//Down the Interpreting Rabbit Hole

The Joint Commission tells us that “effective communication is critical to the successful delivery of health care services.” No one would try to argue with that statement. But what does “effective communication” really mean?  Unfortunately, there is no one answer. In fact, there are millions of answers! Why?

Because health care providers must communicate health information to patients “in a manner tailored to the patient’s age, language, and ability to understand.”

The Joint Commission also directs health care providers to be culturally competent, ensuring that communication takes each patient’s unique cultural background into consideration. So, “effective” communication varies from patient to patient. Let’s take a single point of information that needs to be communicated to two very different patients and see how this works in action.

GOAL: Effectively communicate to the patient that she has Alice in Wonderland syndrome (AIWS). AIWS is a neurological condition often associated with migraine headaches. AIWS patients see humans, parts of humans, animals, and inanimate objects as much smaller than in reality. For example, the family dog may appear to be the size of a kitten or a mansion may look like a dollhouse. There is no known cure, but treatments are available and there is no risk of death or bodily harm.

ROADBLOCKS: Alice in Wonderland is a beloved tale in the United States, popularized by cartoons, movies, children’s stories. However, in some cultures/countries around the world, it is unknown and even reviled.

Patient #1 – Maliha is a 24-year-old, Palestinian woman whose preferred language is Arabic. Palestinian culture has extremely negative views on Alice in Wonderland. Maliha has never read or seen Alice in Wonderland, but knows that it is considered controversial by her family.

  • Challenges: “Alice in Wonderland” will mean nothing to Maliha. Maliha will not understand the reference, and will probably be confused or even upset by the name of the disorder. Both the doctor and the interpreter will have to be sensitive to Maliha’s culture in order to assess her ability to understand.
  • Success: To successfully explain AIWS to Maliha, the doctor may want to explain the symptoms and the connection to migraine headaches first, before explaining the name of the syndrome. Once the name has been mentioned, the doctor must be prepared to answer questions about Alice in Wonderland without showing any cultural bias. Saying, “I can’t believe you’ve never heard of Alice in Wonderland!” would demonstrate cultural insensitivity. The interpreter may need to assist the doctor in understanding Maliha’s culture and lack of knowledge of Alice’s story.

Patient #2 – Roberta is a six-year-old little girl hailing from Mexico. She and her mother, Maria, moved to the United States only a year ago. They both speak Spanish. They both love Alice in Wonderland. In fact, Roberta was Alice for Halloween!

  • Challenges: The challenge here is that Roberta may not understand how something she loves is causing her so many problems. In fact, when she first hears AIWS, she might think it is something great! For Maria, understanding the reference to “eat me/drink me” may make her think that her daughter’s condition was caused by a food or beverage.
  • Success: To successfully explain AIWS to Maria and Roberta, the doctor will need to be sensitive to Roberta’s age and ability to understand. Because AIWS doesn’t cause any physical harm, the doctor may want to use the “eat me/drink me” references from Alice in Wonderland to help explain to Roberta what is happening to her, so she can understand and won’t be afraid. On the other hand, the doctor needs Maria to understand that nothing Roberta ate or drank actually caused the problems, but instead there is a disconnect between what Roberta’s eyes take in and how her brain processes the information. The interpreter needs to choose his language choices carefully, using a child-level vocabulary for Roberta and an adult-level vocabulary for Maria.

The difference in the two examples above demonstrates the difficulty health care providers and interpreters can face in day-to-day care for limited English proficient patients. The same disorder must be explained in very different ways based on the age, language and culture of each patient.

Vocalink ensures that its interpreters are well-versed in medical terminology and culture to help health care providers meet the Joint Commission requirements of effective communication, cultural competence, and patient-and-family-centered care.