UAMS Audience Learns to Bridge Language, Cultural Gaps

Alan Lytle, Ed.D., director of the UALR Intensive English Language Program, left, exchanges business cards with UAMS inpatient clinical interpreter Mariella Hernandez. 

Lytle lectures to an audience April 29 at UAMS.

Lytle, left, talks to David Nelsen, M.D., M.S., UAMS family medicine physician, after the lecture.

May 8, 2013 | Alan Lytle, Ed.D., recently brought what he called a “communication toolbox” to an audience of UAMS medical professionals to show them how to break down the barriers that can hamper communication with non-native-English-speaking patients.

Lytle, director of the Intensive English Language Program at the University of Arkansas at Little Rock, on April 29 presented his lecture, “Second Language 101: Effective Communication Between Native and Non-Native English Speakers.” Sponsored by the UAMS Department of Family and Preventive Medicine, the lecture also was broadcast via teleconference to UAMS regional centers, Arkansas Children’s Hospital and 11 KIDS FIRST sites across the state.

To communicate clearly with non-native speakers, it’s necessary first to avoid making assumptions about their level of proficiency or cultural background.

“Do not assume they have the same level of knowledge that you do,” Lytle said. “You’re not going to offend them if you do it quickly enough in a verbal presentation. Take two minutes to get everyone to the common ground.”

Lytle said it’s also key to explain the importance of a procedure or treatment, focus on one major topic at a time, talk face-to-face whenever possible and be explicit in everything.

“One of the things I see often is that whenever a provider is giving bad news, they go around the topic,” Mariella Hernandez, UAMS inpatient clinical interpreter, said during a question-and-answer discussion following the lecture. “The patient doesn’t understand what they’re saying. Speak as frankly as you can but in a compassionate manner. Always ask them what they want to know about their care and what they don’t understand.”

Although some non-native speakers may have a good grasp of grammar, vocabulary and the mechanics of English, they sometimes lack the background and understanding needed to comprehend an idiom or cultural image. Lytle cited the example of “Juliet on the balcony” from William Shakespeare’s “Romeo and Juliet.”

It’s best to be careful when using those kinds of allusions in communication with non-native English speakers, Lytle said.

Another difference that sometimes can create confusion and miscommunication is the idea of a “soft future.”

“In some cultures, deadlines are more approximate and conditional than in ours,” Lytle said. “Make it clear you truly expect something will happen on a specific date when you try to pass on information about a schedule or time.”

Many people come from cultures where authority figures like physicians simply tell them what is going to happen in their care, Lytle said. That may make them uncomfortable with patient- and family-centered care.

UAMS and many other health care institutions across the United States are moving toward the new model of patient- and family-centered care in which patients and families are encouraged and supported in participating in care and decision-making. Use of the model makes clear communication even more critical to the quality of care a patient receives. It also incorporates into care the values, beliefs and cultural backgrounds of patients and family.

Lytle said making non-native English speakers comfortable with health care decision-making will take relationship building with physicians and other medical professionals involved in it. Introducing them to everyone on their care team from doctors to nurses and pharmacists will be key to that.

“Knowing the doctor can be trusted and giving them a comfort zone, and understanding what that is in their culture, is important,” Lytle said. “At some point, the doctor may simply have to say this is the way we operate, it’s up to you to choose now.”

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