Patients with a variety of cultural backgrounds and languages are a reality in today's health-care environment. If your experience is like most ophthalmologists', the faces awaiting you in the exam lanes are increasingly diverse. Your challenge is to adequately treat your patients, whether they speak your language or not and whether you see one non-English speaker per week or 20. This article suggests some ways in which you can gradually make your practice accessible to non-English speakers. (N.B. Because Latinos are now the largest minority group in the United States, the need for Spanish language capability is discussed here.)

Why Another Language?
If you are an ophthalmologist who sees relatively few non-English speaking patients, you may wonder why you should care about being prepared to treat one of them. The answer is that the likelihood of seeing a patient whose first language is not your own is increasing, and immigration in 2001 was at its highest level in 10 years.1

Then there's the federal government's influence on your world, in the form of the Office of Civil Rights. In government lingo, patients whose first language is not English are called Limited English Proficient (LEP). Their right to the language assistance necessary to afford them meaningful access to health care is protected under Title VI of the Civil Rights Act of 1964. Any health-care providers who receive federal financial assistance (Medicare, Medicaid) already know this, as the Office of Civil Rights has been enforcing its principles for more than 30 years.

A Business Opportunity
A growing minority population represents both a business opportunity and a new set of challenges. "In order to survive in or to gain access to some markets, you need a Spanish-speaking physician. There's no way around it," says Patricia Quintana-Perron, a San Antonio health-care management consultant. She explains that you cannot blend non-English speakers into your practice population if you expect them to make appointments, communicate their problems, take medications and follow instructions in the same way that your English-speaking patients do.

Meaningful access to heath care can be afforded to LEP patients through the people, materials and services of your practice. Few practices have the resources to do a complete second language implementation, but some beginning steps and a commitment to continuing  to make accommodations in the future will point you in the right direction.

Spanish Speakers Wanted
Plan to add a Spanish-speaking staff member the next time there is a vacancy. You can look for a nurse or a physician's assistant who can speak Spanish without sacrificing your staff's skill level. "You're not going to hire people just because they have a second language and expect them to do a job they're not qualified for," states Amy Glenn-Vega, director of allied and public health continuing education at Southern Regional Area Education Center in Fayetteville, N.C. "It's not just about the language; the Spanish is an extra plus." 

In some cases, Ms. Quintana-Perron has worked with physicians to learn Spanish themselves, including one non-Hispanic doctor who learned the language to serve an outlying clinic. It pushed him over the 90th percentile in production, compared to his counterparts who stayed in the city—and probably stayed in the 75th percentile. "It's very lucrative when there's a need to be met," she says.

When looking at language classes, it's important to find a program that includes medical terminology. "Some  Spanish courses at community colleges will have an elective for health-care providers," notes Ms. Quintana-Perron. She recommends some training for everyone in your office, noting that a Latin patient can get an examination and a prescription from the Spanish-speaking doctor, but when he walks out of exam room to pay, make another appointment or calls  later with questions, he'll be dealing with other staff who may not speak his language.

The Best Interpreter?
Whether the Spanish-speaker is a doctor, nurse or physician's assistant, experts agree that any of them is better than falling back on the patient's family member to act as a translator.
Language Resources 
• The American Academy of Ophthalmology offers Spanish-language patient education materials in its store, including fact sheets, brochures and videos. Visit or call (415) 561-8540.
• The American Translators Association offers a searchable database of translators,
• Two of the many telephone interpretation services available have information on the Web at and
First, the family member is no better trained in medical terminology than 
the patient, leaving great room for error. Also, a patient may be less honest with a doctor, and privacy issues are at stake, when family is present.

For the practice that has even the occasional non-English speaker, Ms. Vega recommends working with a telephone interpretation service. (See sidebar.) A telephone interpreter is an impartial, confidential resource who serves only as a voice. "No one uses the interpreter as a crutch; the 'voice' is not diagnosing the problem or influencing the information," says Ms. Vega, who adds that physicians should have little concern about the quality of such a service. "I know the service I've worked with puts its interpreters through an extensive training process, gives ongoing education to medical interpreters and is well-versed in confidentiality."

Written Materials
Chances are that much of the information a patient gets from an ophthalmologist is through written materials. Again, don't rely on the English-speaking family member to correctly interpret your instructions about follow-up care or prescriptions. Use a professional translation service to convert your practice's forms and fact sheets into Spanish. Purchase Spanish-language patient education materials in addition to your usual English supply (See sidebar). And, if you include conversational Spanish classes for the staff in your future practice budget, allow for some money to buy new bilingual signs, business cards and even Spanish-language magazine subscriptions. First impressions count, and patients who are comfortable in your office will come back and recommend you to others.

Other Considerations
No matter what language is used in addition to English in your practice, Ms. Vega encourages doctors to look at the lifestyle and cultural attributes of the patient population to further tailor their services. "If a large number of your LEP patients work in blue-collar jobs or in service industries," Ms. Vega suggests keeping flexible office hours. Her recommendation: "Perhaps one day per week open at 7 a.m. and on another day close at 8 p.m." 

Learning about the culture of your dominant population is important, agrees Ms. Quintana-Perron. "There are some things you don't say to people from certain cultures, or you don't address their spouses. Some cultures don't accept female physicians, so it may be better to have a male doctor for them." 

While the degree of implementation of language accommodation is up to the individual ophthalmology practice, Ms. Quintana-Perron refers back to business basics: If you are not making language accommodations, and you notice a reduction in your patient flow, it may be because there are other alternatives available to your patients. Ms. Vega agrees that even the smallest efforts go a long way, saying, "The patients will notice that you're making an effort. Even when you walk in there with your little dictionary, the patients are so pleased that their doctor is trying to speak their language."  REVIEW

1. Immigration to the United States: Fiscal years 1820-2001. In: 2001 Statistical Yearbook of the Immigration and Naturalization Service.