No Entiendo

This past summer I spent my weeks working at a Gastroenterology office as a medical assistant. I understood that having Spanish on my resume as listed languages gave me the opportunity to speak with Spanish speaking patients. However, I did not realize that I would be walking into a medical office where there was an enormous barrier between patients that spoke Spanish and the English-speaking providers. Especially since the office manager that interviewed me spoke Spanish fluently.

Now this is not to say that our practice does not see other patients that speak other languages (Mung, Mandarin, or Russian) that may be in a similar situation, but our other patient populations are not nearly as large in volume.

A routine portion of my job is to talk through the colonoscopy, endoscopy, or Flex Sigmoid procedures. We have individualized prep instructions for each patient, for their preferred prep (i.e., MiraLAX, Clenpiq, Gallon, etc.) and with specialized instructions per our practice to ensure a clean bowel with no complications. However, this is not the case for out Spanish speaking patients. Our Spanish speaking patients have only two preps that they can be given in their native language. The first prep is MiraLAX which has been roughly translated but still has the frequently asked portion and the cancellation policy in English. The second prep is the Clenpiq prep that has not be drafted by our office but has been printed from the drug companies’ website. This means that additional instructions of how to ensure a clean prep have not been added to the document. Furthermore, there is no frequently asked questions portion or cancellation policy added to this document.

I had heard a few of my medical assistant colleagues mention how it’s unfair that we don’t have full and completely translated prep instructions to give our Spanish patients. But none of them every attempted to advocate for the Spanish patients to a higher power. I had only recently finished my training and began working with our only Spanish speaking doctor when I heard him complain about the translated prep instructions that we had to give out patients that I decided I could fix this problem. So, I translated all prep instructions we had within our practice into Spanish along with the frequently asked and cancellation policy portions. All it took was time, patients and me asking my manager if she was okay with me doing so. I also translated our standard unable to reach letter for procedure and lab results into Spanish for all Medical Assistants to be able to send patients. Now our patients are able to get prep instructions that are equivalent to our English prep instructions ensuring a perfect bowl cleanse. Now out Spanish speaking populations are not having to redo their procedures or cancel them due to lack of understanding of the prep instructions.

There are approximately 40 million Spanish speaking United states residents and about 17.2 million of these residents (43%) are monolingual Spanish speakers (Ortega et al, 2020). This is creating not only a demand for medical Spanish programs in the education program of medical schools but is often creating a barrier in healthcare. As many monolingual patients are unable to get resources within the health field necessary to aid in their understanding and comprehension of treatments. Furthermore, in only 46% percent of ED visits with patients that spoke limited to no English an interpreter was used (Flores, 2006). Could you imagine going to the ED and not being able to communicate with your providers about what happened or even tell them where your pain is? Instead, these patients are having to resort to simply pointing and putting together a few disjointed words. To me this seems cruel. So what is being done to solve the problem.

A suggested plan has been implemented known as Medical Spanish (MS) however there is no standard or recommendations on how to implement or even structure programs for healthcare providers both in school and working around the country. The AAMC annually prioritize diversion, equity and inclusion into their curriculum but have not implemented a standardization to address language proficiency in future doctors that will be working with non-English speaking patients. A Medical Spanish Summit was convened in the state of Washington where experts in US medical Spanish created lists of recommendations for future work and implementation, along with educating attendees on the significance and importance of MS. The goal moving forward from the summit is to begin pilot programs in medical schools that have medical Spanish programs that allow students to receive certificates during their medical school career. There is no doubt that learning a second language as a healthcare provider is useful, especially since after all it promotes justice and ensures non-malfeasance.

 

Ortega, Pilar MD; Diamond, Lisa MD, MPH; Alemán, Marco A. MD; Fatás-Cabeza, Jaime MMA, USCCI, CHI; Magaña, Dalia PhD; Pazo, Valeria MD; Pérez, Norma MD, DrPH; Girotti, Jorge A. PhD, MHA; Ríos, Elena MD, MSPH; on behalf of the Medical Spanish Summit Medical Spanish Standardization in U.S. Medical Schools: Consensus Statement from a Multidisciplinary Expert Panel, Academic Medicine: January 2020 - Volume 95 - Issue 1 - p 22-31 doi: 10.1097/ACM.0000000000002917

Flores, G. (2006). Language barriers to health care in the United States. N Engl J Med, 355(3), 229-231.