Chapter 12: Communication
Katie Baker
Healthcare providers communicate with patients for a number of reasons. You may be discussing test results, lab findings or a new complaint with your patients. You may also be working with them to develop a plan of action for a multidisciplinary team of providers. In all of your Communications with patience, compassion and empathy our top priority. All Communications have the potential to build trust and rapport or to lead to distrust and separation in the provider patient dyad.
In this section, we will explore how to communicate with diverse patient populations. This may include using assistive devices to communicate with individuals who are deaf or hard-of-hearing or who are mute. And may also include communicating with patients who speak a different language through a medical interpreter. We’ll talk about how to access resources that your healthcare organization may already have in place to support patient communication.
It’s important to note that most patients will not have the background to understand medical terminology and so using an understandable and common level of language is important when explaining healthcare options and diagnoses to patients and their families. In some instances, a patient advocate may be helpful to support the patient and their family in navigating their healthcare including helping them to understand the information that their providers are sharing.
Finally, the emotional content of the conversation between a provider and a patient is very important to keep in mind. Unexpected bad news and the negative prognosis of a serious illness require a gentle delivery. Joyful outcomes such as a healthy birth or positive results of a treatment regimen likewise require a provider to express empathy with the patient and their family. Emotional intelligence, including the ability to connect interpersonally and control one’s own emotional expression, is a key skill for every healthcare provider
Communicating With Diverse Patient Populations
You may find yourself seeing a patient who requires particular communication efforts such as interpretation or communication using assistive devices. In these instances, it is the provider’s responsibility to ensure that all communication is clear and is understood by the patient. In this section, we will discuss the laws surrounding the responsibilities of healthcare organizations in this area as well as some examples of assistive devices that you may use. In the following section, we will discuss how to access communication assistance in the state of Washington.
Federal law requires that healthcare organizations provide medical interpreters at no cost to the patient. The laws relating to this include the Americans with Disabilities Act and Title VI of the Civil Rights Act of 1964 (Washington State Health Care Authority, n.d.). In 2000, President Clinton signed Executive Order 13166, requiring all organizations that take federal funds to engage interpreters for their clients (Interpreter Training Programs, n.d.).
In addition to language barriers, cultural differences can affect communication between patients, family members and providers as well as varying expectations or decisions about healthcare. For example, some religions have specific prohibitions around certain medical procedures (such as blood transfusions) or may refuse care based on their beliefs. Other cultures require that medical decisions and provider discussions occur between the provider and the oldest male in the family rather than with the patient themselves. It is important for providers to be aware of, and sensitive to, these culturally-based choices.
Washington state law allows the government to provide spoken language sign language interpreters (known as Language Access Providers or LAPs) for patients on Apple Health/Medicaid, with the exception of inpatient hospital visits, nursing homes, administrative and phone services or for family members (Washington State Health Care Authority, n.d.). For privately insured or uninsured patients, provider organizations are required to supply their own LAP if they take any federal funds, such as for Medicaid or Medicare.
Even if patients primarily speak English, there may be other barriers to communication such as speech and hearing disorders or memory issues. For example, it is important to note that not all hard-of-hearing or deaf individuals can use sign language or lip read proficiently. Further, lip reading and other attempts to bridge communication gaps puts more burden upon the patient and can be mentally exhausting.
Patients may use assistive listening devices such as hearing aids or aac devices such as speech generators or picture boards when verbal communication disorders exist. Patients with memory loss and dementia may utilize scrapbooks, picture boards or other forms of communication to help with recall. Providers should be prepared to engage honestly, patiently and with compassion with patients who are unable to verbally communicate or to hear.
Getting Help With Communication
Although there is no one official language in the U.S, English is the primary language in healthcare settings for provider to provider communications and patient discussions. This leads to issues when a provider is unable to communicate effectively with individuals where English is not their primary language. For small clinics or organizations that do not have a standing relationship with a medical interpreter or LAP, it can be tempting to utilize one of the patient’s family members or a bilingual staff member. There are many issues with this and this practice is discouraged for a number of reasons (Interpreter Training Programs, n.d.).
Using a bilingual staff member is a concern because most staff members are already consumed with their own job requirements and may not be bilingual to the extent of understanding medical terminology in multiple languages. Further, they may not be aware of cultural differences and the ethics and medical interpretation in the same way that someone who is a professional interpreter well. However, this may be the best or only option in some situations. Ideally, bilingual staff members are comfortable with medical terminology in both languages and are compensated for translation services.
Bilingual family members may not understand both languages equally and may encounter the same challenges as a bilingual staff member in this area. In addition, they are frequently emotionally distressed due to their loved one’s illness. They may edit their interpretation of questions being asked or answers being given based on their relationship with the patient. For example, children may not feel comfortable asking their parents or grandparents about reproductive, digestive or urinary health issues or may be concerned about seeming “disrespectful” to their elders by asking certain questions. For these reasons, using a family member as an interpreter may be viewed as a last resort if no professional interpretation services are available.
In Washington state, the Health Care Authority can provide LAPs for spoken and signed language for providers of Medicaid patients through their website. The site also has supportive resources for providers of privately insured patients. Under the Health Care Authority, Washington State contracts with Universal Language Service to provide LAPs. Providers who are working with a patient who is not on Apple Health/Medicaid may use the same system to access LAPs but they will not be reimbursed by the state (Washington State Health Care Authority, n.d.).
Someone who works to convert medical language into the preferred language of a patient.
Also known as auxiliary aids, any device, except for a hearing aid, that amplifies sound or improves communication through alerts, such as vibrating alarm clocks or lights that flash when the doorbell is rung. This includes closed-loop systems that work with hearing aids.
Also known as Augmentative and alternative communication devices. A laptop or tablet computer that helps individuals with speech difficulties to communicate.