Treating the non-English speaking patient.

Whether you only occasionally see patients who don't understand English or regularly treat those who speak a foreign language, you need a plan to communicate with them. Without a well-thought-out plan, you cannot be certain that the patient understands your explanation of procedures and treatment. This could leave you vulnerable to liability should anything go wrong with the patient's care. Further, if you are subject to Title VI regulations, without making arrangements for adequate translation services you could be judged as not being in compliance with its requirements of equal access to health care.

At the core of a plan for accommodating limited or non-English speaking patients is the need for an interpreter. Your choice of an interpreter and the measures you have taken to ensure your patient's understanding of the proceedings could be critical if your treatment should result in an adverse situation. By ensuring accurate patient histories, patient understanding of informed consent and instructions, and your understanding of the patient's concerns, you are better able to protect yourself in the case of a possible malpractice lawsuit or charge of negligence.

The choice of an interpreter can range from a family member to the selection of a professionally trained interpreter.

Family members, friends and "informal" interpreters may be the only option available in some areas. However, these well-meaning individuals are more likely to modify what the patient has said in an effort to be helpful. Further, casual interpreters could lack the language competence to relay important messages to the patient and unintended results could compromise patient care.

The more complicated the procedure, the more care you will need to exercise in assuring that you have accurate information on which to base your diagnosis and treatment plan and in relaying this information to your patient. It is particularly important to ensure that vital documents such as consent forms, post-treatment directions and follow-up care be considered in advance of beginning treatment. A patient's clear understanding of the treatment plan and documentation of the steps taken to assure this could make a substantial difference if there were to be a charge of substandard care.

Contract interpreters, community volunteers or telephone interpreter services can be useful options. However, these services may not always have readily available interpreters who are familiar with the medical terminology peculiar to a dental practice. Your written plan should include a list of qualified individuals who have the medical terminology to satisfy your requirements. Local area hospitals or educational institutions may be resources to contact such persons.

The more qualified the interpreter, the more security you will have in the event of an adverse situation. Your position in a lawsuit will be much enhanced if you have relied on the interpretation of a qualified individual and have documented your diligent efforts to obtain accurately translated health history and have provided correctly translated consent forms and instructions.

Before treatment begins, allow time with the interpreter to discuss what you will be doing and what information you hope to convey. Schedule extra time in the appointment so the translation can be as complete and accurate as possible.

You will also want to document the patient's consent to using an interpreter, the interpreter's name, source and relationship to the patient, if any. Some patients may insist on using a family member or other "casual" interpreter. In this case, you should also document that you have offered a formal interpreter and the patient has refused their services. If no formal interpreter is available, document your efforts to locate one.

Being bilingual in English and another language does not automatically qualify an individual as an interpreter. A professional interpreter has the special skills to fully understand what both parties want to say and the ability to make their messages clear. The more complicated the treatment, the more important this becomes.

Your best defense in any malpractice suit, whether the patient is English speaking or not, is documented records of steps taken to provide the standard of care and to assure the patient understands and agrees to the treatment and post-treatment requirements. With limited or non-English speaking patients, these same careful considerations will also provide your best defense.

For more information, here are some useful websites:

The Office for Civil Rights Policy Guidance: www.hhs.gov/ocr/lep/guide.html Hot Line: 1-877-696-6775

Medical Interpreting Standards of Practice: www.diversityrx.org/

The Providers Guide to Quality & Culture: www.ers.msh.org

Thanks to Marilyn Diers, RPLU, of Harold Diers & Co. for providing this information. Reprinted with permission from the Newsletter of the Nebraska Dental Association.