It was awkward and frustrating — and it shook Rosa Lopez' confidence in her doctor. The 45-year-old resident of Rancho Cordova, a recent immigrant from Mexico who does not speak English, was getting a physical exam when the subject of menstruation came up. The doctor became confused when she used the term "regla," a Spanish colloquial term for menstrual period.
Unaware of this secondary meaning, the doctor thought she was saying "ruler" or "ruling." It took a good five minutes before the doctor understood what the patient was trying to say.
Reducing or eliminating such episodes is the goal of a national program that includes UC Davis Health System and nine other institutions.
Called Speaking Together: National Language Services Network, the program is a high-level learning collaborative that is examining how participating hospitals communicate with non-English-speaking patients and how hospital staff can better structure and manage language programs to provide effective, efficient and timely interpretive services.
Launched last fall, the 16-month program aims to develop methods for measuring the quality of services so that performance benchmarks for communication can be set. The project will culminate in a report in which UC Davis Health System and its Speaking Together partners will detail and share what they've learned.
The project is funded with a $60,000 grant from the Robert Wood Johnson Foundation and receives technical assistance and training support from The George Washington University Department of Health Policy, which developed the quality improvement measures.
UC Davis, which serves one of the most linguistically diverse populations in the country, has 47 interpreters on staff who provide translation services in 19 languages. Medical interpreters for Spanish-, Russian- and Hmong-speaking patients are the most requested of the interpretive services at the medical center in Sacramento.
Sergio Aguilar-Gaxiola, director of the UC Davis Center for Reducing Health Disparities and principal investigator of the Speaking Together program at UC Davis, emphasized that the project is all about self-evaluation.
"You find in all hospitals providers who are bilingual. But rarely are they assessed for language proficiency. We're putting a mirror up to our faces to reflect how we're doing."
Participating institutions communicate regularly and attend quarterly meetings. In addition, a special Web site serves as a forum for sharing information.
Much is at stake. As Aguilar-Gaxiola explained, misunderstandings between patients and doctors can have highly negative consequences: "If the communication is poor, it increases the chances of error, of misdiagnosis and therefore mistreatment."