The Executive Suite: Speak patients’ language

Walk into Tamid Turbay’s internal medicine practice in Rockledge, Fla., and you’ll notice this message featured on glossy brochures atop the waiting room table: “No Tienes Seguro Medico? No Se Preocupe! Ofrecemos Precios Con Descuentos.”

(Translation: Don’t have medical insurance? Do not worry! We offer prices with discounts.)

As a native Spanish speaker, Turbay, MD, is using word-of-mouth and social media to attract Spanish-speaking patients from as far as 60 miles away. He was born in Colombia, and his practice, MHM Medical Group, will mark its two-year anniversary in October.

Rockledge is located in Brevard County, which has 589,000 residents. Census figures from July 2017 show 10.4 percent of the county population is Hispanic or Latino. Some Spanish-speaking patients glance at his name and mistakenly believe Turbay is from India. But when they call, they quickly learn he and his trio of staffers — two full-time, one part-time — are fluent in Spanish and English.

““When they call an office, and they say for example, ‘Do you speak Spanish?’ and the people from the office say, ‘Un pouqito,’ immediately they feel a barrier,” Turbay says.

Before launching his solo practice, he worked as an internal medicine physician with Wuesthoff Health System in Rockledge. Turbay completed his internal medicine residency program in Puerto Rico at the Mayaguez Medical Center. Prior to that, he worked as a primary care physician in Barranquilla, Colombia, and earned a healthcare administration degree from the Universidad del Norte in Colombia.

Turbay said many patients who are non-English speakers not only encounter difficulties in obtaining medical services, but in navigating the intricacies of the insurance system. Some of them are actually afraid to get into the plans, because they feel, ‘I don’t totally understand what I’m getting into,’” Turbay says.

What’s more, Turbay said some bilingual patients who speak fluent English prefer to discuss such matters in their native Spanish. They say, ‘I’d rather talk about money and medicine in my own language,’” he says.

A growing need

Nationwide, 58.9 million Hispanic people live in the United States, July 2017 Census data shows. Ten states host at least 1 million of them: Arizona, California, Colorado, Florida, Georgia, Illinois, New Jersey, New Mexico, New York and Texas. Nearly three-fourths of America’s Hispanic population (72 percent) can speak a language other than English and 30 percent speak English less than “very well,” according to 2017 Census data.

By 2042, one out of every four Americans will be of Hispanic background, the National Hispanic Health Foundation (NHHF) reports.

In March 2018, the NHHF teamed up with the University of Illinois Health Sciences during a daylong Medical Spanish Summit in Washington, D.C., to develop strategies to expand and evaluate Medical Spanish undergraduate curricula. The foundation estimates that 60 percent of U.S. medical schools offer Medical Spanish instruction, but few strategies exist for its standardization, certification and accreditation. Medical Spanish classes teach basic vocabulary and language skills on communicating with Spanish-speaking patients about common medical ailments, symptoms, procedures, treatments and other essential functions.

Per the NHHF summit report, language concordance between physician and patient improves patient compliance, understanding and satisfaction while cutting back on errors, emergency room visits and costs. There is also a lack of Hispanic physicians and physicians who are fluent in Spanish.

The NHHF concludes that equipping physicians with Medical Spanish education will improve quality of care for patients who speak limited English. The foundation supports standardized curriculum, testing and certification for Medical Spanish at the undergraduate, graduate and continuing medical education levels.

“Our No. 1 recommendation is that medical education in this country should have Medical Spanish as a requirement,” says NHHF President Elena Rios, who also serves as president and CEO of the National Hispanic Medical Association (NHMA). She said the need for Spanish speakers applies across the healthcare system into hospitals, nursing homes, clinics, dialysis centers, pharmaceutical companies and insurance companies. This need especially applies to primary care physicians since they serve as care coordinators for patients’ overall health.

“There have been studies that show if you have Spanish-speaking doctors and Spanish-speaking patients, you can increase their understanding in the disease they’re discussing, treatment plan, medication use or testing,” Rios says. “That means they get better quality care. They also take better care of themselves because they understood what’s being told to them. There’s adherence. They come back. They trust the doctor.”

“If we can think about having a healthier Hispanic population now, then we can have a healthier America in 20 years,” Rios said.

Lisa Ward, MD, president of the California Academy of Family Physicians, serves as chief medical officer at Santa Rosa Community Health, a federally qualified health center serving immigrants and refugees. Up to half of these 50,000 patients speak a language other than English at home.

Ward speaks fluent Spanish, and she prefers to hire multilingual physicians and providers such as nurses and medical assistants. Options for patients include on-staff interpreters for patients, video interpreters and telephonic interpreters.

“In my world, staff who are (not only) language competent but also culturally competent are essential to make the practice run, from the first phone call to delivering lab results to booking a new appointment. You can see, at every level of engagement, we need staff who can really talk to our patients,” Ward says.

Those communication gaps can be especially pronounced with new non-English-speaking patients, she said. When she first opens the door with the greeting and says, ‘Hello, I’m Dr. Ward,’ they sometime don’t respond — and they look at her with some level of anxiety.

But if she switches to Spanish and says ‘Hola, mi nombre es Dr. Ward,’ she can see a visible shift in their level of comfort. “(They are relieved) that they’ll be able to talk to someone who can understand them. It’s palpable in the room,” Ward says.

“When you make an effort to understand where they’re coming from, then you start to gain the trust of a patient where they can tell you about what their real needs are. They will trust you to start a new medicine, or to get an X-ray that they otherwise may be afraid to get,” she says.

“It’s really using language as a bridge, and cultural competency as a bridge, to help patients develop the relationships that we need to do our best care,” she said.

Technological trends are reducing obstacles and making things easier for non-English-speaking patients, Turbay said. For instance, his website features a patient portal so patients can send text messages and schedule appointments online, in English or Spanish. At other practices, this online portal could bypass barriers posed by non-bilingual staffers.

Ward notes the healthcare system’s complexities are difficult enough for even native English speakers to navigate.

“Doctors are famous for using jargon or delivering a lot of complex information without actually delivering a lot of understanding,” Ward says, referring to her experiences as a patient.

“Just imagine discussing something like, ‘Take this pill twice a day with food.’ The basic transactions of healthcare are essentially wasted if we cannot reach patients, understand what they need and deliver remedies or recommendations in a way they can understand and trust,” she says. “If we don’t use language and culturally competent care, we’re wasting our time. And, we’re doing a disservice to the patient at the same time.”

While completing his internal medicine residency program, Turbay even recalled experiencing linguistic difficulties with a Spanish-speaking woman in the emergency room: She was from Puerto Rico, and he grew up in Colombia. She rattled off three definitions of a colloquial Spanish term before he understood that her back felt stiff when she moved.

“You know what? She also spoke English. So, if she was here (in the U.S.), she would have rather tried to find someone who understood what she meant,” he says.