Non-English speakers present special problem
While a recent study in the Annals of Emergency Medicine showed that English-speaking adults often have difficulty understanding physicians' instructions, patients who don't understand English present an additional challenge for ED managers.1
"As far as patients who speak other languages, we have on-site interpreters, primarily in Spanish, but also Vietnamese," says Shkelzen Hoxhaj, MD, the ED manager at Houston Ben Taub Hospital. Houston Ben Taub is a Level I trauma center in the inner city, with a patient population that is primarily indigent and minorities. About 60% are non-English-speaking.
"You need on-site interpreters available 24 hours a day, because it can be hard to get a phone to the head of a patient," he notes. "We do have language lines for times when the interpreters are busy and the patient is relatively stable."
Hoxhaj says another project his department is considering is using medical students, many of whom have trained abroad and used medical Spanish, to go over discharge instructions. "They are not as busy, and we hope it will boost the patients' level of comprehension," he says.
Another suggestion is to use more layman's terms rather than "medicalese," Hoxhaj says. "We probably need to be closer to a fourth-grade or lower reading level as far as discharge instructions, and explain each prescription," he advises. "Some patients won't fill a prescription if they don't know what it's for."
Some word processing programs, such as the latest version of Microsoft Word (2007), can tell you the reading level once you have typed in your discharge instructions, says Hoxhaj.
Reference
1. Engel KG, Heisler M, Smith DM, et al. Patient comprehension of emergency department care and instructions: Are patients aware of when they do not understand? Ann Emerg Med 2008; Doi:10.1016/j.annemergmed.2008.05.016.
While a recent study in the Annals of Emergency Medicine showed that English-speaking adults often have difficulty understanding physicians' instructions, patients who don't understand English present an additional challenge for ED managers.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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