Medical Interpretation for Latino/LEP Patients: Dr. Shapiro's Insights on Cultural Healthcare Access

Eyal Heldenberg (00:10)Hi everyone, welcome to Care Culture Talks. My name is Eyal Heldenberg. I'm the CEO of No Barrier, AI medical interpreter for healthcare providers. I'm very happy to have with us Dr. Ilan Shapiro. Dr. Shapiro is an advisor to No Barrier, so happy to have you.

Ilan Shapiro MD (00:29)It's a pleasure. Very excited to be here with you.

Eyal Heldenberg (00:32)Perfect. Amazing. So basically the podcast purpose is to learn from healthcare professionals, from their experience around language accessibility in healthcare and cultural competency. So first, Dr. Shapiro would love to kind of get to know you and your background in medicine.

Ilan Shapiro MD (00:54)Gladly. Well, I'm born and raised in Mexico City. I did my MD degree over there. And afterwards, I worked as a liaison between the WHO and Mexico. I love that because I got to see what was the health care system in Mexico and also compare it in policy with other communities and countries. And that actually opened not just the little pueblitos, the little towns that I was actually taking care of or the big cities in Mexico, but also the perspective of importance of culture, language, and you you're there and there's like at least 50, 60 languages around you. And that actually opened my mind. And that continued during my pediatric training at Mount Sinai Hospital in Chicago, where we had absolutely a very amazing Latino community and also an African-American community, but also a very important migrant community that they came from Russia, they came from Vietnam, they came from a lot of countries and they were all together tied with health. That's something that we all need. Then on my entire background and travel from place to place from Chicago to Fort Myers, Florida, and right now in Los Angeles serving AltaMed, the Fair Qualified Health Center, the continuum of the importance of being there with your patient. Having knowledge, because you don't need to be an expert of the cultural aspect of it, but also the linguistics part of it makes a huge difference for treating our communities and also bringing better quality outcomes.

Eyal Heldenberg (02:38)Perfect. I think you have like a kind of a very unique background coming from the Latino community. And, you know, I wonder you know, there are some unique communication challenges you might encounter as a medical provider, would you like to kind of address unique challenges of communications with Latino communities?

Ilan Shapiro MD (03:04)A lot of the times, the first one and the most common error is to think that all Latinos are the same. And it's really not true, because if you see the difference between an Argentinian, a Mexican, a Dominican, a Puerto Rican, it's different. Maybe the Spanish, we can understand each other, but there will be certain words that would not translate from one side to another. And also the cultural aspect of it, because there are very regional or very localized things that are very different on how they see mental health, how they perceive vaccines, how they actually want to take care of themselves with, you know, alternative medicine. Then all of these things are crucial and important in order to actually take care of our patients, because we're not just seeing a language, we're seeing the entire package. But of course, if you don't have the language. You have that first barrier between you and the patient.

Eyal Heldenberg (04:01)Yeah, yeah, yeah. All right, you mentioned that you are now working at AltaMed. So I wonder if you can take us to how AltaMed navigates now the language barriers when providing care. Are there any particular approaches that you practice there?

Ilan Shapiro MD (04:20)We, from the beginning on the onboarding of our nurses, front staff, physicians, everybody actually gets the tools on how to communicate with a patient. And we have a very diverse set of patients. And part of it, it's understanding what do we have at hand. Then we have different modules from actually in-person, someone actually translating that are certified to do so, or actually a telephone number. Or we also have the technology, it looks like an iPad, practically that you press on it, you select the language, and it actually goes to a database or central base or whatever, and you have an interaction with a human that it's actually translating for you. In this way, at least, if we have sign language, if we have Cantonese or Spanish or whatever language we have in front of us, we can actually leverage all these tools in front of us to connect with our patients.

Eyal Heldenberg (05:21)Perfect. You know, since you are a kind of a native speaker in Spanish, I wonder if during your career you had other, you know, monolingual providers that, you know, approach, hey, Ilan, could you help us with this patient, with that patient just kind of getting this, your knowledge around that.

Ilan Shapiro MD (05:46)Probably I share the same story as many other physician, nurses, and people in healthcare where they were the only ones that actually spoke a language that was not typically used in the healthcare settings. And since I was a medical school, a med student, and in residency, and still today as a provider, as a physician, always there's someone like, can you come in? Can you help me translate? Can you do that part? Can you bridge that gap that we have right now? Because I'm not getting the full picture. And it makes a huge difference. First of all, I love doing it because one, I am helping my partner inquire my fellow physician, my nurse, my team member. And the second one is that I'm most importantly helping my patient. Because at the moment that we raise our hand and go like, well, I need help. Can you come in? I love doing that part. But with that part, a lot of us end up doing a double job because you need to take care of your workflow. You need to take care of your things that you're doing, but also at the same time, the translation. That's a second job at the same time that you're doing your own things. That's kind of what I kind of saw and I'm still seeing for the past almost 20 years that I have been practicing.

Eyal Heldenberg (07:15)Yeah, we heard stories, I had a chat with one Cantonese speaking provider that, you know, a lot of months, you know, he was approached by colleagues and he just couldn't have enough time for his, for his patients. So he shared that he started to kind of push back for, for, hey, just use the formal solutions. You have, you know, medical interpreters available. So we kind of navigate between his patients, but also the need to help. So this is the way he chose to put some boundaries, but totally get the pros and cons of that. We've discussed medical interpretation now. I wonder from your perspective, what kind of evolution in those services in healthcare you see or where do you see room for improvement?

Ilan Shapiro MD (08:11)A couple of things. When I see my patient, we have all this technology that it's there, it's helpful, but it takes time. It takes a process to get there. And it's very cumbersome sometimes, even though that it's maybe a simple click or waiting and stuff like that. If you multiply that for a normal day between 20 and 25 patients and you're adding two minutes, that's almost an hour and a little bit more of your time that you're spending just waiting for the machine to connect. Then having all these things actually align on an easy way would be something that I really, really cherish. Because sometimes you're waiting for the translator, you're waiting for the telephone to be picked up, or there could be little kinks there. They start adding to the process. Of course, you're going to be there with your patient. You want to actually be there with your patient. You want to talk with your patient. But these barriers, at the end of the day, actually takes a toll on the physician, the nurse practitioner, the practitioner that is actually in front of the patient, the nurses that are trying to do something. But because of this technology that it's actually helping us, because before it was horrible, there was really nothing, create a time lag that starts accumulating and it's not kind of the best approach that I'm seeing.

Eyal Heldenberg (09:44)Right, so basically you say like the room for improvement is around the waiting time, the access to care, like can we do it faster in a sense?

Ilan Shapiro MD (09:54)And also give that tools to the patient. Because when they call your office, when they go to the pharmacy, when they're other medical stuff, they need that tool also. Because sometimes actually it happens, and it's a great example. When they go to the pharmacy, the script maybe is not on the language that they have or they perceive or they prefer. Then imagine that they actually have a tool to translate and have that part on their language and actually that it's medically, it's not just like translate from the limbo, but it's something that actually making a difference for them that it's actually medically graded, then that actually can help a lot.

Eyal Heldenberg (10:38)Right, so technology in the hands of the patients could empower them.

Ilan Shapiro MD (10:44)Completely.

Eyal Heldenberg (10:45)Got you. Yeah, yeah, makes sense. All right, perfect. Now I would love to kind of talk about any other cultural factors that you find most important to consider when treating patients from diverse backgrounds, you know, besides language.

Ilan Shapiro MD (11:06)One of the most important parts, and I love doing this, that it's actually learning a little bit more of the culture. If you have a set of patients that are coming from a certain area from China or a certain area from Mexico or Dominican Republic or Ethiopia, you choose whatever country you want. But actually learning a little bit of their culture, what's actually appropriate, what's actually the way that they want to be perceived and approached, that's very important. For example, for Latinos in general terms, usually touching, saying hello with a hand, having a closer space, actually it's OK. And also the eye contact is very important, actually giving space for them and the respect to the patient. And also they see the doctor as someone that actually is bringing a lot of empowerment for their families and their future, then sometimes they are afraid to ask. And it's not because they don't want to ask. It's because they don't want to offend the doctor. Then making sure that we are understanding not just the language, but the cultural aspect that we are taking care of a patient. And that also includes a lot of the times the background of asking my patient, do you take any medications? And they go like, no. After that, go, well, medications or medicines could be natural teas and stuff like that. And they give me a huge list of vitamins and teas and other stuff. Then making sure that we are in tune with the cultural aspect of it and, of course, using the language to actually bridge that gap.

Eyal Heldenberg (12:52)Yeah, yeah, totally makes sense. Are there any, I would say, deeper beliefs? You know, we heard, for example, about some populations, you know, with kind of less of, you know, trust maybe in healthcare or at least, you know, the conventional one. Kind of like different beliefs. I don't know if from the Latino community or others, like how do you see this kind of other belief when they enter the room.

Ilan Shapiro MD (13:25)It's very important because the way it's kind of going to a marathon without training and without, you know, knowing that you're actually going to not make it the first mile. Then the entire idea of this is actually to have that expectation, to open the door to where they're coming from. Because a lot of the patients that I take care of, they have two or three jobs. They are like very, there are fighters, fighters, they're, they're doing their own good, amazing things. And they could be afraid. Maybe they have not been in the doctor for a while. Maybe they just don't like the procedure and that's totally okay. Then we need to be open for that part. And, and most importantly, even though that we can group the Latino community in one group or the African community in one group or the African American in one group. It's very important that at the end of the day, we're still individuals and we all have a different type of experience on what's our day to day. What are we actually doing with our health?

Eyal Heldenberg (14:37)Yeah, yeah. You know, one of the previous guests mentioned for the Asian communities that there are some family dynamics where, for example, the mother could take decisions in the family, right? You need to consult other family members. I wonder if there is some family dynamics of patient in the Latino community where more people needs to be involved. Maybe the provider needs to talk to the, I don't know, grandfather in the room. I wonder if you have kind of any insights on that part.

Ilan Shapiro MD (15:15)One of the best well-kept secrets of absolutely everything that we have in front of us is that the female figure, the grandma, the mother, actually carries a lot of the healthcare power of the family. They are usually the uniting force of the Latino household. Then a lot of the times we have seen it with procedures for screening against cancer, vaccination, and other stuff. That usually if you have and you attach a lot of the conversation with the female part of it, the mom, the grandma, actually that can carry a lot of weight on medical conversations. And at the end of the day, everybody needs to choose whatever path they want to do. But that actually actually starts that conversation in a larger scale.

Eyal Heldenberg (16:09)Yeah. All right, perfect. So I wonder if you could implement one major change across the healthcare system to improve care for patients with language or cultural barrier, what would it be in that sense? Like one change.

Ilan Shapiro MD (16:26)I would love, love, love, love to actually have the tools and everything to empower our patients. And technology where I can actually be with my patient and they can be with me without that cumbersome circulation of having a computer and it's slow and connecting, something that can actually make it more efficient, not only for me, because my nurses actually are talking with my patient first, my front desk is actually talking with my patient first, then making sure that all of those steps are actually integrated and we leverage the time and technology to actually be taking care of our patients and taking care of us as physicians, providers, nurse practitioners, healthcare, anything that they're touching a human.

Eyal Heldenberg (17:03)Mm-hmm.

Ilan Shapiro MD (17:21)That way we can save time and of course, most importantly, be with our patients and improve their health.

Eyal Heldenberg (17:28)Yeah, amazing. Basically you say we need technology to save us from technology in a sense, right? You need to have the second generation through automate EMR, automate the interpretation, automate everything. So in the room, will be the regular bonding like 200 years ago, right? Between the doctor and the provider.

Ilan Shapiro MD (17:54)That's part of the beautiful part of it. And I love your definition of saving us from technology by technology. But that's kind of true. It's kind of at the beginning that technology was actually using a letter and mailing it out. And right now, after that, was an email. And right now, we're chatting. Then, yes, probably that will be a faster way to actually have some type of technology to make the difference.

Eyal Heldenberg (18:18)Perfect. All right. I think we are in the kind of last kind of question of practical advice. So I wonder like what advice would you give to healthcare providers, healthcare organization, wants to prove their ability to provide culturally responsive care, whether language, cultural or other.

Ilan Shapiro MD (18:39)The first part, if you already know that you're serving a certain type of population that comes from a certain ethnicity or have a certain language, try to understand before the language, the culture. Where are they coming from? What's expectation of the interaction with the doctor? And in the old days, was like, actually, you need to go that place to actually experience it. Right now, you can actually Google it, and you will have a decent answer on that part. And try to actually refine that part. Learn a couple of phrases in their language. That actually opens a lot of doors because it creates that bond that you're at least trying to connect. And of course, having technology that can improve the way that I talk with my patients. And because even though that I mainly have monolingual or bilingual patients, Spanish, English, I still have my Mandarin patients. I have Cantonese patients. I do have patients that actually speak other languages, including Russian, then having that ability on my pocket or me or in their pocket as patients, that could make a huge difference. And that's what I really want from healthcare systems and also medical providers to get that you have the linguistic part that is very important. And sometimes we cannot manage it that much, but the cultural aspect, we do have a lot of power for that.

Eyal Heldenberg (20:05)Amazing, Basically you say even with small steps, like those gestures that you know, like the small steps basically could do like a big, a big impact in the room.

Ilan Shapiro MD (20:18)Completely.

Eyal Heldenberg (20:20)All right, perfect. Thank you so much, Ilan, for being with us in Care Culture Talks. Appreciate it.

Ilan Shapiro MD (20:28)Pleasure as always and hope that we open a lot of the linguistically and culturally concordant care that our patients deserve.

Eyal Heldenberg (20:38)Thank you.

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