Whether you live in deep southern
As of July 2006, nearly 44.3 million people of Hispanic origin live in the U.Sapproximately 15% of the nations total population.
Almost one of every two people added to the nations population between July 1, 2005 and July 1, 2006 was Hispanic.
15 states now have at least a half million Hispanic residents. And, in 22 states, Hispanics are the largest minority group.
These numbers should not be surprising to anyone in eye care. But, what is surprising is how little health care providers have done to embrace the opportunity this population presents to our practices. Beyond the patient care considerations and the ability to reach out to an often-underserved segment of the population, many opportunities exist for your practice. For example, when a rural clinic in north-central
Many continuing education conferences include sessions on communicating with Hispanic patients. But, many of these sessions concentrate on memorizing phrases. Unless the doctor already has a background in the language, tackling Spanish in an hour is pretty daunting. Worse, sometimes a few phrases may be damaging to a practice, because giving a patient the impression of fluency without real comprehension can lead to embarrassment, miscommunication or misdiagnosis.
Well, if you cant learn a language in an hour and phrases arent enough, can you still serve your Spanish-speaking patients? Absolutamente! With a little effort, some patience and a lot of respect, you can create an office that meets the needs of this patient population, and also build your practice.
Benefits to Your Practice
In the Los Angeles Latino Eye Study (LALES), nearly half of the participants who had diabetes also had retinopathy, and many were undiagnosed before the study. Of those with signs of age-related macular degeneration (AMD), only 57% reported having ever visited an eye doctor. Of those with glaucoma and ocular hypertension, 75% were undiagnosed before participating in LALES.3 Clearly, patients in this country are not being reached with regard to care and education about the importance of routine eye exams.
Additionally, language can often be a barrier to health care access. One study found that children in homes where English is not the primary language had more health problems and less access to health insurance.4 Census bureau numbers indicate that 78% of Hispanics report speaking a language other than English at home, though half of this group reports speaking English very well.1
Older patients are often less likely to have complete command of a new language. Not to mention, patients are often anxious about making themselves clear when discussing medical problems (in any language). And, they may worry that they dont understand the doctor. So, it makes sense that Hispanic patients would seek out a health care professional who speaks the language. Patients of any background want to be sure they understand their condition, their treatment options and how and when to apply medications.
Some Helpful Vocabulary Words and Phrases Eye(s) Lens Better/Worse Infeccin My name is... What problems are you having with your eyes? Commands: Follow my finger. Open/Close your eyes.
Its important not to mistakenly give patients the impression that youre fluent when youre not. But, making an effort conveys respect as well. Here are a few basic words to use or listen for during the examination. Ojo(s) Left
Pupila Lente cristalino Retina
Retina Optic nerve
Nervio ptico Face
Lgrima Tear duct
Conducto lagrimal Dry (adjective)
Gota(s) Mejor/Peor Pain, painful
Dolor, doloroso Contact lenses
Lentes de contacto Glasses
Introductions: Mi nombre es Nice to meet you.
Mucho gusto. Qu problemas tiene con los ojos? Where does it hurt?
Donde le duele? Look here.
Mire aqu. Siga mi dedo. Abra/Cierre los ojos.
Some Helpful Vocabulary
Words and Phrases
My name is...
What problems are you having with your eyes?
Follow my finger.
Open/Close your eyes.
Where Do You Start?
Patients have a powerful incentive to find an office that provides language-friendly options. And, its not very likely that different family members will go to different doctors. So, if Grandma is comfortable in your office, you are likely to gain Grandmas entire familyeven though the other family members may speak English fluently. You dont need to be fluent in Spanish to provide a comfortable environment for Spanish-speaking patients. But, demonstrate a willingness to try by creating an environment that improves communication between you and your Spanish-speaking patients.
Begin with the sign-in documents and written case history. Generalized forms in Spanish are available, but many practitioners have their own favorite patient history questions. So, translating the practices current forms might make more sense. For example, ACR Systems (www.acr-translations.com) offers professional translation for a fee. For do-it-yourselfers, Web-based translation assistance is available at sites like www.babelfish.altavista.com and www.google.com/language_tools. But, if you use the self-help option, have a native or fluent speaker check your new form, because the literal translation may not make sense, or it may give the wrong meaning altogether.
Bueno Help is Hard to Find
If there is a sizeable Hispanic population in your area, you will likely have an excellent chance of finding a bilingual assistant. But, how can you evaluate a candidates Espaol if you dont speak the language yourself? Ideally, you could ask a bilingual patient or friend to be on hand for the interview. In our practice, one tool we use is a written exam. Such an exam consists of straightforward translation and simple questions that demonstrate the level of language proficiency, and it can be graded with an answer key.
Once you have selected an assistant, try to get the most benefit from his or her knowledge of the language. Have your assistant help your Spanish-speaking patients with the initial paperwork, as well as the case history and pre-testing. This speeds up the sign-in process, avoids communication errors, and builds a rapport that carries through the exam. When patients meet the doctor, they have someone with them whom they are certain understands them.
During the Exam
For the exam, master a few simple phrases in Spanish to maintain direct involvement with the patient. But, understand that the patient will often direct questions to the assistant and wait for his or her translation. Doctors accustomed to direct patient interaction sometimes feel taken out of the flow of the exam; but, arguably, this is one of the most critical parts of the learning process for the doctor. Listen to the questions and translations carefully, even though you may not understand at first. People tend to ask the same questions, no matter what language they use, and this repetition is worth hours of classroom study. It wont be long before you can translate common complaints yourself.
Make sure to have resources available for your Spanish-speaking patients. Printed materials are available through the U.S. Department of Health and Human Services, the National Eye Institute (NEI), and specific agencies, such as the American Diabetes Association. For example, the National Institutes of Health Publication no. 03-201S, Las Cataratas: Lo Que Usted Debe Saber, provides a straightforward, large-print discussion of cataracts for Spanish-speaking patients.5
Also, many publications are distributed by pharmaceutical companies. Pfizer, in association with the
Information on many topics is also available in Spanish on the Web. Such resources can be printed at the end of the patient visit for the patient to take with thembut, make sure to go through them with a translator to verify the information and recommendations first. The NEI Web site has a Spanish language section that covers amblyopia, macular degeneration and many other conditions (www.nei.nih.gov/health/espanol). And, the site provides links to other Spanish language resources, including the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention and MedLine.
And, dont forget to direct the pharmacist to print any label directions in Spanish!
Once you incorporate Spanish into your examinations, youll want to learn more in order to better communicate with the patient. Numerous Spanish programs that cover everyday situations exist, as well as an increasing number of occupation-specific courses. Such manuals as Spanish for Healthcare Professionals by William Harvey, and Speedy Spanish for Medical Personnel by Thomas Hart concentrate on the patient-doctor interactions most likely to occur in your office.7,8
Auditory learners might try Essential Spanish for Healthcare by Miguel Bedolla. McGraw-Hills Spanish for Healthcare Providers gives an excellent overview of medical vocabulary, interviewing and examination scenarios. Spanishonthejob.com sells audio programs for health-care providers and medical receptionists. These audio programs concentrate on the areas that will be of the most use during exams, and unlike written materials, they allow you to listen and mimic correct pronunciation.
There are many online tools available in addition to computer-based retail programs. For example, www.123teachme.com has a variety of free instructional and reference components, including a dictionary, with audio pronunciation help and online learning tools for general conversation. In addition, it includes Medical Spanish for Health Professionals, which provides a sample case history, review of symptoms, vocabulary and emergency questionseach with audio to ensure correct pronunciation. Quizzes to evaluate your progress and medical Spanish podcasts are also available.
The American Optometric Student Associations Web site has useful translations for everyday examinations, from Amsler grid to Worth 4-dot. These can be found under Educational Tools at www.theaosa.org.
For the technophile, Palm OS software provides Spanish dictionaries and word pronunciation software for use on compatible cell phones.
For those of a more adventurous nature, the
Dr. Hirn is in private practice in
2. El Nasser H. Counties feel impact of Hispanic immigrants.
3. National Institutes of Health. U.S. Latinos have high rates of eye disease and visual impairment. Available at: www.nei.nih.gov/news/pressreleases/080904.asp (Accessed May 2009).
4. Flores G,
5. National Eye Institute, National Institutes of Health. Las Cataratas; Lo que usted debe saber. Available at: www.nei.nih.gov/health/espanol/cataratas_paciente.asp (Accessed May 2009).
6. Glaucoma: A Guide for Latinos.
8. Hart TL. Speedy Spanish for Medical Personnel.