What would you do if you were traveling abroad and needed medical care, but did not speak the language? How would you tell the treating physician what is wrong with you? What if you tried to tell her you had a sprained shoulder, but were misunderstood and they started to treat you for chest pain? What if they thought you were psychotic because they could not understand what you were saying and you were dressed differently from everyone else?
In 1983, Rita Patino Quintero was found in Johnson City, Kansas digging through trash cans and talking incoherently. She was oddly dressed and seemed to be claiming she “fell from the heavens.” She was taken to Larned State Hospital, a state psychiatric facility, where physicians diagnosed her as schizophrenic. To support their diagnosis, providers noted her unusual statements, her depression and aggression, and the fact she dressed in layers and refused to bathe. While at Larned, she was treated with psychotropic medications and eventually developed tardive dyskinesia, a condition brought on by long-term use of psychotropic medications and characterized by involuntary movements.
After twelve years of hospitalization, Quintero was finally released in 1995 at the behest of the Kansas Advocacy & Protective Services (KAPS) agency. They found a note in her file from 1983 indicating the Mexican Consulate in Salt Lake City told Larned personnel that Rita matched the description of a Tarahumara Indian, a northern Mexican tribe. KAPS convinced the hospital to release her and allow her to return to Mexico.
This case is an extreme example of what can happen when health care providers ignore a patient’s language needs and cultural context. You can read more of Rita’s story in my recent article on the Importance of Cultural Competence in Health Care – Part Two. Here is Part One in this series.
Promoting diversity and inclusion in the health care setting is not just about reducing health care disparities. A number of health care systems, health plans, national associations, and states believe accounting for the diversity of patients and ensuring your board, clinicians, managers, and staff reflect, understand and address this diversity will improve health care outcomes, increase patient satisfaction, and increase market share.
Health care organizations must effectively interact with their patients who come from different cultural and linguistic backgrounds. To address the lack of clear guidance on how to account for diversity in providing services, the U.S. Department of Health and Human Services, Office of Minority Health developed the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care in 2000. The CLAS Standards were enhanced in 2013 after a public comment period, a systematic literature review and ongoing consultations with leaders and experts from the health care community. The enhanced CLAS Standards are designed to broaden the reach of cultural and linguistic competency at every point of contact in the health care continuum.
Although adherence to the CLAS standards is voluntary, health care organizations should expect accreditation agencies to evaluate their efforts to address these issues. For example, The Joint Commission has established accreditation standards that directly or indirectly measure an organization’s ability to provide culturally and linguistically appropriate services, particularly in the areas of improved communication, cultural competence, patient-centered care, and the provision of language-assistance efforts.
The New England Journal of Medicine is encouraging further research into the impacts of adopting the CLAS standards. Both scientific research and anecdotal information from adopters can help organizations weigh practice options and make business decisions.