Question of the Week

December 4, 2006


Medical terms and instructions can often be confusing. Whether a patient is trying to explain to a doctor what is wrong or trying to understand the directions written on a bottle of medication, misunderstandings can lead to unhealthy consequences.

"Many Americans, including those with college degrees, have trouble interpreting the instructions on prescription drug labels, a new study finds. Indeed, only 34.7 percent of the people with lower literacy, grade level or below, interviewed for the study could determine the number of pills to take daily when faced with 'take two tablets by mouth twice daily,' according to the study report in Annals of Internal Medicine. ... That is often misinterpreted to mean 'two tablets a day,' ... But the number of misinterpretations rises with the amount of numbers included in the instructions, Wolf said. So, 'take one teaspoon twice a day for seven days' is especially confusing, for example, he noted...."

Adults (even those with college degrees) can have trouble understanding the wording on their prescription bottles. Teens (who are going to the doctors without their parents) may misunderstand the instructions on their medications, as well. Teens and parents who are entrusted to read labels and give medication to children and/ or younger siblings are also in a position to read carefully or mistakes can be made. Even non-prescription medications with different dosing information for children of different weights and ages can prove confusing to a healthy, well-rested adult. A caregiver who has been up all night with a sick child (or who is sick themselves) may need extra assistance to make sure the instructions are read and interpreted properly.

"The problem can start in the doctor's office, Davis said. 'Most doctors don't give any instructions on how to take the medicine' that they write prescriptions for, she said. 'Doctors can be more precise -- saying when a drug should be taken, how many times a day and for how long,' she said. This type of detailed information can be included if a patient asks for it, either in the physician's office or at the pharmacy, Davis said. ... The issue of 'how we can confuse patients less' about the drugs they take is of growing importance, Wolf said. He estimated that perhaps 500,000 adverse events occur each year in this country because people misread their drug instruction.

The help is available, but patients and caregivers need to know where to go for help, and when to ask for extra assistance. The problems get even more complex when the communication needs to cross a language barrier, and asking for assistance is easier said than done.

"The directions on the bottle of blood-pressure pills read simply enough: 'Take once a day until finished.' But a Mexican immigrant, still wobbly in her English, misreads just one word. In her native Spanish, 'once,' means 11. The pills, if taken too many at a time, make her dizzy -- or worse. They could kill her. It's the kind of risk 21 million people in the United States, who speak English 'less than very well,' face every day. Many who depend on prescription medicine don't always understand what's typed on their bottles. Some end up getting sicker ... Retail pharmaceutical giants such as CVS Pharmacy, Eckerd, Albertsons and Publix recognize the growing consumer power of such groups and have turned to new technology that translates drug prescriptions into Spanish."

Additional language services are also available at other pharmacies. For example:

"Walgreens is your language-friendly pharmacy. Have your questions answered -- and your prescription explained -- in your language. If no one at your local Walgreens speaks your preferred language, we'll immediately call a licensed Walgreens pharmacist who does.* (* Based on availability of multilingual pharmacists.) Prescription services available at Walgreens stores in 14 languages, including: * English, * Arabic, * Chinese, * French, * German, * Italian, * Japanese, * Korean, * Polish, * Portuguese, * Russian, * Spanish, * Tagalog, * Vietnamese"

If a phamacist is available in your language, they will try to assist you. This can help those who are trying to understand an over-the-counter medication if they bring it to the pharmacist for help and/ or translation services. This can also help patients (and parents) who primarily speak a language other than English to understand prescriptions. While all this can help greatly, it is not the perfect solution. Not all small towns and rural communities have access to big pharmacies with translation services. In addition, there can still be a language barrier before the patient gets to the pharmacist... while he or she is at the doctor's office.

"Matha Xiong is just 13. But the Chico, Calif., girl shoulders responsibilities that most children never dream of. Whenever her Hmong-speaking parents need her to, she assumes the role of tiny interpreter. ... If a bill now winding its way through the state Legislature becomes law, however, Matha's duties will be greatly reduced. Written by Assemblyman Leland Yee (D-San Francisco), AB 292 would ban the use of child interpreters younger than 15 by any state or local agency or program that receives state funding. Children like Matha are known as language brokers. And across California -- where in 2000 more than 12 million people spoke a language other than English at home -- they are their parents' bridge to survival. ... Not only can their interpretations prove inaccurate -- with sometimes tragic consequences -- they can land youngsters in traumatic situations as purveyors of intimate or troubling news. ... The bill by Yee -- a child psychologist who interpreted for his parents after immigrating from China at age 3 -- would likely become the first of its kind in the country. It passed the Assembly 42 to 30 and is working its way through the Senate."

Whether a young teen is being asked to translate for a parent, or is in the doctor's office alone trying to explain and understand their own illness, the situation can be stressful and confusing. While some feel this is an unfair situation for a child or teen, others see it as the best way to get medical assistance for parents in need.

"Opponents say it will backfire on those it seeks to help by compelling strapped rural doctors to shut the door on non-English-speaking Medi-Cal patients. It could also strip away the trust that children provide to immigrant parents. ... Physicians like Dr. Krystyna Belski, a pediatrician in the Central Valley town of Oakhurst, say they can't afford to pay those amounts [ranging from $75 for a 15-minute appointment to $1 per minute for a phone translator]. Belski has been searching unsuccessfully for a Spanish-speaking partner. While she uses AT&T's translation line in grave hospital cases, during office visits involving fevers and coughs, she often turns to English-speaking siblings of the babies and toddlers she treats. ... Others say banning the use of children as interpreters is culturally insensitive. Assemblyman Greg Aghazarian (R-Stockton) grew up translating for his Armenian mother and grandmother. 'We can't assume that just because we have an interpreter available that someone from another culture or background will be readily open to that person,' he said. 'My old Armenian grandmother -- God rest her soul -- would never have trusted' a phone translation service."

There are cultural issues, financial issues, and medical issues that all need to be addressed. Children are there. They are available when other means of translation may not be found. While they are certainly not trained, professional translators, they are better than no translator at all. While parents and doctors have come to rely on them for assistance, they are still children, and there are still issues they may not be ready, able, or willing to discuss -- or that their parents may not be willing to discuss through them.

"It is especially dangerous for children to interpret. They frequently are embarrassed by and tend to ignore questions about menstruation, bowel movements, and other bodily functions and are more likely to make interpretation errors with potential or actual clinical consequence. One study comparing hospital interpreters and ad hoc interpreters, for example, found that when an 11-year-old sibling interpreted during a pediatric visit, 84% of the 58 errors she committed had potential clinical consequences. Child interpreters also are less likely to have complete command of two languages, and their use may result in parents avoiding discussion of sensitive subjects such as domestic violence, sexual issues, or drug and alcohol abuse."

It can often be difficult to bring up certain topics with a doctor, whether a person is being asked to translate or is just talking with their own doctor in their native language. It can also be difficult to ask for extra help when a direction "mostly" clear.

Questions of the Week:
If English is the only language you speak, what aspects of medical misunderstandings can affect you? What resources are available to you as a patient when you don't understand what the doctor is saying? What resources are available to your family members that may have difficulty understanding the directions on a bottle of medicine?

Whether or not you have ever been asked to be a translator -- or have been witness to a medical misunderstanding -- what can you do to be sure that they are avoided in your home and with your family? What can be done when there is no translator available in the language spoken by the patient? What information and resources might you be able to share that would help your friends or family members who are struggling with medical issues and may be able to communicate better in a language other than English?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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