The UK population's changing structure is increasing the challenges for GP practices. In 2001, 8 per cent of residents were born outside the UK. By 2006 this figure was almost 10 per cent.
One of the most important areas of healthcare is communication. A breakdown in communication can trigger a complaint or claim - a danger that is magnified if the patient literally speaks another language.
Lost in translation
Many other cultural factors come into play, such as the use of particular gestures or body language. Even when speaking English, patients for whom this is not their first language may have a different understanding of common English expressions. Consultations can be a mess of misunderstandings.
The Medical Protection Society (MPS) receives a number of calls on this issue. These have mainly been for advice or following a complaint. To date there has not been a case where communication difficulties led to direct harm to a patient or to a subsequent claim.
Using professional interpreters improves care for patients with limited English proficiency, according to research studies. Patients who rate their translator highly are more likely to rate their healthcare highly.
Yet the provision of these services is still largely ad hoc. The National Register of Public Service Interpreters provides a professional quality-assured register but does not regulate interpreters.
In its guide to valuing diversity, the GMC says that the Human Rights Act 1998 and other legislative changes such as the Disability Discrimination Act 1995 provide a strong case for the provision of effective communications in hospitals, in the community and in GP practices. 'Wherever possible, communications should be provided in languages and formats appropriate to the patient group,' it states.
There are certain situations where patients are more at risk, such as consent. Particularly where consent to treatment is complicated, it is important to check the patient's understanding of the risks and benefits.
With older people and those lacking mental capacity, the difficulty of establishing the needs and wishes of these patients will prove more difficult when their English is poor.
Ascertaining such patients' requirements may be exacerbated if it is difficult to separate the interests of the carer, acting as translator, from those of the patient. With child protection, providing support for vulnerable children is made more difficult by communication problems. Patients living partly in the UK, partly abroad may be seeing different health professionals, so matching treatment can be problematic.
It is important to establish what help is available locally to manage language problems. Putting appropriate resources in place for your practice and patients will help prepare you for any problems that do arise. You may find that the resources available are limited - your primary care organisation (PCO) may only fund telephone translation, for example.
As in all cases of limited resources, if you have good reason to think that this is seriously compromising patient safety, then as the GMC advises 'you should draw the matter to the attention of your employing or contracting body'.
- Jonathan Haslam is managing editor at the Medical Protection Society.
- It helps to look at your patient and not at the interpreter when you are speaking, even if the patient cannot understand you. This can reduce certain anxieties or suspicions from your patient and allows you to monitor body language.
- Remember that the interpretation process takes time and ensure that background noise is at a minimum.
- Some people who most need information in their own language may not be literate in any language.
- Be aware that non-medical staff - for example, receptionists - are usually the first people that service users and patients encounter. Communication problems with a busy receptionist can cause distress or discomfort for a range of patients/service users who have specific communication requirements.
- Patient information (for example leaflets, posters) and important signage and announcements should be in plain language and accessible to all the main ethnic groups served by the practice.
- Electronic Quality Information for Patients (EQUIP): with links to a wide range of resources in other languages, including medical factsheets.
- NLH Specialist Library for Ethnicity and Health: aims to select the best available evidence about specific healthcare needs for minority ethnic groups
- Sounds Healthy: information in audio/text formats in several languages.
- Health Information East London: leaflets and posters in a range of languages for Hackney, Newham and Tower Hamlets patients.