It’s evident to anyone walking down the streets of New York City that it’s a diverse place. Memorial Sloan Kettering’s patient population reflects that mix, with a growing number of patients who have limited English proficiency.
MSK’s Immigrant Health and Cancer Disparities Service was created to address language and communication barriers, as well as other issues surrounding our changing patient demographics. The service comprises healthcare experts with a range of specialties who work together to provide health education and medical services to immigrants and other medically underserved communities.
We recently spoke with Lisa Diamond, a member of the service’s research team, about initiatives she and her colleagues are undertaking to improve care for patients who speak little or no English.
Why are language barriers a concern in healthcare, particularly in cancer care?
In an ideal world, we would all speak the languages that our patients speak and there wouldn’t have to be another party — an interpreter — in the room. Certainly with sensitive issues and sensitive conversations about prognosis and diagnosis, it would be great for our doctors and nurses to communicate with patients directly, using the words they want to use.
Absent that, professional medical interpreters are an outstanding bridge. They receive a lot of training in how to handle these difficult situations appropriately and accurately. For patients who don’t have the ability to conduct these important conversations in the same language that their doctors speak, they truly are the best option.Back to top
Tell us about the study that you recently published in the Journal of the American Medical Association.
Census data show us that the United States is getting increasingly diverse, and we thought it was important to find out whether the medical community is prepared to address that. We looked at new doctors applying to residency programs and whether they were fluent in languages other than English, and compared the most common languages spoken by new medical school graduates to the languages that are the fastest growing.
In our study, we found that while many medical residents speak a second language, there was an underrepresentation of those who speak Spanish, Vietnamese, Korean, and Tagalog, which are four of the top five languages spoken in the United States by people with limited English proficiency. [The fifth is Chinese.] We also found a large overrepresentation of those who speak South Asian languages such as Hindi and Urdu compared with the number of patients who speak them.
MSK trains hundreds of new doctors every year, and we as medical educators need to do a good job of teaching them the importance of using interpreters so that all patients can get the care they deserve.
It’s great if doctors speak some Spanish or Russian, for example, which are the two most common languages our patients speak, and can make small talk with patients in those languages. But for matters like medical instructions, discharge instructions, and informed consent, it’s important for doctors to either have complete fluency in the language or to use an interpreter.Back to top
What is MSK doing to address some of these issues?
Interpreter services are always available to our patients who don’t speak English. Sometimes interpreters are present in the room, but other times they are on the phone, especially for hospitalized patients or those being seen at one of our outpatient centers in one of our suburban locations.
This year we will begin piloting a new system I’m very excited about called remote simultaneous medical interpreting. It’s similar to what is used at the United Nations, where both people wear headsets that are connected to an interpreter at a remote location who can interpret as a person is speaking. It’s an amazing technology that makes the communication feel much more like a regular conversation, because there is almost no delay. We hope to eventually offer it at all of our sites.Back to top
Are language barriers a particular problem for hospitalized patients?
Absolutely. These patients have people coming into their rooms all day — from doctors and nurses to the person who delivers the breakfast tray — but they can’t have conversations with them and may feel very isolated if no one speaks their language.
Every year a group of young doctors on the Medicine Service called transitional-year interns is charged with doing quality-improvement projects, and language services have been their focus the past two years.
They came up with the idea of having dual-handset phones at the bedside of every hospitalized patient who identified as having limited English proficiency. Any person who comes into the room can pick up one handset while the patient can pick up another, and an interpreter on the other end of the phone can help them connect. It’s not simultaneous like what I discussed earlier, but it’s very good, and it really helps us offer better care to these patients.Back to top
Can you tell us about some of the other initiatives your service is involved in beyond those related to language and communication?
We have a project for New York City taxi drivers, most of whom are immigrants. We are working to educate them about the importance of cancer screening and to give them better access to cancer care, as well as primary care.
We also are involved in a program through the Mexican consulate in New York, called Health Window or Ventanilla de Salud. This initiative is actually under way at Mexican consulates all over the United States. The idea is to reach out to Mexican citizens who come to the consulate for other services, such as visas, and provide them with information about healthcare while they are there.
In addition, we have programs in the Latino community to raise awareness about the importance of the HPV vaccine [which prevents cervical and head and neck cancers] and to improve access to the vaccine.
We have several studies looking at access to care in the Chinese immigrant community as well.
Overall, our initiatives are aimed not only at learning more about these communities and providing better healthcare services to them but also at gaining insight that will help to establish new policies in New York City and beyond.Back to top