Article Date: 9/1/2010

A Startup Guide for Multilingual Practices

A Startup Guide for Multilingual Practices

Doctors explain how bridging language and cultural barriers enhances patient care and increases marketability

By Erin Murphy, Associate Editor

Having a multilingual practice isn't about encountering language barriers and buying stacks of phrase books to help you struggle through conversations. It's about being flexible. If you're flexible enough to learn eyecare terms in another language or to hire bilingual staff members, then you're capable of meeting the changes in your patient base. You're flexible enough to become the place to go for non-English speakers in your community.

Don't worry if you snoozed through French class or if learning Chinese sounds about as doable as building the Great Wall. Yes, bridging language and cultural barriers requires some learning, but mostly it just requires you to be astute and adaptable. By doing so, you not only ensure that you fulfill the needs of a diverse patient population, but you also gain advantages in terms of your value as an employee or your ability to grow your practice.

Fluency Not Required

It's great to know a few languages, but in professional terms, it's more important that you know how to communicate with your patients. If Spanish is the primary language of 25% of your local population, then it's good patient care and good business to learn key Spanish words and phrases. If you're located in a real melting pot, then you should learn key words and phrases in one or two of the most common languages.

Since you're only one person, the best approach is to spread the multilingual efforts among your staff.

Brian Chou, OD, FAAO, an industry consultant and practitioner in San Diego, Calif., wrote the book, Spanish Terminology for the Eyecare Team — not because he was fluent in Spanish, but because he wasn't.

"I took Spanish in high school and college, but when I got out of school, I didn't know enough to have discussions with my patients," he recalls. "I was working with Spanishspeaking patients in Salinas and on volunteer trips to Guatemala, and I gradually developed an extensive compilation of phrases for performing an exam." He approached a publisher, and today the book is in its second edition.

Dr. Chou still isn't fluent in Spanish, but he continues to use the language as much as his patients require. "I find that patients are very appreciative even if you're not fluent," he says. "They recognize that you're making an effort. You don't have to fully commit to learning a new language to have a better relationship with them."

Courtesy: A Universal Language

Dr. Chou's on-the-job adaptation is common. In the private practice of Madeline L. Romeu, OD, FAAO, in West New York, N.J., Spanish is spoken fluently, while other languages are accommodated through perceptive listening, common sense and, above all, courtesy.

"We're on the Hudson River, a 5-minute ferry fide from Midtown Manhattan. It's a big metropolitan area, representing every language and culture," she explains. "Four out of five people working in the office are Cuban, one is Italian, and I can speak some French, so it's easy to communicate in those languages, as well as other romance languages such as Portuguese that we don't speak fluently."

However, not all languages are so easy for Dr. Romeu and her staff. She has patients from Asia, the Middle East and other parts of the world as well, and she doesn't staff any translators. Not surprisingly, she says, her patients typically handle this issue themselves.

"Immigrants are smart. It takes a lot to get to this country, and they're encountering language barriers everywhere they go," she says. "If a patient from Egypt or Korea walks into my office, she brings her own translator — usually a young adult family member or a friend. No one comes in alone."

What's more, Dr. Romeu explains, is that not all communication is spoken language. A practitioner's warmth and ability to sense a patient's preferred style of interaction goes a long way toward making a patient feel comfortable.

"Everyone likes courtesy. If you treat people with respect, they understand that," she explains. "More than worrying about dealing with multiple languages, you have to be nice, to make an extra effort to show patients, rather than tell them that you welcome them. Smile — that's number one. Be warm and kind. Look your patient in the eye when you meet him and talk to him, even though his son is doing the translating. Ask how he is and ask about his family. Be human before you're a doctor."

When You Need Translators

Drs. Romeu and Chou don't hire anyone to translate for them. They communicate confidently with their patients through a variety of means, from knowing key words and phrases to fluency in several languages to speaking through the patient's companion. That approach may not always be enough. The deciding factor: volume.

Kirk L. Smick, OD, FAAO, has 105 employees in one Atlanta location, where 11 practitioners see 250 patients per day.

"The patient mix has changed dramatically in the last 5 years, and we've had to change our whole outlook on the services we provide," he says.

In addition to English, Dr. Smick's employees speak Cambodian, Chinese, German, Japanese, Korean, Laotian and Spanish, and he has sent two employees to sign language classes. "We often need interpreters in our exam room, so we just check the phone directory, which lists languages after the names, and bring in an employee to sit with us through the exam and continue with the patient to the optical shop and billing."

Even with 11 practitioners on staff, a practice like Dr. Smick's can't leave all the language skills to the doctors — especially given the speed with which the local population has changed. "I made my last seven hires based strictly on language skills," he says. "And I always try to stay a half step ahead of what's going on. The chamber of commerce tracks population trends, as do industry councils and other sources. The population is always changing, and I need to know in what direction so we can be prepared to serve them."

Cultural Factors to Watch

You can say words such as pain, cloudy and clear in three languages. Your receptionist is bilingual, and so is your optician. Your patients bring along a family member to translate. All the language bases are covered. For reasons both social and medical, you should also learn about your patients' cultures.

Dr. Smick prefers to refer to his practice as multicultural, rather than multilingual. "Some think it's a fine point; I think it's a significant point," he says. "It delivers the message that in today's environment, in order to communicate with all of our patients, we've made it a priority to have a broad range of knowledge of our patients' varied cultures, as well as their languages."

The doctor spends a lot of time learning about the different cultures that he serves and teaching his staff about them. "The Hispanic population, for example, is the fastest-growing group in our area. In training classes, we talk to staff about the current population and projections for the next 10 and 20 years. We cover clinical issues such as cataract, glaucoma and diabetes incidence, what's important to our Hispanic patients from a cultural point of view, and economic issues such as buying power," says Dr. Smick, who gave similar cultural presentations to technicians at the American Optometric Association meeting this year.

Understanding Hispanic cultures is second nature to Dr. Romeu, and her patients can feel that. "My Hispanic patients feel so welcome because we're Hispanic, and we can communicate. Patients feel more comfortable with someone who understands their culture. For every culture, that means showing respect. But for our Hispanic and Italian patients, it means greeting them warmly with a touch, asking about family, and giving them a kiss and a hug before they leave."

Dr. Romeu's other patients feel comfortable as well. Many Palestinian women come to her practice because they're culturally inclined to seek treatment from another woman. These patients see Dr. Romeu because she respects their culture and takes her cues from them.

"I don't approach all patients the same way," she says. "My Korean patients smile and bow to me, and I smile and bow to them. If more Korean patients moved to the area and came to the practice, then I'd get a native speaker to translate and welcome them, but for now things work out just fine."

To Dr. Chou, understanding patients' cultures also means understanding their attitudes toward eye care. "From a cultural standpoint, Chinese people have a great deal of concern and anxiety about myopia progression. More than 80% of Chinese patients are myopic, and many are concerned their kids will be as well. They want to prevent it," explains Dr. Chou. In his experience, this anxiety shapes how many of his Chinese patients approach their eye health and vision correction. "In my practice, it's striking to see how many Chinese patients are using corneal refractive therapy. The lenses may regulate myopic progression. I'm also following studies for spectacles and soft contacts that may also regulate myopia, since there's a demand for this particular treatment among my Chinese patients."

In addition, Dr. Chou notes that many of his Asian patients have fears and misconceptions about eye health, and he knows he needs to address that cultural barrier to make sure patients receive the care they need. "Many Asian patients mistakenly believe that if they can see clearly, then their eyes are healthy," he says. "Any practitioner who's working with this population may have more challenges than just language. We need to communicate to patients that just because they see clearly, it doesn't mean that they should skip an exam. Conversely, needing eyeglasses doesn't mean their eyes are unhealthy."

Boosting Your Career and Practice

When one thinks of a multilingual practice, it seems like something that practitioners have to do, but it's actually something that many ODs want to do. For new ODs, being multilingual presents an opportunity to grow a new practice or make yourself more valuable when seeking your first position after graduation.

"What a great way to create a niche and get a head start," says Dr. Smick. "We always talk about niche services, and this is another way to set yourself apart, whether you're multilingual and explaining to a practice owner how you'll boost revenue, or you're in practice and make the effort to hire multilingual staff or brush up your own language skills."

Dr. Chou agrees. "It's a tremendous asset if new ODs can learn a language and culture that's in demand among the patient base," he says. "Here in California, there are many Spanish speakers, but in the state's three optometry schools, more than 40% of new optometry graduates are Asian, with relatively few Spanish speakers."

Rest assured, your studying will pay off. Once patients know you or your staff members speak their language, they'll come to you and tell their friends.

"When patients who don't speak English come in and find someone they can talk to, they feel more at home. They know that you understand their needs, and they help grow your practice for you," says Dr. Smick. "They don't cover this in optometry school. It's something you need to do on your own, but it has real long-term value."

Dr. Romeu takes the edge off this sometimes daunting task by reminding colleagues that they can share the language responsibilities with staff and, in doing so, expand the patient base even further. "I recommend that you learn who's living around your practice and get assistants who are native speakers of the common languages," she says. "Almost all of my assistants are local. They're involved with their communities, and we draw from those communities. One person in the practice might speak a patient's language, but everyone is friendly and conscientious and provides a good service, and that makes patients feel confident that they're being heard." nOD

Products and Literature to Help

You can ascertain that your Spanish-speaking patient has red, dry eyes. You can see that it's meibomian gland dysfunction. But can you explain lid scrubs in Spanish? Can you give him instructions on how to use his eye drops? Before sending all of your pamphlets to a translator, find out who's already done it.
Madeline L. Romeu, OD, FAAO, is the American Optometric Association Chair of the Hispanic Initiative Project.
"We're trying to get the message out bilingually, to address doctors' needs in written communication, including billing," she says.
Kirk L. Smick, OD, FAAO, worked with the Essilor advisory board to help develop materials for eye care practitioners. "We've created a lot of materials to help eyecare practitioners, including Spanish/English bilingual eye exam flip charts to help doctors review patients' conditions."
"Optometrists can also attend talks about language and cultural considerations and the prevalence of eye and systemic diseases in the patients they serve," according to Brian Chou, OD, FAAO. "Be aware that manufacturers have tailored products toward those needs. For example, sun-related eye issues like pinguecula, pterygia and cataracts are more common in the Hispanic community, because social activities often revolve around being outside. There may also be some genetic susceptibility. Manufacturers like Essilor and Vistakon provide educational materials about UV damage in Spanish to go along with their UV protection products."

To bridge language barriers with patients wherever you are, try mobile apps such as Medical Spanish, Pocket Medical Spanish, Medical French or Medical Translator (English, Spanish, Italian, French and German).
For more information on how mobile apps can help you practice optometry, see Apps for ODs of this issue.

Optometric Management, Issue: September 2010