Effective communication, especially when special challenges arise, requires more of the physician than brushing up on basic people skills.

For example, when caring for patients who are deaf or don’t speak English, the physician must be able to communicate effectively using alternative methods.

Hearing-impaired patients
Patients who are hard of hearing or deaf are protected from discrimination by the Americans with Disabilities Act (ADA). This law requires physicians to use auxiliary aids and services to communicate fully and effectively with these patients. Further, it allows the deaf patient to choose which communication method to use, e.g., sign language through an interpreter, lip reading, written notes or telecommunication devices for the deaf.

If the patient wants an interpreter, there are several important points to consider. Ideally, the interpreter should be qualified to translate in medical situations. Certified interpreters may be found through a state agency or the national Registry of Interpreters for the Deaf (301/608-0050).

Although family members or friends may volunteer to interpret, they are unlikely to meet ADA requirements for competency. They may not know how to interpret medical terminology, and they may leave out important information or add their own opinions. Further, deaf patients may be embarrassed to share personal information with them.

Certified interpreters are bound by a professional code of ethics that requires strict patient confidentiality. They are also required to interpret everything said in the room, whether or not it is meant for the patient.

The following advice on working with interpreters will help physicians communicate effectively:

• Seat the interpreter slightly behind and to the side of the physician. The chairs should be arranged in a welllit area free of glare.
• Speak clearly in a normal tone and at a natural pace.
• Look at and speak directly to the patient. Avoid glancing at the interpreter and using phrases such as “Tell him” and “Ask her.”
• Do not attempt to confer privately with the interpreter. If the patient is hearing-impaired but an interpreter is not required, refer to the following guidelines:
• Remove all possible distractions such as poor lighting, gum chewing, surgical masks and, especially for hearing-aid users, background noise (e.g., TVs, people talking).
• Use visual aids such as charts, pictures and models.
• Double-check the patient’s understanding of the conversation and send him or her home with an information pamphlet if possible.

Every office should have additional guidelines for interacting with deaf and hearing-impaired patients. These may include making a note in the chart regarding the patient’s communication preference, establishing a system for alerting these patients in the reception area when it is their turn, and documenting the name and phone number of the service and the interpreter providing assistance.

Non-English-speaking patients
The communication gap between physicians and non-English-speaking patients can be harmful to both. For instance, physicians may be forced to use unnecessarily invasive methods on non-English-speaking patients because they cannot explain their symptoms. Also, physicians may face malpractice action due to incorrect or missed diagnoses.

The federal government requires providers who receive reimbursement for patients enrolled in Medicare, Medicaid and other government programs to provide interpretation services for all of their patients with limited English proficiency—at no charge. Here are some practical solutions to this mandate:

• Take advantage of state and federal funds to pay for interpreter services and translated brochures, pamphlets, patient instructions, history and physical questionnaires, etc.
• Use telephone companies for limited translation. For example, AT&T (800/628-8486) currently charges $4.50 per translation minute.
• Consider hiring bilingual staff members. They should be certified for medical proficiency through an established training program.

As when working with an interpreter for the deaf, document in the patient’s medical record the name and phone number of the interpreter, as well as the service providing assistance.

Communicate Successfully, Cost Effectively
Although the cost of providing professional interpretation services usually lies with the physician, there are ways to help absorb some of the expense. Here are some cost-effective tips, courtesy of the American College of Physicians:

• Take advantage of tax credits available for expenses incurred due to using interpreter services. Interpreter expenses are also deductible as ordinary business expenses. Physicians should ask their accountants for details.
• If possible, schedule all patients who need a professional translator in a single block of time to minimize expense.
• Anticipate translation needs. For instance, if a patient who requires an interpreter is scheduled for a follow-up procedure, explain that procedure at the first appointment so the interpreter won't have to come back.

Conclusion
Being aware of the potential language barriers with patients will help physicians plan practical strategies to overcome them. Bridging communication gaps brings physicians and patients closer to the common goal of good health and a successful relationship.