A 19-year-old Hispanic woman comes to the clinic due to nausea and abdominal pain. She struggles to describe the pain and frequently points to her lower abdomen. The patient shakes her head no when asked if she could be pregnant or is sexually active. When she is asked about her last menstrual period, she nods affirmatively and says "now." She is single and immigrated to the United States several months ago. Physical examination shows moderate abdominal tenderness with no rebound or guarding and vital signs are stable. The patient is discharged home with a diagnosis of food poisoning. Later that day, she is taken by ambulance to the emergency department after experiencing severe abdominal pain followed by loss of consciousness. A diagnosis of ruptured ectopic pregnancy is made. Which of the following interventions would most likely have prevented the delay in diagnosis?

Question

A 19-year-old Hispanic woman comes to the clinic due to nausea and abdominal pain.  She struggles to describe the pain and frequently points to her lower abdomen.  The patient shakes her head no when asked if she could be pregnant or is sexually active.  When she is asked about her last menstrual period, she nods affirmatively and says "now."  She is single and immigrated to the United States several months ago.  Physical examination shows moderate abdominal tenderness with no rebound or guarding and vital signs are stable.  The patient is discharged home with a diagnosis of food poisoning.  Later that day, she is taken by ambulance to the emergency department after experiencing severe abdominal pain followed by loss of consciousness.  A diagnosis of ruptured ectopic pregnancy is made.  Which of the following interventions would most likely have prevented the delay in diagnosis?

Quizplus · Accepted Answer

Nearly 20% of the United States population speaks languages other than English at home. It is therefore essential that physicians assess language proficiency when delivering care to immigrant populations. This patient's immigrant background and difficulty describing her pain should raise concern about limited English proficiency (LEP) and the need for a qualified medical interpreter. In the United States, patients with LEP experience a variety of health care disparities, including reduced clinical encounter time, substandard medical treatment, and higher rates of adverse events and preventable medical errors. The safety of LEP patients is particularly jeopardized in high-risk clinical situations such as emergency department care, surgical care, hospital discharge, and medical reconciliation. A useful screening technique to assess language proficiency is to ask the patient, "How well do you speak English: Not at all, not well, well, or very well?" An interpreter is appropriate for patients who cannot respond or respond "not well." Recommended interventions to prevent adverse events include providing a qualified medical interpreter in high-risk clinical situations and providing translated educational materials. Using the "teach back" method (in which patients are asked to "teach" the physician what was just explained to them) can also serve to confirm understanding. (Choices A, B, and C) Understanding cultural and social factors and sensitivity in obtaining a sexual history are important components of patient-centered care. However, addressing a potential language barrier takes precedence. (Choice D) Contacting the patient's family is unlikely to be productive and may violate patient confidentiality. Educational objective: Physicians must be able to identify patients with limited English proficiency and ensure that professional interpreters are made available in high-risk clinical situations. __________ References: Identification of limited English proficient patients in clinical care. (http://www.ncbi.nlm.nih.gov/pubmed/18618200) Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. (http://www.ncbi.nlm.nih.gov/pubmed/17362215) Language proficiency and adverse events in US hospitals: a pilot study. (http://www.ncbi.nlm.nih.gov/pubmed/17277013)

A 19-Year-Old Hispanic Woman Comes to the Clinic Due to Nausea