COMMUNICATION IN A FOREIGN LANGUAGE

1. COMMUNICATION IN A FOREIGN LANGUAGE Manfred Maier Dept. of General Practice, Medical University of Vienna

2. OVERVIEW • basics • interviewing approaches • interpreters • tips and guidelines Dept. of General Practice, Medical University of Vienna

3. OBJECTIVES • participants should be able to • summarize the nature of problems which might be specific for communication in a foreign language • to choose among various ways to communicate efficiently in a cross cultural encounter • to identify key issues relevant in using an interpreter Dept. of General Practice, Medical University of Vienna

4. COMMUNICATION • there are differences between • what you think you are going to say and what you actually say • what you said and what the patient understands • what the same word means in your or another individual’s context / culture / language • doctor’s and patient’s perspective Dept. of General Practice, Medical University of Vienna

5. CROSS – CULTURAL - ENCOUNTER • in your native language • in a foreign language which you speak / understand • in a foreign language which you don´t speak / understand Dept. of General Practice, Medical University of Vienna

6. DOCTOR – PATIENT - INTERACTION • „history taking“ • the medical interview • determining and monitoring the nature of the problem • developing, maintaining and concluding the therapeutic relationship • patient education and implementation of treatment plans Dept. of General Practice, Medical University of Vienna

7. INFLUENCES • interaction with patient • understanding, accuracy, completeness • trust • compliance • health care outcome Dept. of General Practice, Medical University of Vienna

8. INTERVIEWING APPROACHES • Arthur Kleinman’s tool to elicit health beliefs • L-E-A-R-N module • strategies for clinical cultural assessment and interaction Dept. of General Practice, Medical University of Vienna

9. KLEINMAN‘s TOOL • What do you call your problem? What name does it have? • What do you think caused your problem? • Why do you think it started when it did? • What does your sickness do to you? How does it work? • How severe is it? Will it have a short or long course? • What do you fear most about your disorder? • What are the chief problems that your sickness has caused for you? • What kind of treatment do you think you should receive? • What are the most important results you hope to receive from the treatment? • Source: Arthur Kleinman: Patients and Healers in the Context • of Culture. The Regents of the University of California. 1981. Dept. of General Practice, Medical University of Vienna

10. L-E-A-R-N MODELOF CROSS CULTURAL ENCOUNTER, GUIDELINES FOR HEALTH PRACTITIONERS • Listen with sympathy and understanding to the patient’s perception of the problem • Explain your perceptions of the problem • Acknowledge and discuss the differences and similarities • Recommend treatment • Negotiate agreement • Source: Berlin EA. & Fowkes WC,Jr.: A teaching framework for • cross-cultural health care -- Application in family practice, In • Cross-cultural Medicine. West J. Med. 1983; 139 (12): 93-98. Dept. of General Practice, Medical University of Vienna

11. STRATEGIES FOR CLINICAL CULTURAL ASSESSMENT AND INTERACTIONS (1) • Consider all clients as individuals first, as members of minority status, and then as members of a specific ethnic group. • Never assume that a person’s ethnic identity tells you anything about his or her cultural values or patterns of behavior. • Treat all “facts” you have ever heard or read about cultural values and traits as hypotheses, to be tested anew with each client. Turn facts into questions. Dept. of General Practice, Medical University of Vienna

12. STRATEGIES FOR CLINICAL CULTURAL ASSESSMENT AND INTERACTIONS (2) • Remember that all minority group people in this society are bicultural, at least. The percentage may be 90-10 in either direction, but they still have had the task of integrating two value systems that are often in conflict. The conflicts involved in being bicultural may override any specific cultural content. • Some aspects of a client's cultural history, values, and lifestyle are relevant to your work with the client. Others may be simply interesting to you as a professional. Do not prejudge what areas are relevant. • Identify strengths in the client's cultural orientation which can be built upon. Assist the client in identifying areas that create social or psychological conflict related to bi- culturalism and seek to reduce dissonance in those areas. Dept. of General Practice, Medical University of Vienna

13. STRATEGIES FOR CLINICAL CULTURAL ASSESSMENT AND INTERACTIONS (3) • Know your own attitudes about cultural pluralism, and whether you tend to promote assimilation into the dominant society values or stress the maintenance of traditional cultural beliefs and practices. • Engage your client actively in the process of learning what cultural content should be considered. • Keep in mind that there are no substitutes for good clinical skills, empathy, caring, and a sense of humor. • Source: Nancy Brown Miller: Social Work Services to Urban Indians. In: James Green (ed.): • Cultural Awareness in the Human Services. Prentice-Hall 1982, 182. Dept. of General Practice, Medical University of Vienna

14. INTERPRETERS • ad – hoc interpreter • family, neighbors, friends, practice staff,… • professional interpreter • legal situation ? Dept. of General Practice, Medical University of Vienna

15. INTERPRETERS • their role( interviewer- translator- interpreter) • code of ethics • tips and guidelines for interviews involving interpreters Dept. of General Practice, Medical University of Vienna

16. CODE OF ETHICS • confidentiality • accuracy • completeness • conveying cultural frameworks • non – judgmental attitude about the content to be interpreted • client self- determination • attitude towards client (trust, respect, discretion, equality, dignity,…) • acceptance of assignment • compensation; professionalism Dept. of General Practice, Medical University of Vienna

17. TIPS FOR INTERVIEWS INVOLVING ad hoc INTERPRETERS (1) • Be more directive; insist on literal interpretation. • Use clear, specific, unambiguous language. • Ask that the interpreter identifies remarks as either his or her own or the patient’s. • Consider questions or comments to patient or interpreter that explore their relationship; for example, “Your son is worried about you. He thinks that you have heart trouble. What do you think?” Dept. of General Practice, Medical University of Vienna

18. TIPS FOR INTERVIEWS INVOLVING ad hoc INTERPRETERS (2) • Some questions are best asked twice, once to patient and once to interpreter; for example, “Are there any remedies that your family uses for this trouble?” • Use humor and empathy to avoid being intimidating. • Remind both parties that a hospital interpreter may be scheduled in advance if required for follow-up. Dept. of General Practice, Medical University of Vienna

19. GUIDELINES FOR THE BILINGUAL MEDICAL INTERVIEW (1) • Always use an interpreter (ideally a trained professional rather than an ad hoc interpreter) unless one is fluent in the patient’s language. • Try to match the individual interpreter to the individual patient and clinical setting. Reassure the patient regarding confidentiality. • Avoid technical terms, jargon, lengthy explanations without breaks, ambiguity, idiom, abstraction, figures of speech, and indefinite phrases. Dept. of General Practice, Medical University of Vienna

20. GUIDELINES FOR THE BILINGUAL MEDICAL INTERVIEW (2) • Use clear statements planned in advance with language appropriate for the interpreter and expect to spend twice the usual time. • Be prepared to obtain information via narrative or conversational modes. • Ask the interpreter to comment on nonverbal elements, the fullness of the patient’s understanding, and any culturally sensitive issues. • Learn the basic language and common health-related beliefs and practices of patient groups regularly encountered. • Source: JAMA (1985);254:3344-3348. Dept. of General Practice, Medical University of Vienna

21. USEFUL LINKS • www.diversityrx.org • www.xculture.org Dept. of General Practice, Medical University of Vienna