A mother brings her 4-year-old son to the clinic for evaluation of 2 days of abdominal pain. She moved to the United States from Vietnam 3 years ago with her husband and children and cannot speak or understand English. She is fluent in Vietnamese. Her husband is fluent in English but is currently out of town on business. The boy is accompanied by his 7-year-old sister, who is fluent in Vietnamese and learning English in elementary school. The treating physician is unable to speak or understand Vietnamese, and there is no Vietnamese interpreter available in the clinic. They are joined by a family friend, who is fluent in both languages. The boy has stable vital signs and does not appear to be in distress. Which of the following is the most appropriate choice to communicate with this patient?

Question

A mother brings her 4-year-old son to the clinic for evaluation of 2 days of abdominal pain.  She moved to the United States from Vietnam 3 years ago with her husband and children and cannot speak or understand English.  She is fluent in Vietnamese.  Her husband is fluent in English but is currently out of town on business.  The boy is accompanied by his 7-year-old sister, who is fluent in Vietnamese and learning English in elementary school.  The treating physician is unable to speak or understand Vietnamese, and there is no Vietnamese interpreter available in the clinic.  They are joined by a family friend, who is fluent in both languages.  The boy has stable vital signs and does not appear to be in distress.  Which of the following is the most appropriate choice to communicate with this patient?

Quizplus · Accepted Answer

Explanation: Recent census data estimate that up to 20% of United States residents speak languages other than English at home. Many of these patients have limited English proficiency (LEP) and have difficulty communicating with medical personnel. Communication problems can lead to misunderstanding of diagnoses, medication reconciliation, and follow-up care. As a result, LEP patients can have more adverse events than English-speaking patients. Medical interpreters are trained to take a medical history and would be the preferred method of obtaining this patient's history. However, many health care facilities may not have adequate staffing to cover all major languages. Telephone interpretative services are a reliable back-up option. These services involve the doctor using a speakerphone to contact a trained medical interpreter, who can assist in obtaining an adequate medical history from the patient. (Choice A) Although the boy appears stable, sending him home without further evaluation is inappropriate as he may have a serious condition. (Choice B) Children should not be used as interpreters except in emergency situations when there are no other options. In addition, this child may not be able to use the necessary English to obtain the medical history. (Choice C) Family members and friends can be inaccurate and unreliable with medical details unless they are specifically trained on the expectations of interpretation. (Choice E) Examining the boy to determine the problem without first obtaining a medical history can lead to a misdiagnosis. If he has stable vital signs and does not appear to be in distress, it is best to find an interpreter and obtain an accurate history. Educational objective: Patients with limited English proficiency can have communication problems leading to misunderstanding of diagnoses, medication reconciliation, and follow-up care. Medical interpreters are preferred for obtaining an accurate medical history in these cases. Telephone interpretative services are a reliable back-up option. Using these services, a trained medical interpreter on a speakerphone can serve as the contact between the patient and the health care professional. References: Working with interpreters: practical advice for use of an interpreter in healthcare. (http://www.ncbi.nlm.nih.gov/pubmed/23448332) Navigating language barriers under difficult circumstances. (http://www.ncbi.nlm.nih.gov/pubmed/18711157)

A Mother Brings Her 4-Year-Old Son to the Clinic for Evaluation