What to Do When Your Patient Doesn’t Speak English: Patients are entitled to quality speech-language, swallowing and hearing services, no matter what languages they speak. Here’s how to provide them.

Gennith Johnson; Claudia Saad

doi:10.1044/leader.OTP.19112014.28

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On the Pulse | November 01, 2014

What to Do When Your Patient Doesn’t Speak EnglishPatients are entitled to quality speech-language, swallowing and hearing services, no matter what languages they speak. Here’s how to provide them.

Gennith Johnson, MCD, CCC-SLP; Claudia Saad, MS, CCC-SLP

Author Notes

Article Information

The ASHA Leader, November 2014, Vol. 19, 28-29. doi:10.1044/leader.OTP.19112014.28

An acute-level hospital admits a 67-year-old Haitian man who shows slurred speech and right-sided weakness. He speaks some French but is fluent in Haitian Creole, common to his region of Haiti. A nurse administers a swallow screening in the emergency room—which he fails—but the patient cannot answer standard admission questions because of the language barrier. Hospital staff consult the speech-language pathologist to complete a dysphagia evaluation, because the nurse is hesitant to administer oral medications.

What should an English-speaking SLP do in this situation?

Place the patient on medical hold until he can describe his problem?
Proceed with a swallowing evaluation by giving the patient food and drink?
Use an English communication board to explain the process of the swallow evaluation?
Request a Haitian Creole interpreter to aid communication between the patient and the SLP during the evaluation?

Our patient represents many people in the United States who speak a language other than English, and for whom providing quality health care can be a challenge. But SLPs and audiologists have a responsibility to provide appropriate services to people with communication or swallowing disorders who may not be proficient speakers of English.

To guide practice, the Joint Commission—an accrediting organization that certifies more than 20,500 health care organizations and programs in the United States—developed a set of patient-centered communication standards for hospitals in July 2012. The standards guide clinicians on addressing all patients’ communication needs, and outline qualifications for interpreters and translators. The standards are part of a larger initiative, “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals”, that focuses on effective communication and culturally competent care. Failure to meet these requirements could result in a loss of accreditation. According to the Joint Commission, “No longer considered to be simply a patient’s right, effective communication is now accepted as an essential component of quality care and patient safety.”

Using an interpreter is the best option; ASHA’s Practice Portal provides guidance for collaborating with interpreters. You can also tap these resources to facilitate communication with non-English-speaking patients:

Numerous apps and online translation sites provide immediate translation, but use them with caution: They are not always accurate.
Smartphone technology can facilitate carryover and recall of strategies and techniques. For example, with a smartphone one can record spoken and video-signed clinical recommendations.
Consider using Communication Access Realtime Translation (CART, or Computer Assisted Realtime) on site or remotely for patients who are deaf or hard of hearing, in addition to a sign interpreter. CART transcribes and instantaneously captions spoken language to relay messages.

Let’s return to our 67-year-old Haitian patient with the language barrier. Which option is the right one according to the Joint Commission? Requesting a Haitian Creole interpreter to assist with the evaluation is the only correct answer. Hospitals accredited by the Joint Commission are required to provide language interpreting and translation services. These services can be in-person or via telephone or video.

Language interpreters should demonstrate not only language proficiency, but have qualifications that are typically met through education, training and experience. Hospitals may employ language interpreters or contract out for these services; SLPs can request an interpreter through nursing or social services. Trained bilingual hospital staff may also be a viable option. Research shows that effective patient-provider communication is essential to patient safety as well as to better treatment outcomes.

For more on using interpreters…

ASHA Issues in Ethics: Cultural and Linguistic Competence further outlines the importance of providing culturally competent care that ensures access to services via an interpreter when needed.
ASHA’s Code of Ethics also supports the use of interpreters when working with patients who do not speak English.

2 Comments

November 22, 2014

Speech/Language Eval

Great article, thank you! Would you also you an interpreter phone for the full speech/language evaluation?

November 23, 2014

Whitney Postman

Rehab-Nursing Centers

Neglect of non-English speaking residents in rehab-nursing centers is pervasive. How can the rules enforced in hospitals be extended to other medical settings?

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What to Do When Your Patient Doesn’t Speak EnglishPatients are entitled to quality speech-language, swallowing and hearing services, no matter what languages they speak. Here’s how to provide them.

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