1. Do You Speak English? – Consulting across Language Barriers
Dr Maggie Eisner
Programme Director (Bradford)

2. 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

3. Exercise in pairs

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

5. 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
Translated leaflets
Interpreters – telephone or face to face; professional, informal or ad hoc

6. 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…..

7. 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 ...)

8. 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

9. 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

10. 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

11. 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

12. 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)

13. 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

14. 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