Clear communication between patient and their medical professionals is essential for health - but it doesn't come naturally. Unfortunately, that means far too many people don't get the care they need.
Barriers to clear communication include:
Not Enough Time
The average amount of time spent in an appointment with a primary care doctor in the US is somewhere between 9 and 15 minutes. That can mean important questions don't get asked, or that answers are incomplete. Since the COVID pandemic, it also takes longer to get an appointment (average wait time in 2022 was 26 days), so questions can pile up, too.
What can we do to get past this barrier?
While patients can't do much to change how appointments are scheduled, we can:
Obviously, when we're not speaking the same language, it's impossible to communicate clearly - and there are many different languages spoken, written, or signed (like ASL) in Bay Area communities.
Even when both parties are English speakers patients and medical professionals in the U.S. can be speaking two different languages, American English vs. Medical Jargon.
A different type of language barrier happens when we're too intimidated to speak up. That may be related to factors that are lumped together under the term "health literacy", those who "do not read or write well, has trouble communicating or understanding verbal communications about health, ... or has trouble understanding or using numbers".
What can we do to get past language barriers?
While we turn to our medical professionals to make our lives better, usually they are looking for specific problems to fix. A mismatch between making life better in general vs being totally focused on one issue to fix can cause misunderstandings and frustrations on both sides.
Or there may be a mismatch between our health issues and our health care team's knowledge. Primary Care providers mostly see patients with common, everyday complaints. If a patient's problem is uncommon or serious, they usually refer patients to a medical specialist. In fact, many health insurance plans require that we get a referral from a Primary Care professional before they will pay the cost of seeing a specialist.
But -- although medical specialists will have been trained on certain diseases or parts of the body, they might not be up-to-date about areas outside their specialty. People with a puzzling medical issue are often referred to more than one medical specialist. When they don't agree, or when they all throw their hands up and say "we don't know", patients get caught in the middle. It can also be particularly upsetting when the patient is concerned about one issue but the medical professional is focused on other areas (this situation can lead to medical gaslighting).
What can we do to get past mismatched expectations, or disagreements between specialists?
When someone is terminally or chronically ill, too often medical professionals cannot shift gears away from fixi-it mode, even if the patient's condition cannot be cured. When more treatment is offered in that situation, it is good to ask what benefit it would bring vs. the pain, distress, or possible ill effects of that treatment. Helpfull medical jargon to use: "What are the chances of having a better daily life experience with this treatment versus without it?"
Healthcare in the US is a huge business, regulated by many different agencies - it is very easy for important details to get lost in the shuffle, especially when going between one health care system and another. Medical errors are serious! For example, a simple typo in a prescription can result in getting the wrong drug.
Most treatments and procedures need to be prescribed by a medical professional but then also need to be approved by our health insurance company; disputes and denials of service are common. Also, the costs for medical care can be a surprise, even wildly different at different times - if that happens, ask why. You might also get billed for services, tests, or treatments that you didn't receive.
Since medical records are kept both on paper and in electronic form these days, it's even more confusing and difficult to get all the necessary details in one place. See this page for more on accessing your medical records.
What can we do to minimize errors in health care?
Translators and Interpreters
Health clinics, doctors' and dentists' offices, therapists, urgent care centers, emergency rooms, and hospitals are all required to have some type of interpretation service available for patients. That might be someone on staff who speaks their language, or bringing in medical interpreters, or ir could be a translation service.
If unsure of our ability to speak or understand, let the health care team know in advance so they can have the correct language assistance available at the visit - the I Speak Cards (link below) are a good way to do that.
Translation services must be free to patients in California (there should be no additional bill for these services).
Deaf and hard-of-hearing people in California can turn to the California Telephone Access Program (CTAP) for assistance (including financial aid) with getting the right type of device to communicate over phones with their health care team.
It is not a good idea to ask a friend or family member to translate at a medical appointment. Unless they are health professionals themselves, they might misunderstand what is being said. Or they - or you - might not want to talk about private matters that the health care team needs to know. (Having a friend or family member along might be very helpful as a patient advocate. That's a different job, however.)
Medical language can look like total nonsense.
For help with translating printed information, handouts, or instructions, these links may be useful:
A recent (2022) study reported that medical professionals' spoken or written language matched their patients' language levels less than half the time. No wonder it's hard to understand! Using medical dictionaries can help translate medical terms and jargon - see the links below for free online medical dictionaries.
It's also important to remember that patients have the right to ask for clarifications and explanations in words that make sense to them.
Besides the right to health care services in our language, there are other services required in medicine and health care, under what is sometimes called "Patients Rights". (One of those requirements is to receive a written copy of those rights, in our own language, if requested.)
In California, we should expect to:
To enforce these rights, patients can file a complaint with appropriate agencies, and get an independent review of their grievance.
For a more detailed list, including disability access rights, rights to refuse care, and more, see:
We believe that being well-informed is key to taking better care of health (our own, and of our loved ones), and empowers us to work more effectively with our health care professionals.
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