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Most medical care occurs outside of the doctor-patient contact. Laboratory phlebotomy, “clean catch” urine, electrocardiograms, colonoscopy prep, mammograms and nasopharyngeal swabs are all performed while doctors are busy elsewhere. If there is a delay between the order and completion of that task, the translator for that encounter will usually move on to the next encounter. An interpreter is then called at each site (i.e. lab, MA, radiology) to perform very routine tasks that are discrete, quick, and often require some demonstration.
Worse than calling and waiting is not calling and instead miming the task, or worse, simply proceeding without explanation or warning. The time required to call an interpreter, register for an appointment, wait for the interpreter, and then describe the specific task over the phone creates delays, unequal access to care, and bottlenecks for technicians. The financial cost of time and repeated calls is also high. This has been most evident during the Covid-19 pandemic when LEP patients were screened for symptoms and tested for the virus.
It may be helpful to use actors from the community to immediately provide high-quality explanations and demonstrations of the task at hand in the patient’s language. This communicates key information very clearly and provides a presentation that can be played repeatedly in many simultaneous locations. If there was an option to opt out and request an interpreter, that would also appeal to groups who are anxious, have other issues, and are willing to wait for an interpreter to get care.
By linking language-specific videos on the YouTube channel to QR codes, a library of language-appropriate demos can be instantly used to perform many or specific, simple but potentially confusing tasks, such as FIT tests or spirometry. The QR code can be obtained online, in a book, or printed on the AVS (after the visit summary), allowing the video to be viewed on an iPad in the laboratory or screening station or on a smartphone carried by the patient themselves.
We have attached an example and “proof of concept”. This is an example of the nasopharyngeal swab, a routine that caused great anxiety and avoidance for some people during the 2020 pandemic.
These videos are not intended to replace in-person or telephone interpreters in clinical care, but rather provide better care by ensuring that interpreted instructions are provided. This also avoids delays in written translation of information, as well as the fact that children and many people with visual impairments or low literacy are reluctant to read. Translations are always flawed, expensive, quickly outdated and often lost. The videos are produced in minutes on an iPhone using available hospital interpreters.
An interesting observation by British sociologist Anthony Giddens is that culture and social structures are made up of everyday behaviors. Daily habits such as dress, greetings, rules of conversation, use of cutlery, worship and driving patterns vary from culture to culture and are specific components of culture. These are the things we teach our children and young people that keep cultures and societies alive.
As these practices are modified and changed, culture continues to evolve and adapt. This is evident in medical culture, which consists of myriad routine practices that are repeated, occasionally modified, standardized across settings, and then measured. “Code Blue,” blood pressure measurements, immunizations, use of blood glucose meters, ventilator care—each is a routine that we standardize and teach the next generation to continue practicing health care. These practices are the cornerstone of medical culture. Subtle changes in how these routines are performed can produce significant differences between clinical settings that perform very similar clinical or administrative routines (but with minor differences).
When we expertly translate and present key clinical routines that require patient cooperation, we provide them with equitable access to the culture of medicine and its routines. We also take a step toward eliminating some of the disparities in care because we improve potential inequalities in outcomes that result from poor communication. Such innovations are efficient and inexpensive, but more importantly they are inclusive and lead to equity.
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