How to bridge language barriers with your patients

Of the US population, 25.9 million people ages 5 and older are “limited English proficient," and many of these people face barriers to receiving medical and dental care. As dental professionals, it is our obligation to try to meet the needs of these patients as best as we can. Here are several ways you can help bridge language barriers in dental hygiene and make your patients feel welcomed and cared for.

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AS A YOUNG DENTAL HYGIENE STUDENT, I remember needing to call back my next patient to the operatory and feeling extremely awkward because I had no idea how to pronounce this person’s name correctly. I made my best attempt but ended up butchering it completely. And then once my patient was seated, I quickly ascertained that their ability to speak English was quite limited as I was receiving a lot of responses that didn’t exactly make sense to me.

At this point, I began to wonder how I was going to effectively communicate with this patient for the remainder of the appointment. Important information such as home care instructions and medical history had to be covered, but I wasn’t confident in how to get this objective accomplished. At the time, I definitely felt that the language barrier was hindering my ability to provide my patient with the care he deserved.

43.3 million immigrants resided in the United States in 2015.1 Some of these people are proficient in English, but oftentimes the language barrier can be a challenge. Of the US population, 25.9 million people ages 5 and older are “limited English proficient.” Overall, this amounts to 9% of the population not being able to speak English very well. As reported in the 2011 American Community Survey, the most common language spoken other than English is Spanish, which is used by 37.6 million of US residents.2 These figures show a substantial portion of our population has the potential to encounter significant challenges due to language barriers as they try to receive medical and dental health care. As dental professionals, it is our obligation to try to meet the needs of these patients as best as we can.

Conventional methods don’t always work

When patients with language barriers receive treatment, it is extremely helpful to have a translator present, yet unfortunately we know this is not always possible. Amazingly, there are over 7,000 languages are spoken throughout the world, and 347 of these languages are used in the United States.3 At any rate, finding a translator can frequently be a challenging task. A family member can oftentimes be an invaluable resource when it comes to explaining oral instructions and treatment. But at other times, the person translating may be a child of the patient who Is too young to properly explain recommendations and instructions.

Learning some simple terms in a foreign language can be a great asset when working with patients that speak limited English. Delta Dental has an excellent website with an impressive English to Spanish Phrase Guide with pronunciations included. With my Spanish-speaking patients, I have found the phrase “abre grande,” meaning “open wide,” to be invaluable multiple times throughout my career. Another useful one is “saca la lengua,” meaning to stick out your tongue. Yet at many times, I feel like what I want to say is too complicated for my limited ability to speak Spanish. Fortunately, there are other ways to bridge this communication gap.

Become more comfortable with listening to accents

Sometimes it can be difficult to understand a patient who has a strong accent, and it is difficult to know how to proceed most effectively. A common mistake is pretending to understand that person in an attempt to avoid an awkward situation.4 This can lead to a confusing scenario, as the patient’s needs are not going to be properly addressed and the person may feel like you are not listening to them. Another common mistake is to rush through the appointment and say as little as possible. The patient may well interpret these behaviors as the health-care provider being both uncaring and unfriendly.

I found myself making these mistakes as a dental hygiene student, and I ended up being disappointed in myself. I knew that these patients needed me to spend more time with them in order to effectually deliver their oral health care, not less. Now, when I don’t understand what my patient said, I simply repeat the phrase back and allow that person to correct me if I am confused. Sometimes, it takes several attempts for me to properly understand the message.

Typically, I find that the more time I spend listening to someone’s accent, the easier it is to understand that patient over time. I believe that patients really do appreciate the effort to understand their accents and at the same time I appreciate their effort to understand me and my “accent.” Many of these patients end up requesting me for their next appointment and many times we have ended up having the most interesting conversations about what their life was like before they came to the United States. In the end, I feel privileged to develop a bond with these patients.

Be flexible with your communication methods

When up against a language barrier, I often adapt to my patient’s ability to help them understand me. I begin by enunciating clearly and speaking slowly. After a few questions, I am typically able to gauge my patient’s level of fluency with the English language. Oftentimes, a person who has limited fluency will agree at inappropriate times and I can clearly tell that they are confused by what I am saying. This is when I know I need to change my approach.

Using simple wording can help you effectively communicate with your patient. As clinicians, we are so used accustomed to using dental terminology such as gingivitis, periodontitis, calculus, caries, and gingiva, that it can be difficult change our mode of thinking. But when our patients have language barriers changing our approach can have an amazing effect on promoting understand. I have found that people who speak limited English tend to understand words such as pain, problem, good, bad, infection, and blood. By using simple terms, I am able to get my message through and help my patients be actively involved in their care.

Another thing to remember when working with patients with limited English proficiency is that body language conveys a lot of meaning. Remember to smile, as it is a universally understood gesture. The tone of your voice will be easily interpreted by your patient as being either positive or negative. Using nonverbal cues appropriately will go a long way to help your patient know that they are in a friendly atmosphere with caring dental practitioners that are dedicated to their well-being.

Using visuals aids is another excellent way to relay the message to patients when there are language barriers. When giving these patients brushing instruction, I use a model and toothbrush and explain what I am doing in the simplest terms. The patient is able to see me brush at a 45-degree angle and I simply tell them to “brush teeth and gums softly.” If the patient needs to focus on a particular area, I will tell them to “brush here more.” By using the combination of simple terms and visual aids, I have found that patient understanding is even further amplified.

The Gum Health Physical tool on the Colgate Professional website is a valuable resource for patients with limited English proficiency. It has excellent videos covering toothbrushing, flossing, and periodontal disease that do not contain any audio. A patient report can be created on the website showing the patient which areas to focus on and providing product recommendations. This website also allows the patient to see a periodontal probe in action, so they can see for themselves how gum disease progresses. If the patient is a Spanish speaker, handouts can be printed from the Colgate Professional website in Spanish. There are a variety of educational topics available such as bad breath, canker sores, and dry mouth.

Appreciate the patient’s effort to learn English

Understanding an immigrant’s effort to learn English is key to wanting to provide them with the best care, and I find it a true motivator for me. Imagine going to foreign country permanently and being expected to be able to speak their language effectively in a short amount of time. Imagine people treating you differently if you were unable to meet their expectations. The whole scenario would be completely overwhelming; you are trying your best and others may not be noticing the effort involved.

The following story is a personal experience to illustrate this point. As a child, I remember growing up around my grandmother, who had a very thick German accent. She came to the United States right after World War II, when she married an American soldier (my grandfather, of course) and knew very little English. At the time, she was very desperate to learn English and told me stories of how she would read soup cans and watch television to learn English. In that era, that was much prejudice against people from Germany so she kept to herself and did not get much help from others in learning English.

My grandmother became highly proficient in English as time progressed, but she never lost her strong accent. I remember her saying, “That’s so stupid,” but when she said the word “stupid” it sounded much more like “sh-too-pit.” I thought it was quite interesting as a child and learned to love my grandmother’s accent over time. It was an inseparable part of who she was.

Now that she has passed on, one of the things I miss the most is hearing her beautiful German accent. The point of this story is that any time we encounter a patient with an accent, we can never estimate what effort that person has put into learning English. We also should never underestimate their proficiency level with English until we have had an actual conversation with them. My grandmother wrote hundreds of letters to me and is the person that inspired me to become a writer. I always wonder how many people judged her in some way due to her accent. Thankfully today, we live in a time where differences are celebrated rather than looked upon negatively.

As dental hygienists, we come across patients from a wide variety of backgrounds and ethnicities. As a result, it is not unusual to encounter the challenge of providing treatment to someone who speaks little or no English. It is difficult to know how to provide your patient with high quality care when communication is an issue, but when we take time to understand each other the results can be impressive and we know our patients are receiving the top-notch care that they deserve.

Helpful websites

Gum Health Physical

Colgate Professional Patient Education

English to Spanish Phrase Guide

State Immigration Data Profiles

References
1. Zong J, Batalova J. Frequently requested statistics on immigrants and immigration in the United States. Migration Policy Institute website. http://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states. Published March 8, 2017.
2. Ryan C; United States Census Bureau. Language use in the United States: 2011. https://www.census.gov/prod/2013pubs/acs-22.pdf. Published August 2013.
3. Simons GF, Fenning CD (eds). How many languages are there in the world? https://www.ethnologue.com/guides/how-many-languages.
4. Friedman N. 5 tips on handling the foreign accent. https://www.linkedin.com/pulse/20140916143929-43628775-5-tips-on-handling-the-foreign-accent. Published September 16, 2014.


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