Dr Kiran Keshwara, dentolegal adviser at Dental Protection, looks at how important details can be lost when treating patients who speak different languages
Australia is a fast-changing and culturally diverse nation with almost half (49%) of Australians either born overseas or with at least one parent who was born overseas.
According to the 2016 national census, there were more than 300 separately identified languages spoken in Australian homes and 21% of Australians spoke a language other than English. After English, the most common languages spoken at home were Mandarin, Arabic, Cantonese and Vietnamese.
Most clinicians are confronted with the experience of trying to communicate with patients who have limited, little or no understanding of English. This can, understandably, lead to difficulties and frustration for both parties, the dentist and the patient, while trying to obtain a complete medical history, understand the patient’s complaints and trying to explain all your findings and the patient’s treatment options, while ensuring that the patient fully understands the risks and limitations of the treatment being suggested. Further, the difficulty continues when the patient needs to be given postoperative advice or referred to a colleague.
Personally, I have struggled to explain treatment options and risks and warnings to patients who speak a different language to me and even when they attend with family members, who are often children, the question lingers in my mind as to whether the patient actually understood what I was telling them and if I’ve answered all the questions they have. This can also be an issue for patients with whom I do share a language other than English. As a fluent Gujarati and Hindi speaker, I have not yet been able to fully explain to my Gujarati and Hindi-speaking patients what an extirpation is or the risk of an oroantral communication without resorting to the use of English for the most important words such as “nerve”, “sinus”, “specialist” or “root”.
As clinicians, our duty of care towards the patient means that communication with the patient is of utmost importance, and we need to be careful and confident that we understand what the patient is saying and vice versa.
Often, the patient may attend with a family member and, while their English may be better than the patient’s, it may not be good enough to be able to understand and convey the information between the clinician and patient. Another concern is that we can never be sure what information has been passed between the two, and whether it has been shared with us. As a personal example of this, I was treating an elderly lady who was talking to her granddaughter in Gujarati. The patient did tell her granddaughter about the medication she was taking and was told “the dentist doesn’t need to know that”. Naturally, I did, and had I not been able to understand the conversation, I may have been unaware of the medication and working off false information.
A patient’s medical history is an important consideration when treating a patient and information such as the medication they are taking, any allergies and other pertinent details are necessary to ensure that the clinician is able to confidently treat the patient and reduce the risk of any possible adverse outcomes.
Another aspect of treatment of a patient where communication is of utmost importance is when ensuring that the patient consents to treatment. They need to be provided with all the necessary information including treatment options, costs, risks and benefits, and be given the opportunity to ask questions; failure to do this can lead to legal implications and scrutiny from the Dental Board. Many times, even when the patient speaks English, there is a concern that they haven’t been influenced by family members and this can be further magnified when the dentist is not quite sure what information has been given to the patient and whether they have been given all the information in an unbiased manner.
In order to avoid frustration, confusion and potential litigation associated with miscommunication with patients who speak another language, Dental Protection have some helpful tips that may be useful:
• Thoroughly check the patient’s medical history – if you are concerned that they do not understand spoken English, then how can you be sure that they have answered the questions in the medical history form correctly? Asking the patient for their GP’s contact details and contacting the GP for a medical history will provide a more comprehensive overview of the patient’s health.
• Consider the patient’s level of understanding of what you say – if they are agreeing to everything you say or answering with one-word answers, you should consider whether they have understood your advice or are simply a reflection of the patient’s cultural tendency to completely defer their care out of respect of their healthcare providers.
• Make use of drawings and photos to help explain diagnoses, treatments procedures, and options to the patient.
• Some leaflets are produced in multiple languages and may be provided to the patient in their language if available.
• Make a record of the patient’s language and also who they attend with, if they are attending with family members – as often, the family member will assist with translation and understanding.
• If you are not sure that the family member is translating properly, avoid treatments that are elective or highly costly without further clarification from the patient.
• Make use of the free (to healthcare practitioners) translation services provided by the Australian Government – translating and interpreting services can be found on
131 450 or
www.tisnational.gov.au
• The Victorian Government provide leaflets in a few languages for dental procedures such as postoperative instructions after an extraction, denture care and root canal treatments. You can read through the English version and remove the details that are not relevant to your patient. These can be found on:
www.healthtranslations.vic.gov.au/. Most of the states and territories also provide similar services.
More resources can be found on: