Many patients lack English as a first language - so medical interpreting is crucial, writes Claire O'Connell
If you are reading this newspaper, it's safe to assume you have a good handle on the English language. So when you visit your GP or attend a hospital, you can tell medical staff about your symptoms and then understand what they say in response.
But not everyone is so lucky. Around 5-10 per cent of the population in Ireland may not use English as a first language, and communication barriers between patients and doctors can cause problems, according to a current editorial in the Irish Medical Journal (IMJ).
Difficulty in communicating can delay or thwart diagnosis, and patients may not understand what amounts of medication they need to take. "[ The] doctor-patient relationship can break down, leading to diagnostic errors, poor compliance and treatment failure," writes IMJ editor Dr John Murphy. "We need to reflect on how we communicate with patients with poor English."
In some cases, medical staff rely on a patient's relative or friend who has better English to get the message across, but this is far from ideal, according to Dr Marie-Annick Gash, managing director of Dublin City University Language Services (DCULS). "Is the member of the family going to have enough English to cope with the situation? And it could be very embarrassing for them," she says, adding that it would be "totally inappropriate" if the English-speaking relative is a child who could be cornered into giving a loved one bad news about their health.
The best approach is to use a professional interpreter who has been trained to deal with medical situations, explains Gash. DCU trains community interpreters and provides services to Dublin hospitals on request, and while it has facilities to interpret around 140 languages, the main demands are for French, German, Spanish, Italian, Chinese, Polish and Romanian.
"The interpreter is the voice of the patient or the voice of the doctor, depending on who is speaking," she explains. "And the best practice is for the doctor to look at the patient and speak to them directly, through the interpreter."
Many Irish hospitals now rely on private agencies to provide interpreters in situations where communication becomes difficult, but there are still challenges. "Doctors may not understand how to work with interpreters," says Gash. She referred to anecdotes about doctors telling an interpreter to relay extremely personal medical information. "This is not the way to behave with a patient or an interpreter."
One initiative that has tackled communication is the Migrant Friendly Hospital (MFH) programme, a World Health Organisation-backed project that helped 12 hospitals across Europe identify ways to make their services more available to migrants.
James Connolly Memorial Hospital (JCMH) in Blanchardstown was the pilot hospital for the project in Ireland, which ran from 2002-2004, and Galway Regional Hospital observed and mirrored the initiative.
The programme identified interpreting as an urgent priority at the JCMH, where one-fifth of patients coming into the A&E department are from countries other than Ireland or Britain, says Angela Hughes, who co-ordinated the project there.
"We developed staff guidelines for more effective and timely access of interpreting services and to work more effectively with interpreters, like maintaining eye contact," she says.
Staff on the wards also used translated or pictorial sheets to understand basic patient needs like hunger or thirst. For more sophisticated exchanges, the hospital now uses interpreters from two private agencies - in person, where possible, or on the telephone.
At €45 for a face-to-face session, interpreting costs can add up, but Hughes insists the benefits are worth it. "If these patients are only accessing your hospital once and they have a negative experience, are they going to come back?" she asks. "It could be detrimental to their patient outcome."
JCMH is now working with a number of hospitals around the State to look at models of best practice from the European project, and it hopes to mount a concerted, national effort to improve migrant-friendly practices such as interpreting, says Hughes.
"It hasn't been the answer to all our problems, but it has generated momentum," she says. "And there's definitely a culture developing here around being more sensitive to and aware of cultural diversity."
GPs help to lower the barriers
Language barriers in medical situations are here to stay, according to Dr Niall O'Cleirigh, a practising GP and chairman of communications in the Irish College of General Practitioners (ICGP).
Lacking a common language can have an impact on taking a medical history, identifying any previous medical problems of importance and finding out what medication they are currently on, says O'Cleirigh. "It has become an increasing issue ever since we became a destination for asylum seekers."
The situation becomes "next to impossible" when discussing psychological conditions, he adds. "Often if it's a pain in the stomach or a laceration to the arm, you can get away with a physical examination and just visibly examining the situation. But once we go into the area of psychology and difficulty sleeping and trauma, it really is very difficult to cope."
O'Cleirigh uses interpreters in his own practice, particularly at scheduled clinics like the diabetic shared care programme.
"We have some Romanians and Russians who come to that programme and it's very useful to have an interpreter on site on the day those people come down, but of course that takes organisation and it's also an expensive service," he says.
In the longer term, perhaps in a decade, we could see GPs from other countries setting up practices here to provide first-language services to particular populations, but for the moment the communication issue remains a problem, according to O'Cleirigh.
"Certain GPs do take on the problem wholeheartedly and set about trying to help and then, unfortunately, other colleagues just turn their back on it," he says. "There are areas of the country where we could do with GPs coming forward and helping the asylum seekers."
The ICGP has put together guidelines on its website to help improve communication with non-English-speaking patients. See www.icgp.ie/index.cfm/loc/6-5-3.htm