www.mddus.com


It is essential to obtain informed consent INGUAL CINE


clearly, avoiding jargon or complex phrases. If a professional is not available, other


options include a multi-lingual healthcare professional or ‘ad hoc’ interpreter such as a friend or relative. Remember that there is no guarantee how effective an ad hoc interpreter will be and it is unlikely they will have the relevant experience of medical terminology as a professional would. Ensure the patient can speak freely and comfortably in front of the translator, particularly regarding more sensitive health issues.


Open questions It is crucial to use open questions rather than closed ones when speaking to patients with poor English. Remember the five ‘Ws’: what, where, when, why, who and how/how often. These will help avoid basic yes/no responses and the answers should help you understand more about the patient while being reassured they understand you. Speak slowly and in short sentences and ask the patient to do the same.


Cultural differences Doctors must also take into account potential


cultural differences. A patient who is afraid to cause offence may simply say ‘yes’ even if they haven’t understood you. In some cultures, nodding your head is a gesture of respect to show the person is listening and not necessarily a sign of understanding/ agreement. Similarly, the patient may have no intention whatsoever of complying with the recommended treatment for cultural reasons that were never discussed. At the end of the consultation, ask the


patient to summarise their understanding of the problem and agreed treatment plan, including how to take any medication.


Consent This is a key risk area for patients with poor English. In our scenario it could be argued the patient was not properly consented for her abdominal examination (although fortunately no complaint was made). According to the GMC’s 2013 guidance Intimate examinations and chaperones, an intimate examination includes those of the breasts, genitalia or rectum, but for some patients it may involve simply touching them or even being close to them.


before carrying out an intimate examination and to record that consent. The patient must understand why the examination is being carried out and how it will be conducted. What part of the body will be examined? Will there be any discomfort? A chaperone may be able to confirm that an


examination has been conducted in a professional and appropriate manner but cannot ensure that it was consensual. To avoid any misunderstanding a trained medical interpreter is desirable when dealing with non-English-speaking patients in order to avoid potential complaints or medico-legal claims. It is preferable to have the interpreter present during physical examinations if the patient is agreeable. Otherwise extra care must be taken to explain beforehand and via the interpreter exactly what will happen during the examination. Leaflets can also be very helpful and some


practices routinely have their practice leaflet printed in several languages depending on the practice demographic. The website patient. info has some useful resources.


Conclusion So, back to our scenario. A telephone translator was booked for the next appointment and 20 minutes was allowed. The husband was present but the wife spoke freely with the translator’s assistance and a diagnosis of gastritis was made. The doctor explained how to take the medication, checked the patient’s understanding, and Mrs W left satisfied with an information leaflet in her own language.


Dr Susan Gibson-Smith is a medical adviser at MDDUS and editor of GPST


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16