Clinicians' Challenge - Problem Case
New Zealand and especially Auckland is becoming increasingly multicultural. Public hospital communication resources to support this are not always available. As an intensive care specialist, I usually require clinical information urgently in my patient encounters. However patients may not have an interpreter present when I am called to see them. Hospital interpreters requested for the "usual" non English languages may take anywhere from 30 minutes to 2 hours to arrive. It is possible for interpreting to be done by phone but often speaker phones are unavailable and thus a phone handset needs to be passed back and forth - a very inefficient process.
Even after resolving emergencies, there are still occasions where interpretation would help, but it is felt that the indication is insufficient to warrant the cost of an interpreter. This includes: clinical staff wanting to explain the supportive therapy they need to do e.g. physiotherapists; asking a patient to sit and lie in certain positions in the bed; patients indicating that they want to go the toilet, etc.
I would therefore appreciate a clinical interpretation program. This would not and could not take the place of a trained clinical interpreter, particularly for complex issues such as informed consent, or diagnostic explanations. Instead, it would be designed to get basic clinical information (i.e. enough for urgent therapy to begin), communicate simple clinical requests and therapies, and allow the patient to make simple requests or report problems.
I would envisage that the basic clinical information component would start off with explaining to the patient in the patient's language audiovisually that they would be asked simple questions by the clinician, to which they had to reply either 'yes', 'no', or 'I don't know'. It would then list categories e.g. respiratory questions, cardiovascular questions for the clinician to select for interpretation. The questions would be as simple as possible, e.g. "Are you short of breath now?', "Are you usually short of breath?". Short videos could accompany the printed questions, to make sure the patient and/or their relatives understood the spoken question.
Simple clinical communication would have a similar system: first, explanation of the type of request (eg movement related), followed by a visual demonstration and oral request for e.g. 'please lie down', 'please sit up', 'cough now', 'I need to put a drip in to give you medicine'.
The patient requests part would allow them to communicate e.g. "I want to go to the toilet", "Please call my family".
I am aware of other clinical translation programs but I do not know of any that do all of the following: include Polynesian and South East Asian languages; inclusion of clinician to patient and patient to clinician interpretation; inclusion of both visual and auditory cues for the patient and relatives.
In addition to high acuity situations, such a solution could also be adapted to work for screening situations (e.g. a pre operation checklist) or extended for use in a standard medical/ surgical ward context.
