medical student Daniel Silbiger works with a medical interpreter to
assess simulation patient David Padilla-Llano at the Ohio University
College of Osteopathic Medicine.
Ohio medical students
train with interpreters to improve minority care
By Susie Shutts
Feb. 25, 2008
“In Mexico, my grandmother
delivered the kids,” said Anabella Sanchez,
program manager at Nationwide Children’s Hospital
When Sanchez moved to Texas
from Mexico at 21 she was pregnant, and she prepared for childbirth
not through prenatal checkups, but by drinking cumin tea, a natural
labor inductor used by Hispanic midwives. During her delivery – her
first U.S. hospital visit – Sanchez did not understand a word; she
spoke no English.
Sanchez represented a
growing minority. The most recent U.S. Census figures, from 2000,
estimate that 21.4 million Americans (8.1 percent of the population)
speak English less than “very well.” And, like Sanchez, these
individuals often take different approaches to wellness – for
example, through the use of traditional home remedies.
To help future doctors serve
such patients, Sanchez visited the Ohio University College of
Osteopathic Medicine (OU-COM) on Jan. 22 and Jan. 31. There she led
the college’s third annual medical interpreter simulation lab. All
second-year medical students attended one of four sessions. In May,
all first-year students will participate.
“The state of Ohio isn’t
homogenous,” said lab coordinator Pat Burnett, Ph.D., OU-COM’s
director of student affairs and multicultural programs. “We want to
train student physicians for the future, and the future includes a
For medical professionals,
miscommunication can have dire consequences. In 1984, a 22-year-old
man told his girlfriend he felt ‘intoxicado’ and collapsed. When she
repeated the term, non Spanish-speaking paramedics took it to mean
intoxicated, though the intended meaning was nauseated. His brain
clot was misdiagnosed as a drug overdose, and he later won a $71
million malpractice settlement against the South Florida hospital.
“Que molestias tiene?”
–What seems to be the problem?
Sanchez taught herself
English through books and daily conversation (supplemented, she
says, by English-language soap operas). She mastered her second
language, and years later after moving to Ohio, Sanchez started a
medical interpreter program at Children’s. She now oversees 28
interpreters – 20 for Spanish and eight for Somali – who facilitate
more than 6,000 encounters a month. Sanchez keeps a contingent staff
for 12 other languages, including French, Cantonese, Swahili and
For certification, Sanchez
requires 60 training hours and a verbal language proficiency test,
but there are no hard and fast state or federal rules concerning
medical interpreter training.
The Civil Rights Act of 1964
and the U.S. Department of Health and Human Services mandate that
physicians accepting federal financial assistance such as Medicaid
must provide free interpreter services. But the obligation can be
met in a variety of ways, including community volunteer services.
Although the Office for
Civil Rights guidelines suggest that a patient “may feel more
comfortable when a trusted family member or friend acts as an
interpreter,” untrained individuals are more likely to err. The
provider must inform patients of their right to a provided
professional translator without charge.
“Tiene preguntas?” – Do
you have any questions?
During the OU-COM simulation
labs, Spanish-speaking simulation patients were assigned either
hypertension or diabetes, and they spoke solely in Spanish, aided by
one of six interpreters from Children’s.
With five people crammed in
the examination room, student Jess Nordin was forced to stand. It
made her uncomfortable to look down at a patient, but “the
interpreter made a big difference.”
Students were instructed to
direct all speech and eye contact to the patient and treat the
interpreter as “a floating voice.”
“Even if I don’t understand,
it’s uncomfortable if you aren’t paying attention to me, because I’m
sick,” said Rocio Perez, a simulation patient, during a debriefing
following the lab.
Sanchez later taught Spanish
medical terminology basics at a workshop sponsored by OU-COM’s
Student National Medical Association chapter. She showed slides on
body parts, illnesses and greetings, noting that a doctor’s use of
Spanish greetings, even with an interpreter present, helps build
trust and rapport with the patient.
The golden rule:
while being mindful of cultural differences, “treat patients
the same as if they are speaking English,” Sanchez said.