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Teaching ‘medical Spanish’ to health care workers: Helpful, or not?

Tuesday, January 27, 2009

Tom wrote this …

One problem many U.S. health care providers face now is taking care of patients who don't speak English. It's a problem of particular relevance here in North Carolina, where the state's Spanish-speaking population has increased exponentially since the early 1990s and faces elevated health risks.

Daniel S. Reuland, M.D., M.P.H.
Hospitals and medical schools have responded to this problem by hiring interpreters and offering classes in "medical Spanish." [Full disclosure: UNC Health Care provides both interpreters and medical Spanish classes. And a medical Spanish training DVD was filmed in part at UNC Hospitals.] But a commentary published in the Jan. 28 issue of JAMA, co-authored by UNC's Dr. Dan Reuland, notes that teaching medical Spanish may actually be creating new problems instead of solving an existing one.

Doctors and other health care workers trained in medical Spanish may overestimate their ability to communicate with Spanish-speaking patients, writes Reuland and lead author Dr. Lisa C. Diamond of Yale University.

In their words:

"Evidence supporting this comes from studies demonstrating that brief, intense language training in groups of medical trainees with limited Spanish proficiency may lead to diminished use of interpreters as well as to significant communication errors. … Failure to distinguish between the constructs implicit in the phrase 'medical Spanish' leads to confusion and ultimately to poorer care for patients with limited English proficiency."

In other words, arming health care workers with a little bit of knowledge (i.e., "medical Spanish") can actually lead to worse care for the patient.

The solution? Drs. Diamond and Reuland argue that health care institutions should adopt a formal standard - such as the one used by the Interagency Language Roundtable - that can be used to accurately measure non-English language fluency.

Under such a standard, high scorers could provide patient care without an interpreter while interpreters would be required for low scorers.

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