professional services. We assume no liability for the reader's reliance on this information. Before implementing any of the ideas contained in this publication, consult a professional advisor to determine whether they apply to your unique circumstances.
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