Overview of the Stanford Cross Cultural Medicine Microlecture Series

Microlectures: CCM001-009: Scroll down this page

Microlectures: CCM010-019: Click here

Microlectures: CCM020-       : Click here



The US population is becoming increasingly diverse. About 25 million Americans have Limited English Proficiency. Eleven million are nonliterate in English. An estimated 93 million Americans have Basic or Below Basic Health Literacy. As medicine becomes more complex and specialized by the minute, the communication gulf between doctors and their patients is becoming progressively insurmountable. In order for us to provide quality care for all Americans, we need to become skilled in providing culturally effective care. The Stanford Cross Cultural Medicine Microlecture Series is a series of very short talks (2 minutes each typically), which aims to highlight key issues in cross-cultural encounters. We are the first to acknowledge how complex and challenging this topic is. Thus we seek to share our experiences and sights gained from clinical practice and research about this important issue, more as a starting point rather than as a “gold standard.” Our hope is that trainees and health personnel will use our microlecture series as a tool to pause and reflect about their own practice.

 

Microlecture 001: The Two Sentence Rule




When I interact with patients, I am so eager to tell them everything they need to know about their medical condition, what I am planning to do, what they need to do and so on. While this is a wonderful thing, when I am dealing with patients with limited health literacy and English fluency, I need to work with a medical interpreter (MI) to communicate with the patient. In communicating with the MI, it is important to follow the two sentence rule. Watch the microlecture to find out about more the two sentence rule.
VJ Periyakoil, MD, Stanford University School of Medicine. Tweet to us: @palliator

Microlecture 002: Medical interpreter as a Voice Conduit


 

It can be a bit awkward to figure out how to best to optimally engage the medical interpreter (MI). Is the MI just the “voice” of the patient? Should they transmit only the verbal aspects? What about the nonverbal aspects of what the patient is saying? For example, if the patient is depressed should the MI translate what the patient says with a depressed affect? Does that make the MI a method actor? Also, think about how emotion and social cues vary from culture to culture. For example,  think about a highly volatile and emotional culture and contrast it with a restrained and “stiff upper lip” culture. Will depression present differently in these cultures? 
VJ Periyakoil, MD,  Stanford University School of Medicine. Tweet to us: @palliator

Microlecture 003: What to do when patient’s proxy has Limited English Proficiency


 

When caring for a vulnerable patient, we rely heavily on the proxy to guide us. However, if the proxy has communication difficulties it becomes exponentially difficult to make health decisions.

Watch the microlecture and try to solve the problem of how to provide patient-centered, family-oriented care when dealing with a patient who is a minor and unable to speak for himself and his proxy who has Limited English Proficiency.
VJ Periyakoil, MD, Stanford University School of Medicine. Tweet to us: @palliator

Microlecture 004: Talk Directly To The Patient



This microlecture addresses patient rights. If the patient has Limited English Proficiency., don’t they still have the right to access all the information about their healthcare? Don’t they still have the right to take advantage of the therapeutic bond that should exist between every doctor and the patient? How can we decrease the psychological distance between the clinician and the patient? What are some simple steps we can take?
VJ Periyakoil, MD, Stanford University School of Medicine. Tweet to us: @palliator

Microlecture 005: No Censoring Rule


 

What should the medical interpreter do during the clinical encounter? Should they pick and choose in terms of what information they translate and what they withhold? Should they omit certain aspects of what the clinician says?

What should the interpreter do if  one clinician disagrees with another during the clinical encounter? Should they interpret arguments so the patient can understand opposing points of view?

Find out by watching the microlecture VJ Periyakoil, MD, Stanford University School of Medicine. Tweet to us: @palliator

Microlecture 006: The Interpreter as an Asset



Medical interpreters (MI) report feeling like intruders in some clinical encounters. I have talked to numerous MIs and they are a bit baffled by how some clinicians try to talk in English to patients who do not speak English!

Busy clinicians are often wary of anything that might increase the encounter time with patients. That being said, how can we effectively convey complex information like hospital discharge instructions to patients who do not speak English?
VJ Periyakoil, MD, Stanford University School of Medicine. Tweet to us: @palliator

Microlecture 007: The Low Register Rule



What is “register”?

Take a guess! Do doctors speak in low register or high register?

Should the medical interpreter alter the register during translation to make sure the patient understands? Or, should they pause and ask the doctor to restate the information?
VJ Periyakoil, MD, Stanford University School of Medicine. Tweet to us: @palliator

Microlecture 008: Consecutive Interpretation Rule



Do you know that there are different styles of interpretation? What is simultaneous interpretation? What is consecutive interpretation? Which one is better in a clinical encounter? What are the tradeoffs? Which is the preferred method in a clinical encounter when you are pressed for time?
VJ Periyakoil, MD, Stanford University School of Medicine. Tweet to us: @palliator

Microlecture 009: The Bilingual Rule



 

So here is the provocative question. Does your high school Spanish make you a medical interpreter?

Many times, we have a basic understanding of another language and feel confident that we can communicate in that language. We also feel that even if we are not that great in the new language, it is the job of the native speakers to comprehend what we are saying and pardon our errors. This strategy works OK when you are traveling abroad and lets say you are asking for walking directions to the Colosseum in Rome using your sketchy Italian. This will, however, not pass muster in a clinical encounter.

The patient and family are not there to be on the receiving end of our amateur French or Spanish, nor is it their job to pardon our errors and fill in the gaps. Watch the video to learn the bilingual rule.
VJ Periyakoil, MD, Stanford University School of Medicine. Tweet to us: @palliator