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1.4 Language Education Programs for Health
Staff
The concept of teaching health professionals another language for
the purposes of diagnosis and treatment is becoming a topic of tremendous
controversy. Health care organizations and health professions training
programs are encouraging "survival Spanish" or other quick and/or intensive
language courses as a means of preparing for or coping with the increasing
numbers of LEP. While these courses may enhance basic communication and
rapport with LEP clients, they pose a serious danger by leading clinicians
to believe they can adequately communicate through the breadth and depth
required of complex clinical encounters. A study by Diana Prince
and Marc Nelson, MD at Stanford University found that medical residents
who took a 45 hour course in medical Spanish still made a considerable
number of mistakes in communicating with Spanish-only patients, many of
them that could have an impact on diagnosis or treatment. Linda Haffner,
in her article Translation is Not Enough, reports the many instances
where physicians who thought they had a sufficient command of the language,
in fact understood their patients incorrectly or made replies that were
confusing, incorrect, or insulting. The Downing research mentioned
previously applies here as well: the use of insufficiently bilingual health
professionals can have the same negative impact as using interpreters
of unknown skill.
Nevertheless, language training programs for medical/social service
staff are proliferating. Given the concerns cited above, it seems inappropriate
to suggest there are "best practices" in this area; in fact, some approaches
being implemented are downright dangerous. It can only be misleading to
market 8-hour courses in "survival Spanish" to clinicians or health care
administrators. Still, many medical schools offer or encourage students
to take "medical Spanish."
This issue can also be a problem when assumptions are made about
"bilingual" staff or health professionals. Almost universally, the level
of true bilingual ability is never ascertained, and these individuals
may have learned the language conversationally at home, in high school,
or in college, but lack training in medical terminology and concepts in
the target language. Kaiser Permanente of Southern California
has instituted a competency testing program for staff who wish to function
in a bilingual or interpreter capacity. But many provider organizations
rely heavily on bilingual staff lists (untested) for both direct patient
care and interpreting, and increasing numbers of managed care organizations
market their services to diverse communities by highlighting their list
of bilingual health professionals. There is great resistance to the awkwardness
and potential cost implied in requiring staff to have their language abilities
tested.
Summary Recommendations for 1.4
Promote provider awareness of the appropriate use of second language
instruction (ie., for developing rapport, but not for diagnosis or treatment,
except in an emergency), and encourage competency testing and skills
enhancement for bilingual health professionals. Target audiences would
include providers, provider organizations, cultural competence trainers,
second language instructors, health professions associations, and health
professions training programs.
Contacts, Resources, References
1.4
Jean Gilbert, PhD
Kaiser Permanente
Cultural Competence
393 E. Walnut, LR-6
Pasadena, CA 91188-8361
Jean.Gilbert@kp.org
Prince D, Nelson M. Teaching Spanish to emergency medicine residents.
Acad Emerg Med 1995 Jan;2(1):32-6; discussion 36-7
Haffner, L. Translation is Not Enough--Interpreting in a Medical Setting.
Cross Cultural Medicine: A Decade Later [Special Issue], West J Med 1992
Sep; 157;255-259
Bruce T. Downing, PhD
U. Minnesota, Ling/ILASLL
190 Klaeber Ct., 320 16th Ave. SE
Minneapolis, MN 55455
612-624-6552
bdowning@maroon.tc.umn.ed
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