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Course helps University of Iowa doctors communicate with patients who speak Spanish
‘Course is to establish and cultivate a trusting provider-patient relationship’
IOWA CITY — Speaking a different language in a health care setting cannot only prevent patients from communicating aches and pains or doctors from relaying important medical news or instructions — it can keep people from seeking care altogether.
Jessica Ortiz has seen it firsthand with her Ecuadorian parents, who don’t speak fluent English.
“Sometimes here they feel like, ‘Oh no I don’t feel comfortable, maybe they don’t understand what I’m saying,’” Ortiz, of Coralville, said, noting even scheduling an appointment can become an insurmountable challenge. “So they need help.”
Fortunately, her parents can get that help from their daughter — who has a medical degree and speaks English fluently. Take last year, when her mom twisted her ankle and had to seek emergency care.
“I had to be there the whole time,” she said. “To translate what the provider was saying.”
But because children so often play the translator for non-fluent parents, the message doesn’t always get across. “Sometimes the parents feel embarrassed to say something really private to the kid, that the kid has to say to the provider,” Ortiz said.
That can have meaningful implications and limitations. But something as simple as an “hola” or “como estas” from a physician can change everything, according to Ortiz.
“They relax more,” she said. “They feel more like, OK, I can do this by myself, or the doctor really is going to take care of me.”
Meeting a need
Having volunteered for many of her 16 years in the United States — sharing her language and culture with her daughter’s elementary school and with the Iowa City/Johnson County Senior Center, for example — Ortiz saw a need she could help meet in the University of Iowa Carver College of Medicine.
So she designed a Spanish course for medical faculty who have some Spanish-speaking ability already — similar to one she teaches at the senior center, but catered specifically to those needing to communicate and comprehend medical information.
It doesn’t teach grammar, syntax, or general vocabulary.
“It’s very specifically designed for a health care provider with an intermediate to advance Spanish level, so we can focus just on teaching medical Spanish terminology,” she said. “The topics are very specific.”
The university in fall 2021 offered for the first time the “Free Medical Spanish” course for faculty “with an intermediate to advanced level of Spanish” focused on teaching medical Spanish terminology, pronunciation, and cultural practices and health beliefs unique to the Latinx and Hispanic community.
“So we try to improve their cultural competence,” she said.
Among its goals, the course aims to give providers confidence in obtaining a basic medical history from Spanish-speaking patients and performing a full physical exam.
Other course objectives include teaching physicians Spanish medical terminology; how to translate basic anatomic terms to and from English; and ways to improve conversational skills during a medical interview with Spanish-speaking patients.
“The importance of this course is to establish and cultivate a trusting provider-patient relationship, as well as providing the best patient care possible,” according to a course description the UI Office of Diversity, Equity and Inclusion distributed to medical faculty. “Fear is a common emotion that resides in patients who do not fluently speak English; therefore, having a base knowledge of medical Spanish terminology can eliminate the fear Spanish speaking patients may feel.”
By developing cultural competence alongside the language skills, according to Ortiz, UI providers can ask the best questions in a compassionate way.
“It was something that really, really surprised us, because we had a lot of people that respond really positive about it,” she said.
‘More secure, more confident’
UI clinical professor Katherine Harris, who treats patients in internal medicine who speak many different languages, said Ortiz’s course was especially helpful in that it caters to physicians with some Spanish-speaking skills.
“I found Dr. Ortiz’s classes to be phenomenal,” Harris told The Gazette. “We speak in Spanish for the entire class and role play scenarios which are typical in the medical environment.”
Given many of her patients are both sick and scared when they arrive in clinic — feelings an inability to communicate can exacerbate — Harris acknowledged the best way to help ease their fear is to speak their language.
But, she said, “I am always nervous and embarrassed to speak with my patients in Spanish because I know that I make many errors.”
“But Dr. Ortiz continually encourages us to simply try,” Harris said. “She reminds us of how comforting it is to the patients to hear us trying to speak Spanish, even if we don’t speak perfectly.”
The university’s Spanish-medical course, starting in fall 2021, has offered two cohorts per semester — meaning they’ve done six so far, including spring and fall 2022. Each runs eight weeks, one hour a week — which is about all organizers can squeeze in while maintaining doctor interest, given their busy schedules.
“The challenge here is to find a time for the providers,” Ortiz said.
Because almost everyone carves out a lunch hour, the course is offered at noon on Thursdays and Fridays — with another two cohorts scheduled for spring. Each group so far has included eight to 10 faculty members, and Ortiz said they cap participation so everyone can ask questions and have dialogue.
Those who’ve completed the course have come from internal medicine, surgical units and specialties like gastroenterology.
“They say they feel more secure, more confident about the pronunciation,” Ortiz said, boasting of the benefit of using mock interviews to build confidence. “That's a big thing.”
As demographics shift in Iowa — with the Lanitx population proving the fastest-growing minority group, nearly doubling over the last decade — demand for bilingual medical services could spike. The U.S. Census Bureau projects Iowa’s minority population will surge from more than 400,000 in 2020 to nearly 800,000 in 2040.
Dr. Harris said Spanish is among the most common languages non-English-speaking patients use, and given the value UIHC places on patient communication, “I do think that it is extremely important for us to have classes such as this available.”
“I hope that by speaking with my patients in Spanish, this shows that I care about them and their health,” Harris said. “I hope that it makes patients feel more comfortable speaking with me and disclosing their history.”
Ortiz said she’s been approached by other medical providers — like nurses and lab assistants — who would like something similar for them.
“So we are exploring another course,” Ortiz said.
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