Wanted: Staff who know Je; Ojo; Aankh

Those who speak ‘eye’ in Creole, Spanish, Hindi and other tongues are a boon to your practice.

By Karen Blum, contributing editor

When Mark Packer, MD, was an ophthalmology resident at a Boston hospital in the early 1990s, he frequently encountered Haitian patients who spoke French Creole. Then, he says, it was difficult to get an interpreter. “You could request one but it might be three days before they showed up at the clinic,” recalls Dr. Packer, now an ophthalmology consultant in Boulder, Colo. “You kind of made do and you never really knew if they were using drops the way you told them or what they were doing. It was just a guessing game.”

Fortunately for ophthalmologists and patients, times have changed. Now, it’s more common for ophthalmology practices, especially those in urban areas or other locations serving diverse patient populations, to have at least one or two staff members who are bilingual or multilingual.

Je; Ojo; Aankh; Occhio; oeil; Sy

“The benefits are tremendous,” says Shawn Klein, MD, of Klein & Scannapiego, MD, PA, in Elizabeth, N.J., which serves an ethnically diverse patient population. Among those in this six-physician practice are office staff who speak Spanish, Italian, Portuguese and Creole, and some doctors speak Chinese, Japanese, Korean or Tagalog; all speak some Spanish. “First, it [speaking the language] allows for clear communication,” says Dr. Klein. “In ophthalmology, patients are often taking multiple medications, especially eye drops. Each bottle may have different instructions regarding use and frequency, and patients need to understand.”

Having multilingual staff also fosters good patient relationships and trust, adds Albert Castillo, CEO of San Antonio Eye Center in Texas, where all front desk staff/patient coordinators, surgery schedulers and technicians speak English and Spanish. The San Antonio population is about 77% Hispanic, he says, and 45% of the practice’s patients speak Spanish as their primary language.

“When employees are bilingual, or make an attempt to learn or speak a language that’s not native to them, the patients really appreciate it,” Mr. Castillo says. “I know that when you have a patient who cannot communicate in English and don’t have someone bilingual available, it does create barriers in terms of the understanding and the communication of care. Oftentimes, those patients don’t stick around — they’ll go find someone else.”

Bilingual or multilingual patient care is not only a marketing tool to attract patients. It could give your practice a competitive advantage as health care adjusts to changes happening through the Medicare Access & CHIP Reauthorization Act (MACRA), says Ravi Goel, MD, an ophthalmologist in Cherry Hill, N.J., and volunteer faculty at Wills Eye Hospital in Philadelphia. His practice sees a fair percentage of patients who speak Indian languages or Spanish. He also manages some hearing-impaired patients, as his optician is familiar with sign language.

“I think that if your practice is primarily in a certain language-speaking population, you have to have that bilingual service available to those patients,” he says. “It is a value-add. As ophthalmic practices are trying to become more lean, more efficient and increase the patient experience, patients are going to be drawn toward value-added practices. Language should not be a barrier to a great exam.”

Dr. Goel draws many patients to his clinic because he speaks Hindi, the primary Indian language commonly familiar to Indian Americans of multiple dialects. He also can understand “Hinglish,” in which Hindi and English words are used interchangeably within sentences.

“On more than one occasion, the Wills Eye surgical staff has been pleasantly surprised at my command of Hindi,” he says. About 10 years ago, a colleague operated on a Hindi-speaking patient, and Dr. Goel happened to observe. “I actually just helped things along in between my own cases. The patient, family and my ophthalmology colleague were all ecstatic. The case was perfect, and the patient was comfortable throughout the procedure.”

At San Antonio Eye Center, physicians aren’t required to be bilingual, but the four to five physicians who speak English and Spanish “tend to be the ones who get booked up the fastest, and the longest,” Mr. Castillo says. “The demand to be seen by these physicians is very, very significant.”

In some cultures, like the Hispanic/Latino/Mexican community, it is common for patients to bring family members with them to medical appointments, Mr. Castillo says. In those cases, someone usually speaks English, but “you can’t always rely on the family to be the interpreter,” Dr. Goel says. “You have to make sure you understand a patient’s symptoms and deliver the best care possible.”

Oko; Oog; Szem; Auga; Ochi; Mata

If your practice needs a little help with servicing patients who speak different languages, then our interviewed doctors offer the following advice:

Look at your patient makeup.

Determine if you need a bilingual employee or if you can get by using occasional interpreters. Since Dr. Klein’s father and his partner started their practice in the 1970s, Elizabeth has seen a high influx of Hispanic and Haitian immigrants and the office has adjusted accordingly, he says.

Besides the doctors speaking some Spanish, the bilingual office staff help take medical histories and explain surgical risks and procedures. More recently, he says, the partners realized they needed a Creole speaker because they were servicing many Haitian patients who had both language and education barriers. The office manager, Robin Sigler, contacted a local allied health school to find someone. “We think of it as marketing,” Dr. Klein says. “Our Creole-speaking population has increased since.”

If you have just a handful of patients who speak a particular foreign language, it might make more financial sense to hire an interpreter on occasion and cluster those patient appointments, Dr. Goel advises. Since communication can be a challenge with each point of human contact, including check-in, testing and assessments by technician and doctor, it’s good to allow time for the translator to travel with the patient, he says.

Always be open to hiring

Dr. Packer, who served as managing partner of an ophthalmology practice in Eugene, Ore., from 2000 to 2012, says some of that firm’s best hires happened when there were no openings. For example, an optometrist from Mexico who had moved to the area called to inquire about work. While well-trained, he would have had to return to school to earn his U.S. license to work as an optometrist, which he did not wish to do. The practice was so impressed by his fluency in English and Spanish and by his optometry skills that they created a position for him as a technician, Dr. Packer says. Their level of confidence in him was very high.

This man also helped the team translate informed consent documents for research and answer patient questions. As an added bonus, “he had instant rapport with our Spanish-speaking patients, and they started referring their friends and relatives,” Dr. Packer says.

The practice also hired a bilingual Spanish-English speaker as a front desk secretary; she later asked to learn medical assisting. The practice paid for her education and promoted her to a technician.

The take-home message?

“Keep your eyes open for good people, even if they’re not technically-trained,” Dr. Packer says. “If someone happens by who is a great candidate, even if you don’t have a job for them, take them because they’ll create a job and suddenly you won’t know what you did without them.”

Maintain good relationships

Placing ads for bilingual office workers on websites like Craigslist and Indeed has been helpful for Dr. Klein’s and Mr. Castillo’s practices.

Dr. Packer also advises that a phone call to the employment offices of your local medical schools, hospitals and allied health schools could help. Tell them to keep you in mind if someone inquires about a job and has an ophthalmology background. “It’s really important to have these lines of communications open — you never know what’s going to come from that,” he says.

Also contact professional organizations, such as the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO), the American Society of Ophthalmic Administrators (ASOA), ASCRS and the AAO. Get to know the staff “not just looking at bulletin boards but also knowing the people in the organization who might give you a call if someone good becomes available.”

You can also look in your practice’s neighborhood for potential employees, or network through your patients. But Mr. Castillo advises against hiring patients or their family members as to avoid any potential conflicts of interest.

Allow sufficient time for training

San Antonio Eye Center swings both ways: it hires bilingual speakers who need training in a particular job function, and it hires qualified ophthalmic professionals who need to learn Spanish. In either case, Mr. Castillo says, new hires shadow senior staff and gradually take on their own responsibilities.

Those learning Spanish are given English-Spanish ophthalmic dictionaries and often use special language-learning software like Rosetta Stone. The quickest way to fill the spot: hire someone who knows patient care. Mr. Castillo says hiring the bilingual speaker, and training that person for the position, takes at least six months longer. Those who struggle with the language may work at clinic locations with more bilingual or English-speaking patients, he says.

Emphasize accuracy

If using translators in your practice, make sure they know not to paraphrase your words. This is not acceptable, says Dr. Klein.

“When someone is translating for you, it’s obviously very important that it’s done on a word by word basis. You don’t want them paraphrasing, because when people start to paraphrase what you’re saying in medicine, subtle differences can really affect the conversation. Emphasize to your staff members that it’s not their job to tell the patient what they think you’re saying. It’s [your] staff’s job to say what you’re saying.” OM