HAM! BUR! GER!

How often do you run a call that involves a patient (or family or bystanders) with a grasp of the English language that could charitably be described as tenuous?

It happens to me all the time. America is a nation of immigrants. In addition, plenty of foreign visitors come to the country for both business and pleasure. It is not uncommon at all to have language barriers on a call. There are ways around language difficulties. There are phone-based interpreter services. You may speak the patient’s native language. There may be other people on scene that can provide translation. 

In my opinion, I don’t like to use non-professional translators. The family member (or worse, bystander) who is doing the translating may not need to hear about the patient’s medical problem. Medical problems are private in many cases. So I prefer the professional anonymity that “language line” services provide. Hopefully your agency offers something like that. 

In a lot of cases, though, the patient speaks limited English and basic communication can occur between the provider and patient directly. I have seen a lot of partners make this harder than it needs to be. I can pretty much guarantee that I have made it harder than it needs to be in my past. So here are some tips and lessons to facilitate communication with a person for whom English is a challenge.

Sometimes it is hard for me to find a picture that makes sense for the article.  So enjoy this one.
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1. Don’t shout. This is one of my pet peeves. They aren’t deaf; they just don’t speak English. I grew up in Europe and so I think I notice the “ugly American” getting louder and louder: “Hamburger! HAMBURGER! HAM! BUR! GER!”  Volume doesn’t help. Just speak in your normal, conversational tone.

2. Speak slowly, one word at a time. This is different from speaking words slowly. Speak. Each. Word. Separately. In. The. Sentence. This gives the other person a bit of time to recognize each word. Don’t change your word cadence: Doooonnn’tttt sllloooow doooowwwwwn eaaaaaccchhh wooorrrrddd. On a related note, separate your words instead of running them together. “Did you…” works much better than “Didja…” The problem is that most of us don’t recognize when we are throwing didja’s around.

3. Don’t use baby talk, slang, or incorrect English. Contractions are more difficult to understand than separate words: cannot is better than can’t. Keep your words and sentences as simple as possible. Medical terms probably weren’t covered in the entry-level English class the person you are talking to took, so simplify your words there, as well.

4. Speak about one thing at a time. Ask only one question at a time. It is amazing to me how common it is to have a partner shotgun two or three questions, or two versions of related questions: “How does your chest feel? Did you hurt it in the crash?” Blasting a patient with two questions is more confusing. (And it is usually done in a louder tone than necessary. HAMBURGER!) Ask one question and give the person time to absorb it. They also need more time to formulate their answer – they are translating both the question and the answer in their head. So ask your question and stop talking.

5. Um, this one is, like, sort of tough for me unless I think about it and all. Don’t use habitual fillers. When someone is first learning another language, sounds like ‘um’ sound like words. Filler words (like, totally, and all, and so on) complicate a sentence, as well. Keep your sentences as simple as possible.

6. Body language goes a long way. When your words carry less impact, other forms of communication have to carry more. So use your hands to point to things. Point to your head when you ask: “Does your head hurt?” Also, smile more. You can’t easily use your words to say that you are there to help. You have to show that you are there to help in other ways. So make sure you are giving off an open, friendly vibe.

7. If you have to repeat a question, repeat it the same way you asked it the first time. Don’t change your wording. 

8. Keep in mind that cultural differences exist. Different cultures have different expectations of personal space, for example. People from face-based cultures may not admit they don't understand you. Some people may be extremely uncomfortable at being touched, so you will need to ask first. The list of potential cultural differences is too long to get into here, so just do your best.

Next time you see your partner shouting two questions in a row, you can wince like I do when I see that. Just remember that your partner probably doesn’t even know that he or she is doing it. I didn’t until someone gently told me…