Do You Speak English? – Consulting across Language Barriers Dr Maggie Eisner Programme Director (Bradford) www.bradfordvts.co.uk

Programme May 10th Introduction Exercises – consulting with limited language Interactive presentation – your experiences of limited language consultations and how to improve them DVDs of limited language consultations Briefing for next week May 17th – practising skills: simulated consultations in facilitated small groups

Exercise in pairs

In threes - your experiences of consultations with patients who speak little or no English

What resources can we use? Non verbal signals – body language, gestures Sign language Paraverbal – loudness, tone, manner of speaking Simplified language (‘basic English’) Drawings and diagrams (prepared, or drawn by either doctor or patient) Leaflets in other languages Internet resources Asylum seekers’ health portal http://www.harpweb.org.uk Translated leaflets - http://www.patient.co.uk http://www.mind.org.uk/Information/BT.htm, http://www.healthinfotranslations.com Interpreters – telephone or face to face; professional, informal or ad hoc

Types of consultation with language issues Basic English With interpreter in the room Professional Family member Friend Practice staff member With telephone interpreter …..All need extra time…..

Basic English Speak clearly, slowly, calmly (don’t shout) Simplify English Avoid idioms and colloquialisms Avoid jargon and technical terms Simplify grammar - short, simple sentences Leave gaps for patient to process what you’ve said and compose reply Simplify consultation structure More closed questions But offer alternatives to check that Yes means Yes (is the pain worse when you sit? Or when you walk?) Consider using pictures using mime (but some gestures aren’t universal and some may offend) Remember your own expressions and body language Try to check understanding Don’t overload (unlike this slide ...)

Consultations with interpreters Raise the same issues as other 3 way consultations Who is in control? Risk of it becoming 2 way, someone gets excluded (usually the patient but may be the doctor) Always try and look directly at the patient and address your questions to them

Family and friends of patient – things to consider May be the only option, or may be patient’s preference May be planned or arranged at short notice Confidentiality issues - with relative or with member of same community Or just embarrassment Interpreter may have poor language skills Interpreter may not understand their role Complex – like having a relative in a same-language consultation Can be hard for the friend or relative too

Family and friends of patient – consultation tips Introductions – who are they? What is their relationship? Are they both comfortable with the situation? Assess translator’s level of English – may need to use ‘basic English’ tips with translator Be directive with interpreter Explain what you want to happen and why Ask for direct translation Acknowledge dual role of family member – possibly ask things twice – ask for pt’s view and then relative’s (and they should translate theirs back to patient) Consider offering appt with alternative interpreter

Practice staff members May not have had any training May not understand role May not be comfortable with role; may feel pressurised Variable level of language skills Patient may not understand confidentiality

Telephone interpreters General points Very accessible, 100 languages Interpreter may not be in UK Expensive Differences from face-to-face Feels unfamiliar May make sensitive issues harder – or easier Harder to use diagrams Hard to have help while examining Before starting consultation Introduce self to interpreter Check language/dialect is correct Explain your context Be aware of nonverbals (yours and the patient’s)

What might be going wrong? Doctor Rushed? Jargon or complex English? Complicated or multiple sentences? Rapport with patient or interpreter? Interpreter Language skills Acceptability to patient Inhibiting patient? Not translating fully and/or adding own spin? Patient Lack of trust of interpreter Lack of trust of doctor Embarrassment or taboo subject

Cultural issues which may affect communication in the consultation Styles of greeting and address Formality/informality; politeness Respect for doctors Patients may not expect Patient-centred approach Psychosocial questions Confidentiality