Medical Interpreters: Enhancing Patient Communication

Working with a Medical Interpreter

• Using a patient's preferred language enhances understanding, safety, trust, and positive health outcomes.
• Miscommunication raises the likelihood of misdiagnosis, incorrect treatment, and medication errors.
• Language barriers correlate with increased hospital readmissions and poorer health outcomes.
• Professional interpreters greatly decrease adverse event risks, compared to using family or untrained staff.
• Legal requirement (U.S.) under Title VI of the Civil Rights Act requires federally funded healthcare facilities to offer language assistance to Limited English Proficiency (LEP) patients.
• Ethical Obligation as the American Medical Association (AMA) and Joint Commission emphasize the importance of clear, patient-centered communication.
• Protection against liability exists as miscommunication leading to harm can result in malpractice lawsuits.
• Professional interpreters and translated materials are essential for quality patient care.

Guidelines for Working with an Interpreter: "INTERPRET"

• Introductions: Ensure all individuals are introduced with their roles specified.
• Note Goals: Identify interview goals, including diagnosis, treatment plans, and follow-up.
• Transparency: Inform the patient that all conversation will be interpreted.
• Ethics: Use qualified interpreters to maintain patient autonomy and informed consent.
• Respect Beliefs: Acknowledge LEP patient cultural beliefs with the interpreter's help as a cultural broker.
• Patient Focus: Maintain the patient as the encounter focus while addressing their questions.
• Retain Control: The provider must remain in control of the interaction, not the interpreter or patient.
• Explain: Use simple language and short sentences for clarity in the second language.
• Thanks: Thank both the interpreter and patient, documenting the interpreter's identity on the chart.

Interviewing Techniques

• Active listening, guided questioning, empathetic responses are key.
• Summarization, transitions, partnering, validation, empowering the patient are important techniques
• Reassurance and nonverbal communication is important

Collecting Health Histories

• Identifying Patient Information: Note patient's initials, age, and gender.
• Source/Reliability: The history source (patient, family, etc.) and reliability based on memory, trust, and mood.
• Chief Complaint(s): The primary symptom or concern prompting care.
• History of Present Illness: Details the Chief Complaint’s chronology, patient's feelings, and relevant Review of Systems findings ("pertinent positives and negatives").
• Past Medical History: Lists adult and childhood illnesses, health maintenance practices, medications, and allergies.
• Family History: Outlines family health history.
• Personal and Social History: Includes substance use, sexual history, education, living situation, and interests.
• Review of Systems: Documents the presence or absence of symptoms across major body systems.

Collecting Subjective Data: PQRST

• P - Provocation/Palliation asks what started the symptoms and what makes them better or worse?
• Q - Quality asks to describe the sensation of pain.
• R - Region/Radiation asks where the symptom is located and if it spreads
• S - Severity asks to rate symptom severity.
• T - Timing asks when symptoms started/
• U - Understanding (Patient's Perception): What do you think is causing this?" "How is this affecting your life?"

Techniques of Physical Examination

• Inspection involves close observation of patient appearance, behavior, and movements.
• Palpation the tactile pressure from fingers to assess skin elevation and tenderness.
• Percussion uses tapping to evoke sound waves and tactile vibrations from underlying tissues and organs.
• Auscultation uses a stethoscope to detect heart, lung, and bowel sounds.

Patient Positioning

• Describes positions such as sitting, lying supine, standing, and lithotomy.
• Describes symbols used to indicate patient position in medical notes

Components of the General Survey

• Initial observation of a patient's health status before a focused physical exam.

Physical Appearance

• Level of Consciousness (LOC): Describes state of alertness (alert, drowsy, etc.) and Facial Expression
• Skin Color, signs of acute or chronic illness and Hygiene & Grooming.

Body Structure & Posture

• Looks at Body Build & Symmetry, Posture, Nutritional Status, and Mobility Aids or Prosthetics.

Mobility

• Evaluates Gait, Range of Motion (ROM), and Coordination & Balance.

Behavior

• Assesses Mood & Affect, Speech patterns, Eye Contact, and Interpersonal Interactions.

Clinically Significant Weight Changes

• Focuses on weight gain and weight loss thresholds

Vital Signs

• Temperature typically measured in Celsius and Fahrenheit
• HR and Pulse 60-100bpm
• BP: <120/ <80
• SpO2: 95-100%
• RR: 12-20 breaths/min

Pain

• Differentiates Acute vs chronic and Pain Scales.

Pain Scales

• Examples include Visual Analog Scale, Wong-Baker FACES, and Numeric Rating Scale
• Critical Pain Observation Tool is used in the ICU

Health Disparities in Pain Management

• Health disparities in pain assessment range from lower analgesic in African Americans and Hispanics to disparities in analgesics for cancer.
• Clinician stereotypes, language barriers and bias contribute disparities.

Fever, Chills, and Night Sweats

• Fever denotes abnormal body temperature
• Shaking chills are extreme temperature swings.
• Descriptions of Rising temp, Falling temp, and Night sweats

Special Patient Situations: BP

• White coat hypertension is high BP in medical settings, normal ambulatory.
• Masked hypertension is normal office BP, elevated daytime BP on testing, more serious.
• BP differences between arms, normally a slight difference, indicates further testing.
• Orthostatic hypotension occurs from meds impacting nervous system, leading to vasovagal response.

Head and Neck

• Includes techniques of examination and key components of examination

Key Components of Examination

• Includes Hair and scalp, Skull and skin, Cervical lymph nodes
• Cervical Lymph Nodes can be Bilateral or Unilateral

Eyes

• Acuity testing is done via Snellen, Allen, Tumbling Es
• Field testing done through Finger wiggle test
• Also test Color through plates and assess position.

Examine Eye Components

• Inspect eyebrows, eyelids, lacrimal apparatus and pupils. Descriptions of Miosis, Mydriasis, Anisocoria
• Assess pupillary/corneal reaction to light

Ears and Nose

• Key components of an ear examination include assessment of the Auricle and surrounding tissue
• The ear canal and tympanic membranes can be examined with an otoscope.

Test Auditory Acuity

• Test auditory acuity or gross hearing with the whispered voice test
• Use tuning forks if needed

Nose Examination

• Inspect inside the nares with an otoscope and the nasal septum. Note Deviations
• Palpate for sinus tenderness

Throat and Oral Cavity Examination

• Inspect the oral mucosa looking for ulcerations or swelling
• Palpate the tongue and test the hypoglossal nerve

Unit 2 - Neurologic System

• The Sympathetic Nervous System (SNS) releases catecholamines during stress leading to vasoconstriction and bronchodilation.

Physical Assessment of Neurological System

• Mental status is part of exam
• Glasgow Coma Scale assesses Eye opening, verbal responses, and Motor responses to determine level of consciousness

Glasgow Coma Scale Scores

• Descriptions of Alertness to Obtundation
• Alertness - speak to the patient in a normal tone of voice.
• Lethargy needs a louder voice
• Obtundation - apply tactile stimulus by gently shaking the patient as if awakening a sleeper.

Severity Scale

• Stupor - apply a painful stimulus (pinch a tendon, rub the sternum, or roll a pencil across a nail bed).
• Coma - apply repeated painful stimuli to the trunk and extremities.

Cranial Nerves

• Mnemonic to remember Cranial Nerves is “Oh, Oh, Oh, To Tough And Feel Very Green Vegetables, AH"
• Test each of the 12 Cranial Nerves

Motor System

• Strength tested and rated 0-5
• Cooridnation tested through Rapid alternating movements

Neurological Conditions

Spinal Shock

• Causes a Complete, but temporary loss of motor function
• Treated with Spinal Stabilizations

Neurogenic Shock

• Causes a Loss of autonomic nervous system
• Treated with Spinal Stabilization

Autonomic Dysreflexia/Autonomic Hyperreflexia

• Occurs below the level of spinal cord injury in response to distended bladder.
• Treated by controlling blood pressure and determining the cause.

Headache

• Includes Assessment of onset and duration
• Can be life threatening or benign

Types of Headache

• Subarachnoid Hemorrhage
• Meningitis & encephalitis
• Migraine and Cluster etc.

Seizures

• Sudden, uncontrolled electrical disturbance in patient brain
• There are Generalized Seizures and Nonepileptic Seizures

Effective communication in healthcare is crucial for patient safety and positive outcomes. Utilizing professional medical interpreters ensures understanding and trust. This approach is both a legal and ethical imperative for healthcare facilities.