Thomas Turner talks about how dental teams can effectively communicate and gain consent from patients who speak a different language.
Did you know that 4.2 million people in England and Wales reported that English or Welsh was not their first language? (ONS, 2011a) Furthermore, 726,000 people cannot speak English or Welsh very well and 138,000 people cannot speak these languages at all. (ONS, 2011a)
There is also a vast variety of different languages spoken throughout the UK. This highlights the clinical need for clinicians to be aware of how to manage these situations. No matter where you live you will encounter patients who will speak a different language to yourself and this can create a unique challenge. In a typical week most dentists will encounter such situations. It is essential to manage them to the best of your ability as our ethical and legal duties remain the same, irrespective of language.
Throughout my foundation year I worked in Leicester where 27.5% of the population do not have English or Welsh as their first language (ONS, 2011b). This was a big contrast from my undergraduate dental training in the southwest. As a result, I had to develop new skills and techniques to overcome this barrier. These are my top tips for how to manage these situations.
Be prepared
Accessing a translator can be a time-consuming task. You should ensure you know which translation service you have access to and how to access this service. Where possible, you could also try to book the translator in advance to avoid creating a delay for your patients.
You could also work with your reception team. They can ask patients if they would require a translator before booking an appointment and when registering patients with the practice. You could leave a note on the patient records so the reception can book a translator for you.
Plan with your team
If you know one of your nurses speaks the same language as one of your patients, consider planning ahead and working with them for the day. Whilst it is important to gain consent from an impartial service, a colleague can aid communication throughout the appointment. However, you must also try to consider the wider team and avoid creating issues for others. For example, try to avoid using another clinician’s nurse in the middle of the day. This can create delays for them and their patients.
Know the requirements
For consent to be valid it is essential the patient can understand, retain and weigh up the information and then communicate their decision. For this to happen, when language is a barrier, it is essential to avoid using a bias source for translation.
You must avoid falling into the trap of allowing the patient’s relatives to translate for you. Whilst this may be easy and convenient, how can you be sure the information is not being changed or that the patient is truly making the decision? You should also avoid using your colleagues when gaining consent.
Although colleagues can offer some help it is important to remember there is always a risk of misinterpretation. Their own clinical knowledge may influence the translation and this may be inappropriate for the patient who they haven’t examined. It may also not be within their scope of practice. Therefore, it is vital an impartial translator is used.
Consent is a continuous process
It is important to remember that consent is a continuous process. The patient may change their mind in between appointments or have more questions to ask. It is important to have the translator present at all appointments to ensure the consent is valid. This also gives the patient every opportunity to ask questions and to discuss their options.
It is also a good idea to record the name of the translator and the service they are from in the patient records. This allows them to be traced and they are also another witness to the appointment.
The consent form and patient information leaflets
When gaining consent, you should consider getting the consent form translated by the translation service. Getting a consent form signed in a language the patient is struggling to understand will have very little to no weightage medico-legally. Likewise, post-operative instruction handouts will be of little benefit to your patients if they are in the wrong language.
It would be beneficial to get these translated for your patients too. You could also create translated handouts and posters within your practice for patients. These could explain the process of a dental appointment from what to bring with them to what the dentist will check.
Learn common phrases
If there is a predominant language within your local area, try to learn a few phrases. Showing the patient you are making an effort to communicate with them will only strengthen the working relationship. For example, learning how to say hello will help make the patient feel welcomed. When performing an extra-oral examination, knowing how to ask the patient how to open and close when assessing the temporomandibular joint will make this process easier. You can learn common phrases to help you build rapport and communicate with these patients.
Think outside of the box
Even though you might have valid consent, communicating with the patient throughout the appointment may be challenging. Ideally, try to get the translator to stay on the phone or at the practice throughout the appointment.
If this is not possible, try to create a communication system with the patient so they can communicate more effectively with you. You could create a number system for the patient. For example, you could get them to put one finger up if they would like to ask a question through the translator. Then you could get them to put two fingers up if they would like a break. And three fingers if they are not feeling well.
Imagine if the patient was having chest pains and they did not know how to communicate this with you. The effects could be devastating. If you allow the translator to communicate this or a similar hand signal system to the patient at the start of an appointment, it may help you prevent situations escalating. It could also give the patient a better experience and a sense of control.
Be creative
Performing a bite registration, sensibility testing, assessing occlusion or explaining disease can all be challenging when language is a barrier. Not only can this be difficult and hard to gauge, it can also be daunting and frustrating for the patient. It is important to try to think of ways to make these processes as easy as possible.
You could place toothpaste on the roof of the patient’s mouth to show them exactly where you would like them to place their tongue when putting them into the retruded contact position. You could get pictures to show the patient the stages of periodontal disease. Or you could show them a video of what you would like them to do when assessing occlusal guidance.
Final Thoughts
Whilst managing patients who speak another language can be challenging, it is important to realise how daunting this experience can be for the patient. Imagine having your tooth out and not being able to communicate with the dentist. It takes courage to come and see a dentist, especially when communication may present issues.
It is vital we make this experience as comfortable as we can for patients. These tips have been developed to help you manage these situations safely, effectively and ethically. However, it is important to develop your own style and manage these situations in a way which works for you.
References:
Office for National Statistics, 2011a. 2011 Census general report. [pdf] Office for National Statistics. Available at: <https://www.ons.gov.uk/census/2011census/howourcensusworks/howdidwedoin2011/2011censusgeneralreport> [Accessed 2nd July 2020].
Office for National Statistics, 2011b. Main Language (detailed.) [online] Available at < https://www.nomisweb.co.uk/census/2011/qs204ew> [Accessed 3rd July 2020].
