Unilinigual Dietitian Only

¿Habla Espanol? Not really. I took a few years, even studied abroad in Mexico for a month but my Spanish is rudimentary at best. I can’t deny it would be a handy trait though. I didn’t realize how much value there was in speaking another language until I moved to this area.

Three areas in Montgomery County take spots 2-4 on WalletHub’s list of cultural diversity cities in the United States: Gaithersburg, Germantown, and Silver Spring. We surpass New York and Boston. I’ve noticed this on a daily basis in the hospital setting.

While I would occasionally use a translator working in Tennessee, I rely on translation services for 2-3 patients a day or which equates to ~20% of the patients I assess. Spanish, Cantonese, and Mandarin are probably the three most common

languages needed. In our hospital, we use language line which is a phone interpretation service. We also have qualified bilingual staff that can be used to interpretation. Family and friends are discouraged for translation needs due to possible inaccuracies or bias.

What’s Wrong with Interpreters?

I appreciate that we have the technology to be able to speak to patients in their native language. But multiple problems exist. The primary problem is that using an interpreter or service creates a boundary. However good, some meaning is lost in translation and people aren’t as comfortable sharing information. I note that I feel less connected to my patients when they don’t speak English.

Interpreters also are challenging for older or demented patients. A patient who doesn’t speak clearly can’t understand or respond to language line. A hard of hearing patient won’t be able to use these services either. Any type of altered mental status often precludes interpretation.

Finally, many of these boundaries can be overcome with an in-person interpreter but finding an interpreter is often more trouble than its worth. Many of our interpreters are CNAs and all have jobs that they’re performing. For a busy hospital employee, being asked to take time to interpret takes time away from their primary job. They don’t get any additional help for interpreting. Instead, they have to interpret AND complete their normal tasks within a certain time frame. While some would argue that they are paid additionally for their assistance, I think that’s a problematic perspective.

We want interpreters to be available and willing to help out. We’re not performing a huge service by providing additional compensation for interpretation. Rather, they are providing a huge service to other medical staff by providing accurate and more personal interpretation. If we want to take advantage of these benefits, we have to make it easier for them to be available.

What’s That Got to do with Dietitians?

All health disciplines need good interpretation but I would argue that dietitians are

especially in need of interpretation services that are accurate, accessible, and as personal as possible. At least 50% of my interpretations are used to provide diet education. This area requires a more personal approach than a basic nutrition assessment. The person needs to be able to communicate their current dietary patterns and be able to understand the education that I am providing. A good diet education involves a fair amount of back-and-forth conversation. Instead, we’re often left simply reviewing the diet handout. The patient, often frustrated by the interpretation services, doesn’t ask questions so as to not prolong the education.

The Bottom Line

Although there are multiple poor effects of bad interpretation, the bottom line is that it leads to greater readmissions. Patients who don’t understand a cardiac, diabetic, renal, or other diet won’t follow the recommendations and are more likely to be readmitted which results in hospital penalties. One study involving 7023 patients saw that non-English speakers had a higher risk for readmission with an odds ratio of 1.3. Although these readmissions may be at least partially related to less access to post-hospital care, good communication is an important factor to preventing readmissions.

I would advocate for all dietitians to learn a few words in the predominant foreign language spoken in their area. However, the greater advocacy needs to be for more easy access to bilingual staff employees. Make it easy for staff to take on this extra work and the entire healthcare system will reap the benefits.