What is an appropriate method of communicating with a person with limited comprehension of English?

The number of non-native English speakers in the United States now includes over 60 million people – nearly triple the number from just three decades ago. Spanish and Chinese are the most popular foreign languages spoken in U.S. homes. With roughly one-in-five Americans speaking another language at home, medical professionals are bound to encounter patients with whom it is difficult to communicate. Employing a medical interpreter is vital for situations like this, but it’s not just the interpreter who matters.

Table of Contents Show

1. Learn a few polite expressions
2. Avoid slang
3. Keep it simple
4. Speak in full sentences
5. Be culturally sensitive
6. Look at the medical interpreter
Contact Christopher Benum
Contact Christopher Benum

You can play an active role in helping to make your non-English speaking patients more comfortable by following these six tips:

1. Learn a few polite expressions

A simple ‘good morning’ or ‘thank you’ in the patient’s native language will go a long way toward improving your relationship and building trust. Having a medical interpreter on your staff will help ensure you are able to connect with your patients immediately.

2. Avoid slang

Use standard English to make sure your explanations and instructions will be understood correctly. For times when you don’t have your medical interpreter on hand, avoiding slang will allow you to speak more clearly and concisely.

3. Keep it simple

As with may have, the shorter the explanation, the better. Aim for words and phrases that are simple to understand and easily translated. Long explanations could lead the medical interpreter to summarize your words in a way that doesn’t fully express what you’re trying to say. At the same time, be careful not to patronize your patient!

4. Speak in full sentences

You may think it’s helpful to stop mid-sentence to allow the medical interpreter to catch up, but doing so may put information out of context and lead to a confusing or inaccurate oral translation.

5. Be culturally sensitive

Topics such as death, sexuality and women’s health must be addressed with care and respect, even with a medical interpreter present. Also, be careful about making jokes that might not translate well (or appropriately) into your patient’s native language.

6. Look at the medical interpreter

It’s very important to stay engaged while the medical interpreter is translating your words. Don’t look through charts, talk to others in the room or stare out the window. Instead, signal your interest by facing the interpreter while they’re talking.

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The ability to communicate well with adults with limited English requires a special set of skills. It is quite different from communicating and establishing rapport with someone from your own language background. Speaking more loudly does not necessarily help. Using more words to explain it can create even more confusion.

Here are some tips and some things to keep in mind. These are based on my own twelve years of experience teaching English to speakers of other languages and five years of life experience as a limited-language speaker in China and Vietnam.

Use fewer words rather than more to convey the same meaning:

Once, I was teaching a group of immigrants and refugees who were just starting to learn English in Tukwila, Washington. I made the mistake of phrasing the question, “How much is a quarter worth?” This caused some confusion, since they didn’t understand the word “worth”.

The following day, I came in with some coins. I held up a nickel and asked, “How much is it?”, and someone said “five cents”. The word “worth” threw people off; it had caused unnecessary confusion because it wasn’t needed to convey the meaning of the question. Use as few words as possible to convey the meaning.

Use common, near-global reference points or analogies:

Keep in mind that some experience and knowledge is common throughout most of the world, while other references are specific to one country or a smaller group of cultures. This is true both for cultural groups and economic classes within the same culture. Analogies to globally common events, people or experiences can be used to help non-Native English speakers understand the situation and relate to what you are trying to communicate.

For example:

Refer to the World Cup rather than Superbowl

Refer to globally-known pop stars rather than heavy metal bands

Refer to a trip to the beach or park rather than a luxury vacation in Paris

Communicate an identical message in both speech and writing:

This gives people with limited English proficiency two chances to understand what is being said, and helps them keep their attention on what is being conveyed. Written and spoken English comprehension are two different skills, and people have different strengths and weaknesses. Conveying an identical message in both writing and speaking maximizes comprehensibility for everyone and gives people a second chance to fill in gaps in their understanding.

Break up longer thoughts into shorter ones:

Longer sentences often string together multiple ideas in ways that are complex. In particular, native speakers of tonal languages, such as Chinese or Southeast Asian languages, may have difficulty in catching nuances of English grammar that indicates time. In these language backgrounds, time is often expressed with phrases like “already”, “right now” or “at that time”.

Take for example, the sentence: “I was writing an e-mail to you when you called.” The same meaning can be conveyed with “You called at about 4 p.m. At that time, I was writing an e-mail.” Using shorter sentences and time markers can improve comprehensibility.

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When possible, demonstrate rather than explaining

For example, in employee training, have someone demonstrate unacceptable behavior and someone else demonstrate preferred behavior. Ask trainees which way is better and why.

Pictures that show a desired outcome or avoidable incident can also be more useful than trying to explain situations or risks in detail.

Never ask “Do you have any questions?” to low-level English speakers, especially if they have a lower status within the organization:

Formulating questions is a complicated grammatical task. It requires a deep understanding of the relationship between words in a sentence, and how the order of words changes meanings. Many languages use tones differently than English, and even intermediate non-Native speakers might not understand how tones relate to the meaning of English sentences. Some non-Native speakers who lack formal training in English grammar might not even understand whether a question or command is intended.

In contrast to North America and Northern Europe, many non-English speaking cultures are very hierarchical. In many cultures, asking direct questions to a superior may be considered disrespectful, and runs the risk of being perceived as challenging the superior’s authority. Where hierarchies are rigid, it is much safer to keep a low profile. People adapted to these environments typically ask someone of the same status what they understand, or simply pretend that they have understood and hope for the best.

Instead of asking “Do you understand?”, ask them simple questions to check for understanding.

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Refugee Communities in the Seattle Area

With an estimated 44 million foreign born people living in the U.S. and 22 percent of the population not speaking English at home, we are more likely than ever to encounter non-English speaking people. Effective communication is important in all aspects of life, but it’s even more crucial in the workplace. Being able to communicate in a way that makes those who are less proficient in your native language comfortable is a useful skill to cultivate.

If you work in the life sciences or medical industry, chances are good that you encounter non-English speaking or ESL patients regularly. Certainly, there are times when patient safety requires making an interpreter available to communicate effectively with non-English speakers, but the job of putting patients at ease cannot be left solely to interpreters.

You can put non-native English speakers at ease by following these seven simple tips:

Whenever communicating with patients, colleagues, or other contacts in a business context, no matter what language they speak, it is good practice to speak slowly and deliberately. When speaking with non-experts who use English as a second language, you will want to speak even more slowly than you normally would, but without being condescending. Keep in mind that most language learners who are not yet proficient, may understand more than they can speak. Still, it can take them longer to comprehend your words.

It’s also important to stick to simple explanations whenever possible. Using plain language goes a long way. This is especially true when explaining complex or technical systems or procedures to non-experts. The shorter the explanation, the better. When working with an interpreter, long explanations can cause the interpreter to summarize in a way that doesn’t convey all that you want the person to know.

With language barriers, eye contact is an especially powerful tool you can use to make the listener feel more comfortable. Even though you may be communicating through an interpreter, look at the patient and make sure you are engaging her in the same way you would engage someone who is fluent in English. Although this may feel slightly awkward at first, it will help bridge the communication gap.

You will also want to stay engaged with the interpreter to ensure that this professional hears and understands you well. Do not flip through charts, keep your head buried in a screen, or look out the window as you talk with the non-English speaking patient and interpreter. Signal your interest and concern by staying engaged with everyone involved.

Body language is another tool that helps us communicate beyond the words we use. Being aware of your own body language and what it conveys helps you communicate effectively with non-English speakers. You should also pay close attention to the body language and facial expressions used by those to whom you’re speaking. It can give you vital clues about whether the patient is understanding you.

Above all, putting non-English speaking patients at ease requires that you demonstrate patience and respect. It can be frustrating to speak with someone who does not understand you or who cannot easily communicate with you. However, as a professional, controlling your frustration will increase your odds of achieving a successful outcome.

Finally, be sure you are signalling cultural sensitivity in your interactions with patients and others. You can do this in several ways:

Learn a few polite expressions in the languages you encounter most frequently on the job. For example, even being able to offer common greetings, as well as saying “please” and “thank you” in a pateint’s native language shows that you are ready to listen.
Familiarize yourself with the cultural norms around sensitive topics such as death, sexuality, and women’s health. Koreans, for instance, view being present for the death of their loved ones as particularly important.
Avoid using jokes, idioms, and proverbs that may not translate well. These kinds of phrases can make non-native English speakers feel left out of conversations despite any well-meaning intentions.

Communicating effectively with non-English speaking people can be challenging, but also rewarding. You likely don’t need to make big policy changes to ensure that you and your team demonstrate equal respect for people of all backgrounds. Follow the above tips and emphasize that outcomes improve in the life sciences when patients feel comfortable communicating with all staff members.