Sunday, January 19, 2003
Copyright © Las Vegas Review-Journal

COMMUNICATIONS GAP: Doctors fear mistakes in translation

Growing Hispanic population a challenge for smaller practices

Pediatrician Leroy Bernstein examines 2-year-old Angel Hernandez while his mother, Paula Parra, holds him. The youngster had an eye infection. Photo by Gary Thompson.

Pediatrician Leroy Bernstein says he lies awake at night worrying that some of his patients might be harmed because he has trouble communicating with their parents.

He fears he might not make a correct diagnosis because parents who don't speak English have difficulty explaining what's wrong with their babies. Or he worries that parents won't understand his instructions once they get their child home.

"I don't want to stop seeing these patients, but it makes me very uncomfortable," Bernstein said. "If I can't get the message across to the patient or they can't get the message across to me, that baby is in trouble."

With the growing Hispanic population in the Las Vegas Valley, Bernstein and other doctors say they find themselves increasingly trying to cope with communication gaps. Although larger practices may have the luxury of having several bilingual doctors on staff, physicians with small practices, such as Bernstein, often have no help when a non-English-speaking patient arrives.

"Most of the time it's not a disaster, but what if a mom gives her baby the wrong dose or the wrong medicine because she didn't understand my instructions," said Bernstein, who sees about two non-English-speaking patients a day.

Some patients do bring a family member along to help translate, but that remedy is often inadequate, doctors say. They also say it's too expensive to hire a professional translator.

"It's so frustrating when patients bring in a family member or a kid to translate," Bernstein said. "I asked one mom if her child had vomited, waited for two minutes while she and the translator went back and forth, and then I was told, `Sometimes.' What is that? Something has been lost."

Pediatrician Dr. Kenneth Misch agrees that working with a nonprofessional translator can be difficult. He said, however, that at his large practice, five of the 13 physicians speak Spanish.

"Patients don't ask many questions and don't get their concerns addressed when they're talking to someone they can't fully communicate with," Misch said. "That's why when I first see a patient who can't speak English, I tell them they can see one of our Spanish-speaking doctors instead."

Misch said he's addressed the communication issue by trying to hire more bilingual staff and doctors. Hospitals, however, have helped address their language problems by giving doctors and nurses access to a 24-hour translation hot line.

"This language line has medically trained, professional translators that can talk to you in every conceivable language you could imagine," said Ann Lynch, spokeswoman for Sunrise Hospital and Medical Center.

All phones in the hospital can access the hot line. A doctor or nurse can call and quickly find a medically trained translator to communicate with the doctor in English and the patient in dozens of different languages, including French, Japanese, Mandarin Chinese and Thai.

The hospital spent $56,000 in translation services last year and expects that figure to rise this year, Lynch said.

University Medical Center provides both on-site interpreters as well as a translation hot line, according to interpreter services coordinator Michelle Sotero.

"All of our bilingual employees are proficiency tested to ensure they are fluent enough to communicate with a patient," she said.

Officials from both hospitals say the phone system coupled with bilingual staff has worked so far in breaking language barriers between doctors and patients. They do say, however, that there is always a need for more bilingual medical professionals, especially those who are fluent in Spanish, Mandarin Chinese and Cantonese.

Both Misch and Bernstein say it's vital for parents to be able to communicate with their pediatricians, especially when determining medical histories.

"Eighty percent of the diagnosis is in the history, 19 percent in the exam and 1 percent in the lab and X-ray," Bernstein said. "If a patient can't talk to you, you've just lost your biggest diagnostic tool."

Paula Parra, the mother of one of Bernstein's patients, said she understands her pediatrician's concerns because she regularly has to translate for her own mother.

"My mother speaks no English and I have to go with her to doctor's appointments all the time," Parra said while her 2-year-old son, Angel Hernandez, was examined by Bernstein. "I get mad at her for not learning English; imagine if I wasn't here for her?"

Teri De La Torre, executive director for the Nevada Association of Latin Americans, said her organization aims to help people communicate with their doctors, but they are often overwhelmed. The nonprofit organization offers many different services for low-income Las Vegans, including child care and translation services.

"The language and cultural barrier really poses a significant problem," De La Torre said. "When we go and assist patients in hospitals or with medical visits it really takes a lot of time to translate to the client and make sure they understand everything."