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GOOD AFTERNOON.

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I'M THE DIRECTOR OF THE NATIONAL

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INSTITUTE ON MINORITY HEALTH AND

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HEALTH DISPARITIES.

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I WANT TO THANK YOU FOR JOINING

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US TODAY FOR THE NIMHD DIRECTOR

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SEMINAR SERIES.

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AS YOU MAY KNOW WE ARE IN

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HISPANIC HERITAGE MONTH WHICH IS

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CELEBRATED FROM SEPTEMBER 15 TO

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OCTOBER 15 EVERY YEAR.

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THE 2023 THEME IS WE ARE ALL WE

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ARE ONE.

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THIS THEME CAPTURES THE

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UNWAIVERRING STRENGTH,

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RESILIENCE AND GRIT DEEPLY

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INGRAINED WITHIN THE LATINO

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COMMUNITIES.

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IN HONOR OF HISPANIC HERITAGE

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MONTH I INVITED ALICIA FERNANDEZ

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TO BE OUR SPEAKER TODAY.

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HER PRESENTATION IS ENTITLED HOW

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LANGUAGE BARRIERS CONTRIBUTE TO

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HEALTHCARE DISPARITIES.

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A FEW WORDS ABOUT ALICIA.

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SHE'S A GRADUATE OF YALE

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UNIVERSITY AND THE ALBERT

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EINSTEIN COLLEGE OF MEDICINE.

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SHE'S A NATIVE OF ARGENTINA AND

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IMMIGRATED TO THE U.S. AT THE

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TIME OF THE DICTATORSHIP.

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I MET HER WHEN SHE WAS A FIRST

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YEAR MEDICAL RESIDENT.

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AFTER A YEAR AS CHIEF RESIDENT

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AND FELLOWSHIP, SHE JOINED THE

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FACULTY AT SAN FRANCISCO GENERAL

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AND HAS BEEN INVOLVED IN

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MULTIPLE RESEARCH, EDUCATIONAL

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AND CLINICAL PROGRAMS AT UC F.

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ALICIA IS A PROFESSOR OF

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MEDICINE PRACTICING AT SAN

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FRANCISCO GENERAL HOSPITAL AND

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ASSOCIATE OF POPULATION HEALTH

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AND HEALTHS EQUITY FOR THE

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SCHOOL OF MEDICINE.

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SHE'S ALSO HAD HEALTH RESOURCES

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AND SERVICE ADMINISTRATION

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CENTERED OF EXCELLENCE ON LATINO

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HEALTH AT UCS F.

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DR. FERNANDEZ DIRECTS THE

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IMMIGRANT HEALTH PROGRAM AT THE

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USCF PROGRAM.

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HER RESEARCH EXPERTISE INCLUDES

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LANGUAGE AND LITERACY BARRIERS

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WHICH WE'LL HEAR ABOUT.

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HEALTHCARE EQUITY IN CHRONIC SA

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DOZES AND BIASES IN MEDICINE

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JUST TO NAME A FEW.

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SHE'S PUBLISHED OVER 160 PEER

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REVIEW PUBLICATIONS.

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SHE'S RECEIVED A NUMBER OF

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TEACHING AWARDS RECOGNITION FROM

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THE SAN FRANCISCO PUBLIC HEALTH

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DEPARTMENT AND MOST RECENTLY A

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DISTINGUISHED CITIZEN AWARD FROM

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THE COMMON WEALTH CLUB IN SAN

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FRANCISCO.

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ALL OF THIS FOR HER WORK TO

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ADDRESS ISSUES AROUND HEALTHS

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DISPARITIES, WORK FORCE

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DIVERSITY AND SOCIAL JUSTICE.

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ALICIA HAS SERVED IN A NUMBER OF

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PANELS ON A NATIONAL LEVEL BUT

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MOST IMPORTANTLY SHE'S BEEN A

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MEMBER OF THE BOARD OF GOVERNORS

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FOR THE PATIENT CENTERED

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OUTCOMES VERGE INSTITUTE FOR A

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NUMBER OF YEARS.

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SINCE 2020 SHE'S ALSO BEEN ON

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THE BOARD OF DIRECTORS OF THE

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AMERICAN BOARD OF INTERNAL

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MEDICINE WHICH GOVERNS THE

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CLINICAL TRAINING OF INTERNAL

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MEDICINE RESIDENCY.

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PLEASE JOIN ME IN THIS VIRTUAL

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WELCOME TO OUR HISPANIC HERITAGE

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MONTH SPEAKER LISA

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SAPINSLEYLESS.

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>> DR. FERNANDEZ: THANK
YOU SO

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MUCH.

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I'M DELIGHTED TO BE HERE.

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I'LL SHARE MY SLIDES.

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IT SHOULD BE COMING UP NOW.

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THANK YOU SO VERY MUCH FOR

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HAVING ME HERE.

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I'M TRULY HONORED TO BE WITH YOU

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NIH.

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FUNDING HAS BEEN CRUCIAL TO MY

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WORK AND CRUCIAL TO ADVANCING

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SCIENCE TREMENDOUSLY.

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I'M PARTICULARLY GLAD TO BE ABLE

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TO ADDRESS THE STAFF AND

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SCIENTISTS WHO WORK AT NIH AND

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SPECIFICALLY AT NIMHD.

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WHAT I THOUGHT I WOULD COVER

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TODAY IS TALK A LITTLE BIT ABOUT

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THE CONTEXT OF LANGUAGE BARRIERS

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AND THEN TALK ABOUT WHAT WE KNOW

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ABOUT LANGUAGE BARRIERS AND

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PATIENT OUTCOMES AND LANGUAGE

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BARRIERS IN CLINICAL OUTCOMES

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AND I MIGHT SHARE WITH YOU A

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VERY FEW THOUGHTS ON HOW WE CAN

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MOVE FORWARD IN THIS WORK.

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MY HOPE IS TO LEAVE PLENTY OF

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TIME FOR QUESTIONS AND

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DISCUSSION AS THAT NOURISHES ME

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AND I THINK NOURISHES ALL OF US

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IN OUR SCIENCE.

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I DID WANT TO TAKE A MOMENT TO

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TALK ABOUT MY VERY LONG JOURNEY

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HERE.

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I THINK THAT ACTUALLY MOST OF IT

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WAS COVERED.

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BUT WHAT I WANTED TO HIGHLIGHT

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WAS HOW IMPORTANT AND CRUCIAL AN

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INTERNAL WAS TO MY CAREER.

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WHAT I'VE WRITTEN HERE IS TRUE.

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WITHOUT HAVING HAD THE

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INCREDIBLE FORTUNE OF CROSSING

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PATHS WITH HIM EARLY ON IN MY

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CAREER I WOULD NEVER HAVE BECOME

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AN ACADEMIC AND NEVER GONE INTO

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RESEARCH.

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HE'S BEEN A CONSTANT SOURCE OF

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GUIDANCE, OF EMOTIONAL SUPPORT

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AND QUITE FRANKLY OF INSPIRATION

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IN ALL OF HIS WORK.

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AND THAT MAKES ME EVEN MORE

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HONORED TO BE HERE.

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AND ALSO BEFORE I START, I WANT

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TO SAY THAT I DO SEE PATIENTS AT

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SAN FRANCISCO GENERAL HOSPITAL.

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AND WE ARE THE ONLY PUBLIC

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HOSPITAL IN A HIGHLY DIVERSE

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CITY.

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WE HAVE OVER 40 LANGUAGES SPOKEN

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PER MONTH, OVER 120 PER YEAR.

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WE HAVE AWARD WINNING

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PROFESSIONAL INTERPRETERS AS

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WELL AS RELYING ON COMMERCIAL

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SERVICES.

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AND EVEN THOUGH I HAVE A VERY

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SMALL PANEL OF SOMEONE MAINLY

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FOCUSED ON RESEARCH N. MY

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PERSONAL PANEL THERE ARE PEOPLE

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WHO SPEAK ALL SORTS OF LANGUAGES

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INCLUDING OF COURSE MANDARIN,

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VOTE NA MEESE AS WELL AS OTHERS.

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AND I BRING THIS UP BECAUSE IN

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MY TALK I'M GOING TO BE TALKING

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A LOT ABOUT SPANISH SPEAKERS

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BECAUSE THAT'S WHERE I FOCUS MY

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RESEARCH.

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IT CAN BE TOO EASY TO THINK WELL

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SHE HAS A PRIVILEGED POSITION

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VISA SEE LANGUAGE BARRIERS THAT

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CAN SHAPE THE WAY PEOPLE LISTEN.

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I ENCOUNTER LANGUAGE BARRIERS

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EVERY DAY THAT I DO CLINICAL

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WORK.

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BECAUSE I DON'T ACTUALLY SPEAK

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ANY OF THESE OTHER LANGUAGES

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OTHER THAN SPANISH.

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SO WITH THAT CONTEXT, LET ME GET

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STARTED.

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AS YOU MAY KNOW, THERE IS

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DIVERSITY THROUGHOUT THE UNITED

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STATES.

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IT'S NOT JUST IN THE TRADITIONAL

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IMMIGRANT PORTALS.

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AND HERE THESE DARK BARS

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REPRESENT AREAS STATES WHERE

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OVER 28 PERCENT OF THE

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POPULATION SPEAKS A LANGUAGE

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OTHER THAN ENGLISH AT HOME.

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BUT EVEN THE VERY LIGHTEST BARS

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REPRESENTS STATE WHICH IS HAVE A

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LITTLE UNDER 7 PERCENT OF PEOPLE

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SPEAK SPANISH.

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AS YOU CAN SEE THERE ARE MANIES

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PLACES WHERE THE PROPORTION OF

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PEOPLE WHO SPEAK SPANISH IS

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BETWEEN 10 AND 30 PERCENT.

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ANOTHER WAY OF LOOKING AT THE

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SAME DATA IS WHILE THE

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PROPORTION OF PEOPLE WHO SPEAK

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ENGLISH IS MORE OR LESS REMAIN

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THE SAME, THE NUMBER OF PEOPLE

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WHO SPEAK SPANISH -- SORRY, THE

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NUMBER OF PEOPLE WHO SPEAK A

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LANGUAGE OTHER THAN ENGLISH AT

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HOME HAS GROWN BOTH AS A

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PERCENTAGE OF THE POPULATION BUT

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ALSO AS -- BUT ALSO IN ABSOLUTE

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NUMBERS.

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I THINK MOST PEOPLE REALIZE

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SPANISH IS THE DOMINANT

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NON-ENGLISH LANGUAGE.

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I WANT TO EMPHASIZE HOW

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EXTRAORDINARILY DOMINANT IT IS.

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61 PERCENT OF THE LANGUAGE OTHER

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THAN ENGLISH AT HOME SPEAK

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SPANISH.

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AND THE NEXT MOST COMMON

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LANGUAGE IS WHAT THE CENSUS

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QUALIFIES AS CHINESE WHICH

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GROUPS LANGUAGES AS DIVERSE AT

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CAN'T NIECE ETC.

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ALL THE OTHER LANGUAGES FALL

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UNDER 2 PERCENT OR 1 PERCENT.

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SO 68 MILLION PEOPLE SPEAK A

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LANGUAGE OTHER THAN ENGLISH AT

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HOME, MORE THAN HALF ARE SPANISH

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SPEAKERS.

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SO ANOTHER WAY OF THINKING ABOUT

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THIS IS THAT IS TO MENTION THE

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IMPORTANCE OF LINEAGESICALLY

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ISOLATED HOUSEHOLD.

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HOUSEHOLDS WHERE NO ADULT SPEAKS

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ENGLISH.

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AMONG SPANISH SPEAKERS, AROUND

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22 PERCENT OF HOUSEHOLD ARE W

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LIMITED ENGLISH SPEAKERS WHERE

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PEOPLE SPEAK LESS THAN VERY

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WELL.

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MORE THAN 22 PERCENT ARE

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ISOLATED.

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I DON'T WANT TO BEAT AN OBVIOUS

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ONE.

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WHAT IS IMPORTANT TO SAY IS

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13 MILLION PEOPLE IN THE U.S.

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REPORT SPEAKING ENGLISH NOT AT

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ALL OR NOT WELL.

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THEY TRULY HAVE LIMITED ENGLISH

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PROFICIENCY.

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13 MILLION PEOPLE IS ABOUT

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4 PERCENT OF THE POPULATION.

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AND THAT IS EQUIVALENT TO ALL

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PATIENTS WITH SCHIZOPHRENIA,

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RHEUMATOID ARTHRITIS, HEP-C AND

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END STAGE RENAL DISEASE GROUPED

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TOGETHER.

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I USE THIS TO EXPLAIN HOW

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IMPORTANT IT IS TO THINK ABOUT

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LANGUAGE ACCESS.

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THAT THEY ARE TRULY MILLIONS OF

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PEOPLE INVOLVED WHO FACE PROBLEM

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WITH LANGUAGE.

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WITH THAT LET ME TURN TO ONE OF

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THE FIRST PROBLEMS PEOPLE FACE

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00:11:28,866 --> 00:11:31,903
AND THAT IS UNDERUSE OF

263
00:11:31,903 --> 00:11:32,537
INTERPRETERS.

264
00:11:32,537 --> 00:11:34,839
AS YOU KNOW PROFESSIONAL

265
00:11:34,839 --> 00:11:36,007
INTERPRETERS ARE KNOWN TO

266
00:11:36,007 --> 00:11:39,177
IMPROVE PATIENT AND CLINICAL

267
00:11:39,177 --> 00:11:40,711
OUTCOMES, PATIENT REPORTED

268
00:11:40,711 --> 00:11:41,712
CLINICAL OUTCOMES.

269
00:11:41,712 --> 00:11:44,315
THERE ARE DECADES OF VERGE ON

270
00:11:44,315 --> 00:11:44,515
THIS.

271
00:11:44,515 --> 00:11:46,384
THERE ARE MANY SYSTEMATIC

272
00:11:46,384 --> 00:11:47,819
REVIEWS THAT SHOW THIS.

273
00:11:47,819 --> 00:11:52,356
HERE THE COMPARISON IS ADD H, E

274
00:11:52,356 --> 00:11:53,491
OC INTERPRET TORNADOES.

275
00:11:53,491 --> 00:11:56,494
FAMILY MEMBERS OR STAFF ASKED TO

276
00:11:56,494 --> 00:11:59,997
INTERPRET AND NOT TRAINED AS

277
00:11:59,997 --> 00:12:00,331
INTERPRETERS.

278
00:12:00,331 --> 00:12:01,499
IT IS ALSO WELL KNOWN THAT WHILE

279
00:12:01,499 --> 00:12:05,503
THIS IS MANDATED BY FEDERAL

280
00:12:05,503 --> 00:12:06,871
STATUTE, WHAT PEOPLE TURNOVER AS

281
00:12:06,871 --> 00:12:09,974
AN UNFUNDED MANDATE.

282
00:12:09,974 --> 00:12:10,541
MEANING HEALTH SYSTEMS THAT

283
00:12:10,541 --> 00:12:11,709
RECEIVE FEDERAL FUNDS WHICH

284
00:12:11,709 --> 00:12:17,081
MEANS ALL HOSPITALS MUST PROVIDE

285
00:12:17,081 --> 00:12:17,648
INTERPRETATION FOR GROUPS OF

286
00:12:17,648 --> 00:12:19,617
PATIENTS THAT MEET A PARTICULAR

287
00:12:19,617 --> 00:12:25,456
THRESHOLD BUT ARE NOT -- HAVE NO

288
00:12:25,456 --> 00:12:26,257
MECHANISM BY WHICH TO FUND THOSE

289
00:12:26,257 --> 00:12:26,591
SERVICES.

290
00:12:26,591 --> 00:12:31,129
WHICH IS WHY THOSE SERVICES ARE

291
00:12:31,129 --> 00:12:33,865
USUALLY UNDERFUNDED.

292
00:12:33,865 --> 00:12:38,269
AND USUALLY AND VERY OFTEN NOT

293
00:12:38,269 --> 00:12:39,137
EMPLOYED.

294
00:12:39,137 --> 00:12:43,141
THIS IS DESPITE TECHNOLOGICAL

295
00:12:43,141 --> 00:12:44,609
ADVANCES INCLUDING VIDEO

296
00:12:44,609 --> 00:12:47,612
INTERPRETATION WHICH MAKES

297
00:12:47,612 --> 00:12:48,913
INTERPRETATION MORE EFFICIENT TO

298
00:12:48,913 --> 00:12:50,748
DEPLOY AS WELL AS MORE

299
00:12:50,748 --> 00:12:51,015
EFFECTIVE.

300
00:12:51,015 --> 00:12:53,351
IN FACT, IN ONE STUDY ONLY

301
00:12:53,351 --> 00:12:55,820
70 PERCENT OF HOSPITALS ACTUALLY

302
00:12:55,820 --> 00:12:58,523
OFFERED LANGUAGE SERVICES.

303
00:12:58,523 --> 00:13:03,161
AND STUDIES OF USE DOCUMENT VERY

304
00:13:03,161 --> 00:13:07,198
LOW RATES, BE IT IN PATIENTS

305
00:13:07,198 --> 00:13:08,733
UNDERGOING INPATIENT SERVICE,

306
00:13:08,733 --> 00:13:10,101
INFORMED CONSENT FOR SURGERIES

307
00:13:10,101 --> 00:13:15,173
AND PROCEDURES, BE IT IN OFFICE

308
00:13:15,173 --> 00:13:19,477
SPACE PHYSICIANS WHERE

309
00:13:19,477 --> 00:13:22,713
29 PERCENT IN A RECENT STUDY

310
00:13:22,713 --> 00:13:25,216
29 PERCENT OF OFFICE BASED MDS

311
00:13:25,216 --> 00:13:27,585
REPORTED USING PROFESSIONAL

312
00:13:27,585 --> 00:13:29,020
INTERPRETERS OFTEN.

313
00:13:29,020 --> 00:13:31,055
BUT 40 PERCENT REPORTING USING

314
00:13:31,055 --> 00:13:33,991
THEM NEVER DESPITE TAKING CARE

315
00:13:33,991 --> 00:13:40,264
OF PATIENTS WITH LIMITED ENGLISH

316
00:13:40,264 --> 00:13:42,366
PROFICIENCY.

317
00:13:42,366 --> 00:13:45,703
A RESEARCH IMPERATIVE IS TO

318
00:13:45,703 --> 00:13:48,339
ACTUALLY BE ABLE TO TRACK

319
00:13:48,339 --> 00:13:50,608
UNDERUSE OF INTERPRETERS USING

320
00:13:50,608 --> 00:13:51,943
NATIONAL DATA.

321
00:13:51,943 --> 00:13:54,212
WE HAVE NO METHODS TO DO THAT

322
00:13:54,212 --> 00:13:56,280
CURRENTLY.

323
00:13:56,280 --> 00:13:57,048
SO CURRENTLY HAVE REALLY NO

324
00:13:57,048 --> 00:14:01,018
METHODS TO TRACK ON A NATIONAL

325
00:14:01,018 --> 00:14:03,754
LEVEL HOW MUCH IMPROVEMENT THERE

326
00:14:03,754 --> 00:14:08,392
IS OR NOT IN USE OF LANGUAGE

327
00:14:08,392 --> 00:14:10,127
ACCESS SERVICE TO PROFESSIONAL

328
00:14:10,127 --> 00:14:10,561
INTERPRETERS.

329
00:14:10,561 --> 00:14:13,564
IN A RECENT STUDY IN OUR

330
00:14:13,564 --> 00:14:17,268
HOSPITAL, WE FOUND THAT OUR

331
00:14:17,268 --> 00:14:18,869
RESIDENTS REPORTED DOING A MUCH

332
00:14:18,869 --> 00:14:21,806
BETTER JOB IN USING INTERPRETERS

333
00:14:21,806 --> 00:14:23,708
WHEN THEY HAVE TO GET

334
00:14:23,708 --> 00:14:25,142
PROFESSIONAL CONSENT HERE IN

335
00:14:25,142 --> 00:14:25,443
BLUE.

336
00:14:25,443 --> 00:14:27,979
BUT IN DAILY ROUNDS FOR EXAMPLE

337
00:14:27,979 --> 00:14:31,482
WITH PATIENTS IN THE HOSPITAL,

338
00:14:31,482 --> 00:14:33,651
45 PERCENT REPORTED GETTING BY

339
00:14:33,651 --> 00:14:35,653
MEANING NOT USING PROFESSIONAL

340
00:14:35,653 --> 00:14:37,321
INTERPRETERS AND INSTEAD RELYING

341
00:14:37,321 --> 00:14:42,093
ON GESTURES OR ON ONE WORD OF

342
00:14:42,093 --> 00:14:44,862
SPANISH OR VIET.

343
00:14:44,862 --> 00:14:48,933
I ALSO WANT TO POINT OUT THIS IS

344
00:14:48,933 --> 00:14:51,736
A ACADEMIC MEDICAL CENTER WHERE

345
00:14:51,736 --> 00:14:54,772
THERE HAS BEEN A LOT NOT NONOUR

346
00:14:54,772 --> 00:14:56,140
HOSPITAL BUT IN ALL HOSPITALS

347
00:14:56,140 --> 00:14:58,075
THERE HAS BEEN A LOT OF

348
00:14:58,075 --> 00:14:59,577
ATTENTION PAID TO HOW IMPORTANT

349
00:14:59,577 --> 00:15:01,812
IT IS TO USE PROFESSIONAL

350
00:15:01,812 --> 00:15:02,146
INTERPRETERS.

351
00:15:02,146 --> 00:15:04,949
THERE IS A LONG WAY TO GO

352
00:15:04,949 --> 00:15:06,150
PARTICULARLY IN INSTRUCTIONS

353
00:15:06,150 --> 00:15:09,420
WHICH IS THE CRUCIAL STEP TO

354
00:15:09,420 --> 00:15:11,922
ENSURING THAT PATIENTS GET GOOD

355
00:15:11,922 --> 00:15:18,029
CARE AS THEY LEAVE THE HOSPITAL.

356
00:15:18,029 --> 00:15:19,797
WHY DO WE UNDER USE?

357
00:15:19,797 --> 00:15:21,999
I TALKED ABOUT ONE OF THE MOST

358
00:15:21,999 --> 00:15:24,802
IMPORTANT PARTS WHICH HAS TO DO

359
00:15:24,802 --> 00:15:29,106
WITH NOT VALUING AND NOT FUNDING

360
00:15:29,106 --> 00:15:32,476
INTERPRETER SERVICE FULLY

361
00:15:32,476 --> 00:15:33,878
ENOUGH.

362
00:15:33,878 --> 00:15:35,479
AND SUBSEQUENTLY THERE IS

363
00:15:35,479 --> 00:15:38,049
USUALLY A WAIT AND A HASSLE

364
00:15:38,049 --> 00:15:38,516
FACTOR.

365
00:15:38,516 --> 00:15:40,518
WHEN CLINICIANS ARE INTERVIEWED

366
00:15:40,518 --> 00:15:42,320
ABOUT WHY THEY DON'T USE

367
00:15:42,320 --> 00:15:43,854
INTERPRETERS, THEY SAY WE USE

368
00:15:43,854 --> 00:15:45,890
THEM IN IMPORTANT SITUATIONS.

369
00:15:45,890 --> 00:15:47,958
I WOULDN'T START CHEMO THERAPY

370
00:15:47,958 --> 00:15:49,493
WITHOUT USING AN INTERPRETER.

371
00:15:49,493 --> 00:15:51,195
I WOULDN'T MAKE A DECISION BASED

372
00:15:51,195 --> 00:15:53,197
ON ADVANCED DIRECTIVES WITHOUT

373
00:15:53,197 --> 00:15:54,699
USING AN INTERPRETER.

374
00:15:54,699 --> 00:15:57,168
BUT FOR EVERYTHING ELSE, DAILY

375
00:15:57,168 --> 00:15:59,537
HOSPITAL CARE FOR EXAMPLE,

376
00:15:59,537 --> 00:16:01,972
GETTING BY IS AN ACCEPTABLE

377
00:16:01,972 --> 00:16:02,540
SHORT CUT.

378
00:16:02,540 --> 00:16:04,508
AND I THINK THAT WHAT THIS HAS

379
00:16:04,508 --> 00:16:07,144
TO DO WITH IS REALLY PREMISE

380
00:16:07,144 --> 00:16:09,747
PREMISED IMPLICITLY ON THESE

381
00:16:09,747 --> 00:16:11,048
PATIENTS SHOULD BE GRATEFUL FOR

382
00:16:11,048 --> 00:16:12,416
THEIR CARE.

383
00:16:12,416 --> 00:16:14,285
AND THEY ARE IMPLICITLY VALUE

384
00:16:14,285 --> 00:16:16,887
THE EXPERIENCE OF THESE PATIENTS

385
00:16:16,887 --> 00:16:18,723
LESS THAN THE EXPERIENCE OF

386
00:16:18,723 --> 00:16:21,125
PATIENTS WHO SPEAK ENGLISH.

387
00:16:21,125 --> 00:16:22,927
AND SO ONE OF THE THINGS THAT I

388
00:16:22,927 --> 00:16:24,829
HAVE STARTED DOING NOW THAT IT

389
00:16:24,829 --> 00:16:27,198
IS A LITTLE BIT EASIER TO DO

390
00:16:27,198 --> 00:16:29,500
THAT IS NAMING THIS FOR WHAT IT

391
00:16:29,500 --> 00:16:29,667
IS.

392
00:16:29,667 --> 00:16:31,402
IT'S A LACK OF INTERPRETER

393
00:16:31,402 --> 00:16:34,105
ACCESS AND LACK OF INTERPRETER

394
00:16:34,105 --> 00:16:36,774
INFRASTRUCTURE IS AN EXCELLENT

395
00:16:36,774 --> 00:16:38,376
CLEAR CUT EXAMPLE OF STRUCTURAL

396
00:16:38,376 --> 00:16:41,612
RACE IMP AND CARE THAT THEN IS

397
00:16:41,612 --> 00:16:47,952
SUPPORTED BY CLINICIAN GOING ON

398
00:16:47,952 --> 00:16:48,552
WITH THAT.

399
00:16:48,552 --> 00:16:51,455
SO IF YOU LOOK AT A CLASSIC

400
00:16:51,455 --> 00:16:53,424
MODEL OF WHAT EXPLAINS

401
00:16:53,424 --> 00:16:57,027
HEALTHCARE DISPARITY, CLEARLY

402
00:16:57,027 --> 00:17:02,366
THERE IS CLINICIAN ACCEPTANCE OF

403
00:17:02,366 --> 00:17:05,336
LESS OF A SHORT CUT THAT THEY

404
00:17:05,336 --> 00:17:08,105
KNOW HARMS PATIENTS IF IT'S INTO

405
00:17:08,105 --> 00:17:09,306
THIS BOX.

406
00:17:09,306 --> 00:17:12,376
BUT ALSO JUST AS CLEARLY IT IS

407
00:17:12,376 --> 00:17:13,411
THE OPERATION OF THE HEALTHCARE

408
00:17:13,411 --> 00:17:15,813
SYSTEM THAT NEEDS TO BE THOUGHT

409
00:17:15,813 --> 00:17:16,213
ABOUT.

410
00:17:16,213 --> 00:17:17,748
I'M NOT GOING GO THROUGH THIS

411
00:17:17,748 --> 00:17:21,118
BUT THIS IS A JOURNEY MAP TO

412
00:17:21,118 --> 00:17:24,522
USING AN INTERPRETER WITH AN LEP

413
00:17:24,522 --> 00:17:26,991
PATIENT STARTING WITH THE

414
00:17:26,991 --> 00:17:29,660
PATIENT SELF-IDENTIFIES OR

415
00:17:29,660 --> 00:17:30,694
CLINICIAN IDENTIFIES THE NEED

416
00:17:30,694 --> 00:17:31,695
FOR AN INTERPRETER AND ALL THE

417
00:17:31,695 --> 00:17:33,164
DIFFERENT STEPS THAT NEED TO BE

418
00:17:33,164 --> 00:17:33,397
DONE.

419
00:17:33,397 --> 00:17:36,767
AND WE USED HERE IMPLEMENTATION

420
00:17:36,767 --> 00:17:40,471
DO MAIN TO CALL OUT HOW MUCH OF

421
00:17:40,471 --> 00:17:43,441
THIS IS ON THE INDIVIDUAL LEVEL,

422
00:17:43,441 --> 00:17:46,911
HOW MUCH IS ON THE HEALTHCARE

423
00:17:46,911 --> 00:17:48,279
ORGANIZATION LEVEL AND HOW MUCH

424
00:17:48,279 --> 00:17:51,982
OF THIS FALLS CLEARLY INTO THE

425
00:17:51,982 --> 00:17:53,117
IMPLEMENTATION PROCESS.

426
00:17:53,117 --> 00:17:56,120
IT IS ALSO IMPORTANT TO NOTE

427
00:17:56,120 --> 00:17:58,289
THAT THERE IS IMPLEMENTATION

428
00:17:58,289 --> 00:18:00,024
MODELS CALL AN OUTER AREA AS

429
00:18:00,024 --> 00:18:00,357
WELL.

430
00:18:00,357 --> 00:18:02,993
AND THAT HAS TO DO WITH WHETHER

431
00:18:02,993 --> 00:18:05,729
OR NOT INTERPRETER SERVICES NOT

432
00:18:05,729 --> 00:18:07,531
ONLY HAVE POLICIES AROUND THEM

433
00:18:07,531 --> 00:18:10,000
BUT THAT THOSE POLICIES ARE

434
00:18:10,000 --> 00:18:13,003
AUDITED AND THAT IN TURN IS

435
00:18:13,003 --> 00:18:16,841
SUPPORTED BY MECHANISMS SUCH AS

436
00:18:16,841 --> 00:18:20,277
QUALITY CONTROL FROM THE JOINT

437
00:18:20,277 --> 00:18:21,011
COMMISSION, ETC.

438
00:18:21,011 --> 00:18:23,948
SO IT IS IMPORTANT TO NOTE THAT

439
00:18:23,948 --> 00:18:26,116
INTERVENTIONS THAT HAVE FOCUSED

440
00:18:26,116 --> 00:18:28,018
SOLELY ON EDUCATING CLINICIANS

441
00:18:28,018 --> 00:18:29,653
TO USING INTERPRETERS HAVE

442
00:18:29,653 --> 00:18:31,055
REALLY NOT WORKED.

443
00:18:31,055 --> 00:18:33,224
THE HASSLE FACTOR IS TOO BIG.

444
00:18:33,224 --> 00:18:36,494
THE INTERVENTIONS THAT HAVE

445
00:18:36,494 --> 00:18:41,899
WORKED ARE INTERVENTIONS SUCH AS

446
00:18:41,899 --> 00:18:42,533
FROM THE ROBERT JOHNSON PROJECT

447
00:18:42,533 --> 00:18:44,869
WHICH USED ALL OF THESE

448
00:18:44,869 --> 00:18:48,973
MULTIMODAL INTERVENTIONS TO

449
00:18:48,973 --> 00:18:52,276
INCREASE INTERPRETATION SUCH AS

450
00:18:52,276 --> 00:18:54,144
CAPTURING PATIENT LANGUAGE

451
00:18:54,144 --> 00:18:54,912
PREFERENCE, CAPTURING THE

452
00:18:54,912 --> 00:18:56,113
INTERPRETER USE IN CLINICAL

453
00:18:56,113 --> 00:18:58,582
RECORD WHICH IS NOT DONE

454
00:18:58,582 --> 00:19:01,018
AUTOMATICALLY NOW, IMPROVING

455
00:19:01,018 --> 00:19:06,223
ACCESS TO LANGUAGE CAN

456
00:19:06,223 --> 00:19:07,157
CLINICIANS BY ASKING IF THEY

457
00:19:07,157 --> 00:19:09,393
WISH TO BE PLACED WITH A

458
00:19:09,393 --> 00:19:11,929
LANGUAGE COORDINATION CLINICIAN.

459
00:19:11,929 --> 00:19:12,863
EASE OF INFRASTRUCTURE WHICH HAS

460
00:19:12,863 --> 00:19:16,267
TO DO WITH REORGANIZING AND

461
00:19:16,267 --> 00:19:16,700
FUNDING.

462
00:19:16,700 --> 00:19:17,334
ADEQUATE LEADERSHIP AND CLEAR

463
00:19:17,334 --> 00:19:17,601
POLICIES.

464
00:19:17,601 --> 00:19:22,206
MOST PLACES DO NOT HAVE CLEAR

465
00:19:22,206 --> 00:19:24,275
POLICIES PARTLY BECAUSE THEY ARE

466
00:19:24,275 --> 00:19:27,278
NOT MANDATED EXTERNALLY.

467
00:19:27,278 --> 00:19:29,146
FOR EXAMPLE, IT IS MY BELIEF

468
00:19:29,146 --> 00:19:30,648
THAT THAT FUR SICK ENOUGH TO BE

469
00:19:30,648 --> 00:19:38,322
IN THE HOSPITAL, YOU SHOULD HAVE

470
00:19:38,322 --> 00:19:39,356
YOUR ABILITY TO TALK WITH A

471
00:19:39,356 --> 00:19:39,590
DOCTOR.

472
00:19:39,590 --> 00:19:41,425
WE DON'T HAVE A POLICY THAT

473
00:19:41,425 --> 00:19:43,594
PATIENTS SHOULD HAVE ACCESS --

474
00:19:43,594 --> 00:19:44,895
THAT PATIENTS SHOULD RECEIVE

475
00:19:44,895 --> 00:19:46,530
COMMUNICATION FROM THEIR

476
00:19:46,530 --> 00:19:50,000
CLINICAL TEAM WHEN HOSPITALIZED

477
00:19:50,000 --> 00:19:53,370
AS A NATIONAL POLICY.

478
00:19:53,370 --> 00:19:56,340
AND I BELIEVE THAT MOST HOSPITAE

479
00:19:56,340 --> 00:19:58,609
HAVE NOT STUDIED THIS, DO NOT

480
00:19:58,609 --> 00:20:00,044
HAVE THAT AS A POLICY.

481
00:20:00,044 --> 00:20:02,012
WE DON'T HAVE ACCESS TO AUDITS

482
00:20:02,012 --> 00:20:04,415
OF THAT USE.

483
00:20:04,415 --> 00:20:06,483
AS WELL AS DIGITAL TOOLS THAT

484
00:20:06,483 --> 00:20:08,085
WOULD INCREASE INTERPRETER

485
00:20:08,085 --> 00:20:10,588
ACCESS OR DIGITAL TOOLS THAT

486
00:20:10,588 --> 00:20:12,590
WOULD PERMIT AUDITING OF

487
00:20:12,590 --> 00:20:12,990
ADHERENCE.

488
00:20:12,990 --> 00:20:15,292
WE ALSO HAVE NO FINANCIAL

489
00:20:15,292 --> 00:20:17,728
INCENTIVES OR PENALTIES FOR

490
00:20:17,728 --> 00:20:20,564
ORGANIZATIONS THAT DO NOT --

491
00:20:20,564 --> 00:20:23,400
THAT DO A GREAT JOB WHEN USING

492
00:20:23,400 --> 00:20:25,569
THIS DESPITE THE FACT THIS WOULD

493
00:20:25,569 --> 00:20:28,172
BE A CLEAR TIE IMPROVE SUCH AN

494
00:20:28,172 --> 00:20:29,673
IMPORTANT HEALTHCARE DISPARITY.

495
00:20:29,673 --> 00:20:33,777
AND FINALLY, AS YOU KNOW, WE ARE

496
00:20:33,777 --> 00:20:37,114
WAY BEHIND WHERE WE NEED TO BE

497
00:20:37,114 --> 00:20:41,752
IN HAVING A LINGUISTICALLY

498
00:20:41,752 --> 00:20:42,953
CULTURALLY DIVERSE WORK FORCE

499
00:20:42,953 --> 00:20:46,156
AMONG PHYSICIANS, AMONG NURSES,

500
00:20:46,156 --> 00:20:48,993
RAIDOLOGY TECHS A AMONG ALL

501
00:20:48,993 --> 00:20:50,561
ASPECTS OF THE COMPLEX

502
00:20:50,561 --> 00:20:52,162
DEVELOPMENT OF THE DELIVERY OF

503
00:20:52,162 --> 00:20:52,830
HEALTHCARE.

504
00:20:52,830 --> 00:20:56,500
SO WITH THAT IN MIND, LET'S MOVE

505
00:20:56,500 --> 00:20:58,435
TO WHAT HAPPENS WHEN YOU DO USE

506
00:20:58,435 --> 00:20:59,536
AN INTERPRETER.

507
00:20:59,536 --> 00:21:01,538
HERE IS THE QUESTION FOR ALL OF

508
00:21:01,538 --> 00:21:03,073
YOU AND YOU CAN PUT THE ANSWER

509
00:21:03,073 --> 00:21:05,676
IN THE CHAT OR YOU CAN JUST

510
00:21:05,676 --> 00:21:09,546
THINK THE ANSWER TO YOURSELF.

511
00:21:09,546 --> 00:21:11,615
DURING AN ENCOUNTER WITH A

512
00:21:11,615 --> 00:21:13,917
PROFESSIONAL INTERPRETER, HOW ON

513
00:21:13,917 --> 00:21:15,819
AVERAGE IS PATIENT COMPREHENSION

514
00:21:15,819 --> 00:21:18,889
COMPARE TO ENCOUNTERS WITH

515
00:21:18,889 --> 00:21:21,225
LANGUAGE CONCORDN'T POSITION?

516
00:21:21,225 --> 00:21:23,060
PATIENT USING AN INTERPRETER AND

517
00:21:23,060 --> 00:21:24,862
YOU ARE SAYING IF I USE A

518
00:21:24,862 --> 00:21:26,830
PROFESSIONAL INTERPRETER, WILL

519
00:21:26,830 --> 00:21:28,532
THE PATIENT UNDERSTAND ME?

520
00:21:28,532 --> 00:21:30,000
IS IT ABOUT THE SAME?

521
00:21:30,000 --> 00:21:32,069
IS IT A LITTLE LESS?

522
00:21:32,069 --> 00:21:42,379
IS IT SOMEWHAT LESS OR A LOT

523
00:21:42,379 --> 00:21:42,579
LESS?

524
00:21:42,579 --> 00:21:43,247
I'LL GIVE YOU A MINUTE TO THINK

525
00:21:43,247 --> 00:21:45,082
WHAT THE ANSWER IS.

526
00:21:45,082 --> 00:21:47,418
AND THE ANSWER IS ACTUALLY A LOT

527
00:21:47,418 --> 00:21:47,651
LESS.

528
00:21:47,651 --> 00:21:50,054
THIS HAS BEEN A DIFFICULT ISSUE

529
00:21:50,054 --> 00:21:52,556
TO STUDY.

530
00:21:52,556 --> 00:21:56,193
IT HAS BECOME CLEAR THAT IN

531
00:21:56,193 --> 00:21:57,528
INTERPRETIVE CONVERSATION WITH

532
00:21:57,528 --> 00:21:59,763
PROFESSIONAL INTERPRETER, THE

533
00:21:59,763 --> 00:22:01,331
SAME THING I'VE SPENT THE FIRST

534
00:22:01,331 --> 00:22:03,500
FEW MINUTES ADVOCATING FOR AND

535
00:22:03,500 --> 00:22:06,603
MAKING THE CASE THAT WE NEED TO

536
00:22:06,603 --> 00:22:08,338
DO BETTER, INTERPRETEDDIVE

537
00:22:08,338 --> 00:22:09,740
CONVERSATIONS RESULT IN LESS

538
00:22:09,740 --> 00:22:10,074
COMMUNICATION.

539
00:22:10,074 --> 00:22:12,009
HOW DO WE KNOW THIS?

540
00:22:12,009 --> 00:22:13,744
WE KNOW IT FROM STUDIES LIKE

541
00:22:13,744 --> 00:22:15,112
THIS ONE FROM BELIVEAU.

542
00:22:15,112 --> 00:22:18,115
THIS IS NOT ONE OF MY STUDIES.

543
00:22:18,115 --> 00:22:21,385
THIS STUDY DONE IN BELIVEAU.

544
00:22:21,385 --> 00:22:24,655
PEOPLE WANTED TO STUDY TWO

545
00:22:24,655 --> 00:22:25,723
INTERPRETER SYSTEMS.

546
00:22:25,723 --> 00:22:28,258
THEY WANTED TO COMPARE AN

547
00:22:28,258 --> 00:22:32,329
INTERPRETER BY THE BEDSIDE

548
00:22:32,329 --> 00:22:33,497
VERSUS REMOTE INTERPRETATION

549
00:22:33,497 --> 00:22:33,731
SYSTEM.

550
00:22:33,731 --> 00:22:34,631
SO WHAT HAPPENED?

551
00:22:34,631 --> 00:22:37,534
THEY TOOK PATIENTS COMING IN TO

552
00:22:37,534 --> 00:22:39,269
THE E D.

553
00:22:39,269 --> 00:22:40,838
AND THEY SAW WHO THEY WERE

554
00:22:40,838 --> 00:22:41,505
ASSIGNED TO.

555
00:22:41,505 --> 00:22:44,641
AND THEY WERE ASSIGNED TO A

556
00:22:44,641 --> 00:22:46,243
LANGUAGE DOCTOR, OBVIOUSLY THEY

557
00:22:46,243 --> 00:22:48,779
DIDN'T NEED AN INTERPRETER.

558
00:22:48,779 --> 00:22:54,518
ALL THESE PATIENTS DON'T SPEAK

559
00:22:54,518 --> 00:22:55,486
ENGLISH.

560
00:22:55,486 --> 00:22:56,587
OTHERWISE THEY COULD COMPARE THE

561
00:22:56,587 --> 00:22:58,956
EXPERIENCE OF PATIENTS WITH ONE

562
00:22:58,956 --> 00:23:01,024
SYSTEM OR ANOTHER SYSTEM BY

563
00:23:01,024 --> 00:23:03,761
ASKING PATIENTS AS THEY LEFT THE

564
00:23:03,761 --> 00:23:06,497
ER DID THEY UNDERSTAND THE

565
00:23:06,497 --> 00:23:07,798
DOCTOR'S EXPLANATION OF WHAT WAS

566
00:23:07,798 --> 00:23:09,299
WRONG WITH THEM AND DID THEY

567
00:23:09,299 --> 00:23:12,469
UNDERSTAND WHAT THEY NEEDED TO

568
00:23:12,469 --> 00:23:15,539
DO TO TAKE CARE OF THEMSELVES.

569
00:23:15,539 --> 00:23:20,511
AND AS THEY LEFT, FEWER THAN

570
00:23:20,511 --> 00:23:24,982
40 PERCENT WHO WERE TAKEN CARE

571
00:23:24,982 --> 00:23:26,683
OF WITH ONE OF THESE STATE OF

572
00:23:26,683 --> 00:23:29,419
THE ART SYSTEMS UNDERSTOOD THE

573
00:23:29,419 --> 00:23:30,187
DOCTOR'S EXPLANATION.

574
00:23:30,187 --> 00:23:32,322
AND FEWER THAN 40 PERCENT

575
00:23:32,322 --> 00:23:34,291
UNDERSTOOD THE CARE INSTRUCTION.

576
00:23:34,291 --> 00:23:36,760
WHAT WAS INTERESTING IS WHAT A

577
00:23:36,760 --> 00:23:38,595
HUGE GAP THAT IS BETWEEN THE

578
00:23:38,595 --> 00:23:43,233
PEOPLE WHO HAD SEEN A LANGUAGE

579
00:23:43,233 --> 00:23:45,636
CONCORDANT DOCTOR WAS AROUND

580
00:23:45,636 --> 00:23:45,936
60 PERCENT.

581
00:23:45,936 --> 00:23:47,704
YOU CAN SAY AND I HOPE SOME ARE

582
00:23:47,704 --> 00:23:49,373
SAYING WOW, ONLY 60 PERCENT OF

583
00:23:49,373 --> 00:23:50,340
THE PATIENTS UNDERSTOOD WHAT

584
00:23:50,340 --> 00:23:52,075
THEY NEEDED TO DO.

585
00:23:52,075 --> 00:23:54,111
AND THIS IS WITH A DOCTOR THAT

586
00:23:54,111 --> 00:23:57,915
SPEAKS THEIR LANGUAGE?

587
00:23:57,915 --> 00:23:58,115
RIGHT.

588
00:23:58,115 --> 00:24:00,217
WE ARE TERRIBLE AT COMMUNICATING

589
00:24:00,217 --> 00:24:02,119
OUR PATIENTS.

590
00:24:02,119 --> 00:24:06,924
AND WE DO NOT ADDRESS CAREFULLY

591
00:24:06,924 --> 00:24:09,226
ENOUGH OUR COMMUNICATION STYLE

592
00:24:09,226 --> 00:24:13,263
TO THE PATIENTS AND WE DO NOT IN

593
00:24:13,263 --> 00:24:16,567
A ROUTINE MANNER ASSESS FOR

594
00:24:16,567 --> 00:24:17,768
PATIENT UNDERSTANDING.

595
00:24:17,768 --> 00:24:21,438
SO WE CLEARLY HAVE A LOT TO DO

596
00:24:21,438 --> 00:24:24,208
WITH WHEN WE DO SPEAK THE SAME

597
00:24:24,208 --> 00:24:25,642
LANGUAGE AS OUR PATIENT.

598
00:24:25,642 --> 00:24:27,110
THE POINT THAT I'M TRYING TO

599
00:24:27,110 --> 00:24:30,647
MAKE SURE IS THAT ROMP MENTION,

600
00:24:30,647 --> 00:24:33,450
EVEN WITH REALLY GREAT

601
00:24:33,450 --> 00:24:36,687
INTERPRETERS IN A GREAT SYSTEM

602
00:24:36,687 --> 00:24:38,856
IS MUCH LESS WHEN PATIENTS ARE

603
00:24:38,856 --> 00:24:41,592
USING PROFESSIONAL INTERPRETER.

604
00:24:41,592 --> 00:24:46,330
I'VE BEEN STUDYING SOME OF THIS

605
00:24:46,330 --> 00:24:46,797
ATAXIESER IN NORTHERN

606
00:24:46,797 --> 00:24:47,097
CALIFORNIA.

607
00:24:47,097 --> 00:24:48,866
EXCELLENT SYSTEM OF CARE WHICH

608
00:24:48,866 --> 00:24:50,567
HAS PROFESSIONAL

609
00:24:50,567 --> 00:24:51,468
INTERPRETERRINGST AVAILABLE AT

610
00:24:51,468 --> 00:24:53,203
ALL OF THEIR SITES.

611
00:24:53,203 --> 00:24:55,873
AND HERE WE SURVEYED ENGLISH

612
00:24:55,873 --> 00:24:59,676
SPEAKING LATINOS, LATINOS WITH

613
00:24:59,676 --> 00:25:03,981
LAP, LIMITED ENGLISH PROFICIENCY

614
00:25:03,981 --> 00:25:05,782
AND ABOUT A QUARTER OF THEM

615
00:25:05,782 --> 00:25:08,018
REPORTED LACK OF TRUST IN THEIR

616
00:25:08,018 --> 00:25:09,186
DOCTORS.

617
00:25:09,186 --> 00:25:11,121
1/3 REPORTED DOCTORS DON'T SHOW

618
00:25:11,121 --> 00:25:13,690
RESPECT AND 1/3 REPORTED DOCTORS

619
00:25:13,690 --> 00:25:15,125
DON'T LISTEN TO THEM WELL.

620
00:25:15,125 --> 00:25:17,127
DO NOT LISTEN.

621
00:25:17,127 --> 00:25:19,696
MORE PATIENTS THAT WERE LEP

622
00:25:19,696 --> 00:25:21,798
REPORTED BEING TREATED POORLY

623
00:25:21,798 --> 00:25:23,800
BECAUSE OF LANGUAGE.

624
00:25:23,800 --> 00:25:25,369
WHAT WAS THEN INTERESTING IS WE

625
00:25:25,369 --> 00:25:28,505
TOOK THESE PATIENTS WHO ARE

626
00:25:28,505 --> 00:25:31,975
DON'T SPEAK ENGLISH AND

627
00:25:31,975 --> 00:25:33,710
SEPARATED THEM INTO PEOPLE WHO

628
00:25:33,710 --> 00:25:37,080
SEE A LANGUAGE CONCORDANT

629
00:25:37,080 --> 00:25:39,016
PRIMARY CARE DOCTOR AND PEOPLE

630
00:25:39,016 --> 00:25:41,785
WHO SEE A LANGUAGE DISCORDANT

631
00:25:41,785 --> 00:25:43,487
PRIMARY CARE DOCTOR, WHICH IS

632
00:25:43,487 --> 00:25:45,322
SOMEONE WHO DOES NOT SPEAK THEIR

633
00:25:45,322 --> 00:25:45,789
LANGUAGE.

634
00:25:45,789 --> 00:25:48,659
AND WHAT WE FOUND IS THAT THE

635
00:25:48,659 --> 00:25:51,295
TRUST WAS -- THE REPORTS OF LACK

636
00:25:51,295 --> 00:25:53,463
OF TRUST WERE MUCH LESS IN

637
00:25:53,463 --> 00:25:55,265
PEOPLE WHO SAW A DOCTOR THAT

638
00:25:55,265 --> 00:25:57,801
SPEAKS THEIR LANGUAGE.

639
00:25:57,801 --> 00:26:02,105
SO WAS DISRESPECT AND SO FEELING

640
00:26:02,105 --> 00:26:03,640
TREATED POORLY BECAUSE OF

641
00:26:03,640 --> 00:26:05,175
LANGUAGE.

642
00:26:05,175 --> 00:26:07,110
AND SO WAS THE FEELING THAT THE

643
00:26:07,110 --> 00:26:10,881
MD DID NOT SHOW THEM RESPECT.

644
00:26:10,881 --> 00:26:12,883
AND THESE ARE VERY LARGE

645
00:26:12,883 --> 00:26:13,417
DIFFERENCES.

646
00:26:13,417 --> 00:26:15,419
THAT SAID, ABOUT 1/3 OF ALL OF

647
00:26:15,419 --> 00:26:16,954
OUR PATIENTS THINK THAT WE DON'T

648
00:26:16,954 --> 00:26:19,089
LISTEN, DO A GOOD JOB LISTENING

649
00:26:19,089 --> 00:26:20,657
TO THEM IRRESPECTIVE OF WHETHER

650
00:26:20,657 --> 00:26:22,793
OR NOT WE SPEAK THEIR LANGUAGE,

651
00:26:22,793 --> 00:26:24,995
THEY ARE PROBABLY RIGHT ABOUT

652
00:26:24,995 --> 00:26:25,429
THAT.

653
00:26:25,429 --> 00:26:27,764
SO THE THING THAT THIS STUDY

654
00:26:27,764 --> 00:26:29,499
SHOWED AND MANY OTHER STUDIES

655
00:26:29,499 --> 00:26:31,068
HAVE SHOWN THAT IT IS VERY

656
00:26:31,068 --> 00:26:34,671
DIFFICULT TO ELICIT TRUST AND TO

657
00:26:34,671 --> 00:26:37,074
ELICIT PATIENT FEELING RESPECTED

658
00:26:37,074 --> 00:26:40,677
ACROSS A LANGUAGE BARRIER.

659
00:26:40,677 --> 00:26:41,979
WHY IS THIS?

660
00:26:41,979 --> 00:26:47,551
IT'S PARTLY BECAUSE USE OF AN

661
00:26:47,551 --> 00:26:48,118
INTERPRETER ALTERS WHAT I'M

662
00:26:48,118 --> 00:26:49,753
GOING TO CALL THE COMMUNICATION

663
00:26:49,753 --> 00:26:50,087
ARCHITECTURE.

664
00:26:50,087 --> 00:26:52,589
IN THE RELATIVELY FEW STUDIES

665
00:26:52,589 --> 00:26:55,525
THAT HAVE EXAMINED HOW PATIENTS

666
00:26:55,525 --> 00:26:58,829
ARE WHAT HAPPENS IN AN

667
00:26:58,829 --> 00:26:59,830
INTERPRETED CONVERSATION,

668
00:26:59,830 --> 00:27:01,565
STUDIES THAT HAVE AUDIO TAPED

669
00:27:01,565 --> 00:27:04,001
DOCTORS AND PATIENTS TALKING

670
00:27:04,001 --> 00:27:06,203
WITH AN INTERPRETER.

671
00:27:06,203 --> 00:27:08,572
WHAT IT'S FOUND IS THAT PATIENTS

672
00:27:08,572 --> 00:27:11,775
TALK A LOT LESS BETWEEN DOCTOR

673
00:27:11,775 --> 00:27:13,410
TALKING AND THE INTERPRETER

674
00:27:13,410 --> 00:27:15,379
TALKING, PATIENTS TALK A LOT

675
00:27:15,379 --> 00:27:15,812
LESS.

676
00:27:15,812 --> 00:27:17,914
SECOND, PHYSICIANS ARE LESS

677
00:27:17,914 --> 00:27:20,183
LIKELY TO ELICIT THE PATIENT'S

678
00:27:20,183 --> 00:27:23,353
POINT OF VIEW.

679
00:27:23,353 --> 00:27:25,622
I VERY MUCH KNOW HOW EASY IT IS

680
00:27:25,622 --> 00:27:27,090
TO MAKE THIS MISTAKE.

681
00:27:27,090 --> 00:27:29,426
I TAKE CARE OF A LOT OF PATIENTS

682
00:27:29,426 --> 00:27:30,060
WITH DIABETES.

683
00:27:30,060 --> 00:27:35,465
I'M SO FOCUSED ON TAKE YOUR MEDS

684
00:27:35,465 --> 00:27:39,036
TWICE A DAY, YOU TAKE THE

685
00:27:39,036 --> 00:27:40,337
CHOLESTEROL PILL ONCE A DAY.

686
00:27:40,337 --> 00:27:42,305
IT'S IMPORTANT TO TAKE BOTH OF

687
00:27:42,305 --> 00:27:43,473
YOUR BLOOD PRESSURE MEDICATIONS

688
00:27:43,473 --> 00:27:44,574
IN THE MORNING.

689
00:27:44,574 --> 00:27:47,144
I'M SO FOCUSED ON MAKING SURE

690
00:27:47,144 --> 00:27:54,317
THAT I'M COMPREHENDING THAT MY

691
00:27:54,317 --> 00:27:57,454
INSTRUCTIONS TO THE PATIENTS ARE

692
00:27:57,454 --> 00:27:58,755
CLEAR THROUGH PROFESSIONAL

693
00:27:58,755 --> 00:28:01,124
INTERPRETER THAT I FORGET TO SAY

694
00:28:01,124 --> 00:28:04,394
HOW DO YOU FEEL ABOUT TAKING A

695
00:28:04,394 --> 00:28:06,463
MEDICINE FOR THE METAPHOR

696
00:28:06,463 --> 00:28:07,297
MINUTE.

697
00:28:07,297 --> 00:28:09,466
HOW DO YOU FEEL ABOUT TAKING A

698
00:28:09,466 --> 00:28:10,667
CHOLESTEROL MEDICINE?

699
00:28:10,667 --> 00:28:12,235
WHAT ARE YOUR QUESTIONS ABOUT IS

700
00:28:12,235 --> 00:28:13,403
THAT THAT?

701
00:28:13,403 --> 00:28:16,339
IN THAT WAY MY CARE BECOMES MUCH

702
00:28:16,339 --> 00:28:18,075
LESS PATIENT CENTERED.

703
00:28:18,075 --> 00:28:22,079
NOT BECAUSE I'M A BAD PERSON OR

704
00:28:22,079 --> 00:28:24,714
DON'T RESPECT MY PATIENTS BUT

705
00:28:24,714 --> 00:28:28,819
BECAUSE THE NEED TO SPEAK WITH

706
00:28:28,819 --> 00:28:33,723
AN INTERPRETER PUSHES ME TO A

707
00:28:33,723 --> 00:28:37,494
NARROWER MUCH MORE MEDICAL

708
00:28:37,494 --> 00:28:44,434
CONVERSATION IN WHICH I LEAVE

709
00:28:44,434 --> 00:28:46,503
LITTLE ROOM TO ELICIT THE

710
00:28:46,503 --> 00:28:51,108
PATIENT'S POINT OF VIEW OR THEIR

711
00:28:51,108 --> 00:28:51,374
CONCERNS.

712
00:28:51,374 --> 00:28:52,642
I'LL TELL YOU ANOTHER STORY.

713
00:28:52,642 --> 00:28:54,878
I WAS PRECEPTING IN OUR CLINIC.

714
00:28:54,878 --> 00:28:59,549
AND WE HAVE TO GO IN AND OBSERVE

715
00:28:59,549 --> 00:29:00,183
PATIENT CONVERSATIONS FROM TIME

716
00:29:00,183 --> 00:29:00,484
TO TIME.

717
00:29:00,484 --> 00:29:02,252
I DID THAT A FEW YEARS AGO WITH

718
00:29:02,252 --> 00:29:06,356
A RESIDENT WHO IS AN EXCELLENT

719
00:29:06,356 --> 00:29:06,957
RESIDENT.

720
00:29:06,957 --> 00:29:13,263
AND HE WAS SPEAKING WITH A

721
00:29:13,263 --> 00:29:16,500
CANTONESE SPEAKING PATIENT WITH

722
00:29:16,500 --> 00:29:16,867
AN INTERPRETER.

723
00:29:16,867 --> 00:29:17,501
HE WAS LOOKING AT THE COMPUTER

724
00:29:17,501 --> 00:29:20,270
AND HE SAID I SEE YOU MISSED

725
00:29:20,270 --> 00:29:23,073
YOUR APPOINTMENT WITH THE

726
00:29:23,073 --> 00:29:25,675
PULMONARY DOCTOR OR PULMONARY

727
00:29:25,675 --> 00:29:25,976
SPECIALIST.

728
00:29:25,976 --> 00:29:31,581
AND THE PATIENT SAID YES.

729
00:29:31,581 --> 00:29:32,816
MY MOTHER DIED.

730
00:29:32,816 --> 00:29:34,518
AND THE DOCTOR TURNED BACK TO

731
00:29:34,518 --> 00:29:36,720
THE COMPUTER AND SAID OK I'LL

732
00:29:36,720 --> 00:29:39,723
MAKE YOU ANOTHER APPOINTMENT

733
00:29:39,723 --> 00:29:41,858
WITH THEM.

734
00:29:41,858 --> 00:29:43,693
NOW IS IT BECAUSE THIS WAS A

735
00:29:43,693 --> 00:29:46,329
YOUNG DOCTOR WHO WAS

736
00:29:46,329 --> 00:29:47,564
OVERWHELMED?

737
00:29:47,564 --> 00:29:47,764
MAYBE.

738
00:29:47,764 --> 00:29:51,034
BUT WHAT HAPPENS IS THAT AGAIN

739
00:29:51,034 --> 00:29:53,837
WE BECOME VERY BIO MEDICALLY

740
00:29:53,837 --> 00:29:54,070
FOCUSED.

741
00:29:54,070 --> 00:29:57,774
VERY FOCUSED ON TASKS.

742
00:29:57,774 --> 00:29:59,943
IT TURNS OUT THAT IN THE

743
00:29:59,943 --> 00:30:02,412
LITERATURE FOR EXAMPLE ON TRUST

744
00:30:02,412 --> 00:30:03,547
BETWEEN AFRICAN-AMERICAN

745
00:30:03,547 --> 00:30:07,784
PATIENTS AND THEIR DOCTORS, IT

746
00:30:07,784 --> 00:30:15,025
TURNS OUT THAT THE EMPATH I CANC

747
00:30:15,025 --> 00:30:16,193
REMARKS IS USUAL TO TRUST.

748
00:30:16,193 --> 00:30:17,427
I THINK THIS DIDN'T HAPPEN

749
00:30:17,427 --> 00:30:19,262
BECAUSE OF THE PRESENCE OF THE

750
00:30:19,262 --> 00:30:19,596
INTERPRETER.

751
00:30:19,596 --> 00:30:23,300
BECAUSE THIS WAS AN -- BECAUSE

752
00:30:23,300 --> 00:30:27,837
THIS AGAIN PUSHED WARD THE LET'S

753
00:30:27,837 --> 00:30:28,138
GET IT DONE.

754
00:30:28,138 --> 00:30:33,210
SOME PLACES HAVE REACTED BY

755
00:30:33,210 --> 00:30:34,978
GIVING MORE TIME FOR

756
00:30:34,978 --> 00:30:36,613
CONVERSATIONS THAT ARE MEDIATED

757
00:30:36,613 --> 00:30:39,082
TO AN INTERPRETER.

758
00:30:39,082 --> 00:30:41,184
BUT BILLING SYSTEMS TEND NOT TO

759
00:30:41,184 --> 00:30:42,919
SUPPORT THAT AND THE PLACES THAT

760
00:30:42,919 --> 00:30:45,422
HAVE DONE THAT HAVE R VERY FEW.

761
00:30:45,422 --> 00:30:47,057
AND THEN ON TOP OF THAT, MOST

762
00:30:47,057 --> 00:30:49,759
PEOPLE ARE NOT THE SCIENCE OF

763
00:30:49,759 --> 00:30:53,730
WHAT HAPPENS IN INTERPRETIVE

764
00:30:53,730 --> 00:30:54,130
CONVERSATIONS.

765
00:30:54,130 --> 00:30:55,999
THIS IS AN AREA WHERE WE NEED

766
00:30:55,999 --> 00:30:58,168
MUCH MORE RESEARCH SO THAT WE

767
00:30:58,168 --> 00:31:01,004
CAN START TEACHING FOLKS REALLY

768
00:31:01,004 --> 00:31:03,206
WHAT TO LOOK FOR AND HOW THE

769
00:31:03,206 --> 00:31:07,177
WORK WELL WITH AN INTERPRETER.

770
00:31:07,177 --> 00:31:10,981
SOME OF YOU WILL RECALL A FEW

771
00:31:10,981 --> 00:31:14,384
YEARS AGO WHAT BECAME REALLY

772
00:31:14,384 --> 00:31:15,585
IMPORTANT WHERE SHOULD AN

773
00:31:15,585 --> 00:31:18,221
INTERPRETER STAND, SHOULD THEY

774
00:31:18,221 --> 00:31:19,389
STAND BEHIND THE PATIENT.

775
00:31:19,389 --> 00:31:20,657
THOSE QUESTIONS MIGHT BE

776
00:31:20,657 --> 00:31:21,124
IMPORTANT.

777
00:31:21,124 --> 00:31:22,659
WHAT WE KNOW LITTLE ABOUT AGAIN

778
00:31:22,659 --> 00:31:26,363
IS WHAT ACTUALLY HAPPENS.

779
00:31:26,363 --> 00:31:29,699
WE HAVE NOT PUT IN THE RESOURCES

780
00:31:29,699 --> 00:31:33,270
TO ENABLE PEOPLE TO UNDERSTAND

781
00:31:33,270 --> 00:31:36,539
MORE ABOUT INTERPRETIVE

782
00:31:36,539 --> 00:31:36,973
CONVERSATION.

783
00:31:36,973 --> 00:31:40,143
SO TO SUM MARRIZE WHILE UNDER

784
00:31:40,143 --> 00:31:43,913
USE OF INTERPRETER IS COMMON AND

785
00:31:43,913 --> 00:31:45,749
NORMALIZED, WE'RE QUITE CLEAR

786
00:31:45,749 --> 00:31:47,484
THAT INTERPRETIVE CONVERSATION

787
00:31:47,484 --> 00:31:50,720
OFTEN RESULT IN LESS

788
00:31:50,720 --> 00:31:52,689
COMPREHENSION AND TRUST AND

789
00:31:52,689 --> 00:31:54,224
PATIENT SATISFACTION ARE MUCH

790
00:31:54,224 --> 00:31:56,192
LOWER WHEN CARE TENDS TO GO

791
00:31:56,192 --> 00:31:58,762
ACROSS A LANGUAGE BARRIER.

792
00:31:58,762 --> 00:32:01,665
LET'S TURN NOW TO CLINICAL

793
00:32:01,665 --> 00:32:02,032
IMPACTS.

794
00:32:02,032 --> 00:32:05,035
I THINK SOME OF THIS IS FAMILIAR

795
00:32:05,035 --> 00:32:06,870
TO YOU.

796
00:32:06,870 --> 00:32:08,505
PATIENTS REPORTED MORE

797
00:32:08,505 --> 00:32:09,372
MEDICATION ERRORS.

798
00:32:09,372 --> 00:32:12,976
THEY ARE MUCH MORE LIKELY NOT TO

799
00:32:12,976 --> 00:32:15,011
UNDERSTAND THEIR PRESCRIPTION

800
00:32:15,011 --> 00:32:17,681
LABELS ABOUT GETTING BETTER AS

801
00:32:17,681 --> 00:32:19,149
BOTH THE LARGE NATIONAL CHAINS

802
00:32:19,149 --> 00:32:21,651
AND INDEPENDENTS ARE STARTING TO

803
00:32:21,651 --> 00:32:24,387
PUT PRESCRIPTION LABELS IN MANY

804
00:32:24,387 --> 00:32:26,323
COMMON LANGUAGES.

805
00:32:26,323 --> 00:32:28,358
HOWEVER THEY ARE LESS LIKELY TO

806
00:32:28,358 --> 00:32:30,226
KNOW WHAT THEIR MEDICATIONS ARE

807
00:32:30,226 --> 00:32:32,028
AT HOSPITAL DISCHARGE AND LESS

808
00:32:32,028 --> 00:32:33,997
LIKELY TO KNOW ABOUT THE

809
00:32:33,997 --> 00:32:36,933
FOLLOWUP APPOINTMENTS THAT HAVE

810
00:32:36,933 --> 00:32:37,334
ALREADY BEEN MADE.

811
00:32:37,334 --> 00:32:39,202
AND ON TOP OF THAT LANGUAGE

812
00:32:39,202 --> 00:32:40,937
BARRIERS HAVE BEEN IMPLICATED IN

813
00:32:40,937 --> 00:32:45,442
PATIENT SAFETY EVENTS BECAUSE OF

814
00:32:45,442 --> 00:32:46,810
PROCEDURES BEING SHORT CIRCUITED

815
00:32:46,810 --> 00:32:49,212
BECAUSE OF LANGUAGE BARRIERS

816
00:32:49,212 --> 00:32:51,514
SUCH AS TIMEOUT PROCEDURES TO

817
00:32:51,514 --> 00:32:53,516
VERIFY THAT THE PERSON IS --

818
00:32:53,516 --> 00:32:55,285
THAT THE PATIENT IS THE RIGHT

819
00:32:55,285 --> 00:33:01,391
PERSON OR TO ASK AGAIN ABOUT

820
00:33:01,391 --> 00:33:02,926
HOSPITAL ALLERGIES.

821
00:33:02,926 --> 00:33:04,394
WHAT I WANT TO TALK ABOUT ARE

822
00:33:04,394 --> 00:33:06,129
SPECIFIC CLINICAL OUTCOMES I.

823
00:33:06,129 --> 00:33:08,198
WANT TO TURN HERE TO DIABETES.

824
00:33:08,198 --> 00:33:13,203
AS YOU PROBABLY KNOW, DIABETES

825
00:33:13,203 --> 00:33:16,005
CARE IS CONTROL IS MUCH WORSE

826
00:33:16,005 --> 00:33:20,410
AMONG LATINOS VERSUS WHITES.

827
00:33:20,410 --> 00:33:21,478
AND WHITES HERE ARE THE VERY

828
00:33:21,478 --> 00:33:22,011
LAST BAR.

829
00:33:22,011 --> 00:33:27,283
AND THIS IS DATA FROM -- AND ALL

830
00:33:27,283 --> 00:33:30,220
OF THIS OTHER DATA ARE FROM THE

831
00:33:30,220 --> 00:33:32,088
STUDY OF LATINOS.

832
00:33:32,088 --> 00:33:38,361
AND WHILE WE SEE VARIATION, THE

833
00:33:38,361 --> 00:33:40,397
CUBANS HAVING BETTER GLUE SEEMIC

834
00:33:40,397 --> 00:33:40,630
CONTROL.

835
00:33:40,630 --> 00:33:45,468
NONE OF THESE ARE AS GOOD AS THE

836
00:33:45,468 --> 00:33:46,536
WHITE GROUP.

837
00:33:46,536 --> 00:33:47,971
WE BECAME VERY INTERESTED IN

838
00:33:47,971 --> 00:33:49,706
THIS QUESTION BECAUSE I WANTED

839
00:33:49,706 --> 00:33:52,876
TO SEE WHAT ROLE LANGUAGE

840
00:33:52,876 --> 00:33:54,844
BARRIERS SAY IN POOR GLUCOSE

841
00:33:54,844 --> 00:34:01,651
CONTROL IN WITH DIABETES.

842
00:34:01,651 --> 00:34:03,052
I HAD FORTUNE OF WORKING WITH

843
00:34:03,052 --> 00:34:08,925
ANDY CARTER AND A GROUP WHERE WE

844
00:34:08,925 --> 00:34:10,527
SURVEYED 20,000 PATIENTS IN FIVE

845
00:34:10,527 --> 00:34:12,829
LANGUAGES INCLUDING ENGLISH AND

846
00:34:12,829 --> 00:34:15,064
SPANISH AND ALSO WERE ABLE TO

847
00:34:15,064 --> 00:34:18,735
EXTRACT DATA FROM THEIR

848
00:34:18,735 --> 00:34:21,504
FANTASTIC ELECTRONIC DATA SET.

849
00:34:21,504 --> 00:34:25,508
WHAT WE FOUND IS WE LOOKED AT

850
00:34:25,508 --> 00:34:27,477
LATINO PATIENTS WHO SPOKE

851
00:34:27,477 --> 00:34:30,079
ENGLISH AND LATINO PATIENTS WITH

852
00:34:30,079 --> 00:34:32,649
LIMITED ENGLISH PROFICIENCY.

853
00:34:32,649 --> 00:34:33,983
WHAT WE FOUND IS THOSE PATIENTS

854
00:34:33,983 --> 00:34:38,321
WERE PRETTY SIMILAR IN TERMS OF

855
00:34:38,321 --> 00:34:39,289
THEIR AGE, PRESENTATION.

856
00:34:39,289 --> 00:34:41,224
BUT THEY WERE VERY DIFFERENT IN

857
00:34:41,224 --> 00:34:43,026
THEIR EDUCATION LEVEL.

858
00:34:43,026 --> 00:34:46,729
ABOUT 70 PERCENT OF THE ENGLISH

859
00:34:46,729 --> 00:34:48,331
SPEAKERS HAD FINISHED HIGH

860
00:34:48,331 --> 00:34:50,166
SCHOOL.

861
00:34:50,166 --> 00:34:51,801
WHERE 70 PERCENT OF THE SPANISH

862
00:34:51,801 --> 00:34:54,771
SPEAKERS OR LEP SPEAKERS HAD NOT

863
00:34:54,771 --> 00:34:57,273
FINISHED HIGH SCHOOL.

864
00:34:57,273 --> 00:34:58,007
AND THEY WERE ALSO VERY

865
00:34:58,007 --> 00:34:58,775
DIFFERENT IN THE AMOUNT OF MONEY

866
00:34:58,775 --> 00:35:00,777
THEY MADE WITH PEOPLE WHO WERE

867
00:35:00,777 --> 00:35:04,948
LEP MAKING LESS MONEY.

868
00:35:04,948 --> 00:35:07,650
WHEN WE TOOK THE GROUP OF PEOPLE

869
00:35:07,650 --> 00:35:11,254
BY LEP AND DIVIDED THEM UP INTO

870
00:35:11,254 --> 00:35:13,223
WHETHER OR NOT THEIR DOCTORS,

871
00:35:13,223 --> 00:35:15,859
PRIMARY CARE DOCTORS SPOKE

872
00:35:15,859 --> 00:35:17,727
SPANISH, LANGUAGE CONCORDANT OR

873
00:35:17,727 --> 00:35:20,530
NOT, WE FOUND THAT THEY ACTUALLY

874
00:35:20,530 --> 00:35:23,366
LOOKED PRETTY SIMILAR ON PAPER.

875
00:35:23,366 --> 00:35:26,302
THERE WERE VERY FEW DIFFERENCES

876
00:35:26,302 --> 00:35:27,170
BETWEEN THEM.

877
00:35:27,170 --> 00:35:31,908
BUT THEN WHEN WE LOOKED AT THEIR

878
00:35:31,908 --> 00:35:33,643
GLUCOSE CONTROL, WE FOUND VERY

879
00:35:33,643 --> 00:35:34,677
LARGE DIFFERENCES.

880
00:35:34,677 --> 00:35:37,013
AMONG THE WHITE ENGLISH

881
00:35:37,013 --> 00:35:39,983
SPEAKERS, 10 PERCENT AT AHEM

882
00:35:39,983 --> 00:35:42,652
GLOBEN A1C OVER 9.

883
00:35:42,652 --> 00:35:45,355
LATINO ENGLISH SPEAKERS

884
00:35:45,355 --> 00:35:48,958
18 PERCENT HAD A A1C OVER 9.

885
00:35:48,958 --> 00:35:51,261
AMONG THE LEP THAT WAS

886
00:35:51,261 --> 00:35:51,995
21 PERCENT.

887
00:35:51,995 --> 00:35:54,163
AGAIN WHEN WE DISAGGREGATE THE

888
00:35:54,163 --> 00:35:57,734
LEP INTO THOSE WITH A LANGUAGE

889
00:35:57,734 --> 00:35:59,969
CONCORDANT DOC AND THOSE

890
00:35:59,969 --> 00:36:01,204
WITHOUT, WE FOUND LARGE

891
00:36:01,204 --> 00:36:03,439
DIFFERENCES.

892
00:36:03,439 --> 00:36:07,110
ABOUT 16 PERCENT HAD VERY POOR

893
00:36:07,110 --> 00:36:10,847
GLUCOSE CONTROL WHICH WAS AS

894
00:36:10,847 --> 00:36:12,148
GOOD AS A LATINO ENGLISH

895
00:36:12,148 --> 00:36:13,182
SPEAKER.

896
00:36:13,182 --> 00:36:15,685
AND 28 PERCENT OF PEOPLE WHO IS

897
00:36:15,685 --> 00:36:18,655
DOCTOR DID NOT SPEAK SPANISH HAD

898
00:36:18,655 --> 00:36:22,358
POOR GLUCOSE CONTROL.

899
00:36:22,358 --> 00:36:23,927
THESE DIFFERENCES HELD TRUE

900
00:36:23,927 --> 00:36:29,532
AFTER ADJUSTING PHYSICIAN,

901
00:36:29,532 --> 00:36:30,900
PHARMACY, ETC.

902
00:36:30,900 --> 00:36:34,771
THE ODDS RATIO WAS ALMOST TWO

903
00:36:34,771 --> 00:36:36,906
COMPARED TO A LATINO ENGLISH

904
00:36:36,906 --> 00:36:39,842
SPEAKER OF PATIENTS WHO WERE

905
00:36:39,842 --> 00:36:42,245
SPANISH SPEAKERS AND DID NOT

906
00:36:42,245 --> 00:36:46,849
SEEK A SPANISH SPEAKING DOCTOR.

907
00:36:46,849 --> 00:36:49,452
WE THEN LOOKED AT THE SAME

908
00:36:49,452 --> 00:36:52,388
COHORT AND SAID WELL WHAT ABOUT

909
00:36:52,388 --> 00:36:55,692
LIPID, ARE WE GOING TO SEE THAT

910
00:36:55,692 --> 00:36:56,259
DIFFERENT?

911
00:36:56,259 --> 00:36:57,694
WHAT ABOUT BLOOD PRESSURE, ARE

912
00:36:57,694 --> 00:36:59,395
WE GOING TO SEE THAT DIFFERENCE?

913
00:36:59,395 --> 00:37:01,898
WHAT WE WANT TO POINT OUT THERE

914
00:37:01,898 --> 00:37:04,100
WERE SOME SMALL DIFFERENCES BUT

915
00:37:04,100 --> 00:37:05,568
THERE WERE NO LARGE DIFFERENCES,

916
00:37:05,568 --> 00:37:07,270
SIGNIFICANT DIFFERENCES IN THE

917
00:37:07,270 --> 00:37:10,006
GROUP IN LIPID CONTROL OR BLOOD

918
00:37:10,006 --> 00:37:10,773
PRESSURE CONTROL.

919
00:37:10,773 --> 00:37:12,709
SO THIS IS VERY INTERESTING.

920
00:37:12,709 --> 00:37:14,510
BECAUSE IT STARTS TO TEACH US

921
00:37:14,510 --> 00:37:16,479
ABOUT WHERE LANGUAGE BARRIERS

922
00:37:16,479 --> 00:37:18,681
APPEAR TO PLAY A BIG ROLE AND

923
00:37:18,681 --> 00:37:21,284
WHERE LANGUAGE BARRIERS MAYBE

924
00:37:21,284 --> 00:37:24,087
DON'T PLAY SUCH A BIG ROLE.

925
00:37:24,087 --> 00:37:26,255
MAYBE IT'S ENOUGH THAT I SAY TO

926
00:37:26,255 --> 00:37:28,024
MY CANTONESE SPEAKING PATIENT

927
00:37:28,024 --> 00:37:30,493
TAKE THE MEDICINE EVERY DAY.

928
00:37:30,493 --> 00:37:32,762
AND HE OR SHE UNDERSTANDS THAT.

929
00:37:32,762 --> 00:37:35,264
AND THEN I'M KIND OF DONE WITH

930
00:37:35,264 --> 00:37:37,033
LIPID CONTROL.

931
00:37:37,033 --> 00:37:38,568
MAYBE GLUCOSE CONTROL WHICH IS

932
00:37:38,568 --> 00:37:42,438
SO MUCH MORE COMPLICATED IS

933
00:37:42,438 --> 00:37:42,705
DIFFERENT.

934
00:37:42,705 --> 00:37:45,475
SO IN WAS A CROSS SECTIONAL

935
00:37:45,475 --> 00:37:45,675
STUDY.

936
00:37:45,675 --> 00:37:48,845
LIKE ALL CROSS SECTIONAL

937
00:37:48,845 --> 00:37:52,815
STUDIES, ARE SUBJECT TO MANY

938
00:37:52,815 --> 00:37:53,116
CONFOUNDERS.

939
00:37:53,116 --> 00:37:54,350
IN THE IDEAL WORLD YOU WANT TO

940
00:37:54,350 --> 00:37:57,920
TAKE A BUNCH OF LEP PATIENTS AND

941
00:37:57,920 --> 00:38:00,957
GIVE YOU A DOCTOR THAT SPEAKS

942
00:38:00,957 --> 00:38:02,392
YOUR LANGUAGE OR DOESN'T SPEAK

943
00:38:02,392 --> 00:38:03,426
YOUR LANGUAGE.

944
00:38:03,426 --> 00:38:05,061
THAT IS DIFFICULT TO DO.

945
00:38:05,061 --> 00:38:06,162
BECAUSE I DON'T THINK PATIENTS

946
00:38:06,162 --> 00:38:08,865
WANT TO BE RANDOMIZED.

947
00:38:08,865 --> 00:38:10,933
WE ALREADY KNOW THAT TRUST,

948
00:38:10,933 --> 00:38:12,535
RESPECT AND OTHER PATIENT

949
00:38:12,535 --> 00:38:14,003
CENTERED OUTCOMES ARE DIFFERENT.

950
00:38:14,003 --> 00:38:16,172
SO WE DECIDED MAYBE THE BEST WAY

951
00:38:16,172 --> 00:38:19,442
TO STUDY THIS IS BY STUDYING

952
00:38:19,442 --> 00:38:20,343
NATURAL EXPERIMENTS.

953
00:38:20,343 --> 00:38:23,946
SO WE LOOKED AT SWITCHES.

954
00:38:23,946 --> 00:38:27,083
WE TOOK DATA OF NORTHERN

955
00:38:27,083 --> 00:38:29,052
CALIFORNIA AND WE LOOKED AT

956
00:38:29,052 --> 00:38:31,020
SWITCHES FROM A DISCORDANT

957
00:38:31,020 --> 00:38:37,560
DOCTOR TO A CONCORDANT DOCTOR.

958
00:38:37,560 --> 00:38:40,930
AND WE SAID ONE YEAR LATER WHAT

959
00:38:40,930 --> 00:38:43,232
HAPPENS TO THEIR A1C?

960
00:38:43,232 --> 00:38:45,902
IT TURNS OUT THAT THE ONLY

961
00:38:45,902 --> 00:38:49,505
SWITCH THAT WAS EXTREMELY

962
00:38:49,505 --> 00:38:50,773
SIGNIFICANT WAS WHEN PEOPLE

963
00:38:50,773 --> 00:38:52,508
SWITCHED FROM A DOCTOR THAT

964
00:38:52,508 --> 00:38:54,610
DIDN'T SPEAK SPANISH TO A DOCTOR

965
00:38:54,610 --> 00:38:56,946
THAT SPEAKS SPANISH.

966
00:38:56,946 --> 00:39:00,316
AND MORE OF THEM GOT INTO GOOD

967
00:39:00,316 --> 00:39:03,052
CONTROL WITH AN A1C UNDER 8 AND

968
00:39:03,052 --> 00:39:07,056
FEWER OF THEM HAD A1CS OVER 9.

969
00:39:07,056 --> 00:39:08,925
THIS IS REALLY PORN.

970
00:39:08,925 --> 00:39:13,196
THIS SHOWS US THAT LANGUAGE

971
00:39:13,196 --> 00:39:16,833
MATTERS A GREAT DEAL FOR A1 C.

972
00:39:16,833 --> 00:39:20,169
IT ALSO HAS IMPORTANT POPULATION

973
00:39:20,169 --> 00:39:22,238
HEALTH OR REGISTRY HEALTH

974
00:39:22,238 --> 00:39:22,872
IMPLICATION.

975
00:39:22,872 --> 00:39:24,407
WHY IS THAT?

976
00:39:24,407 --> 00:39:28,244
BECAUSE THESE SWITCHES HAPPEN

977
00:39:28,244 --> 00:39:31,047
WITHIN KAISER.

978
00:39:31,047 --> 00:39:33,082
NO NEW RESOURCES WERE USED.

979
00:39:33,082 --> 00:39:34,517
THESE FOLKS GOT BETTER JUST

980
00:39:34,517 --> 00:39:36,385
BECAUSE THEY SWITCHED TO A

981
00:39:36,385 --> 00:39:37,787
DOCTOR THAT SPOKE THEIR

982
00:39:37,787 --> 00:39:38,054
LANGUAGE.

983
00:39:38,054 --> 00:39:39,989
WHEN WE LOOK AT WHETHER OR NOT

984
00:39:39,989 --> 00:39:43,993
THAT WAS TRUE FOR LIPIDS OR SIS

985
00:39:43,993 --> 00:39:46,129
TOLLIC BLOOD PRESSURE, NO IT WAS

986
00:39:46,129 --> 00:39:46,462
NOT.

987
00:39:46,462 --> 00:39:50,533
THE SWITCHES ALL RESULTED IN

988
00:39:50,533 --> 00:39:51,934
IMPROVEMENT WHERE PATIENT --

989
00:39:51,934 --> 00:39:55,138
WHERE I THINK PATIENTS WHO HAD

990
00:39:55,138 --> 00:39:59,408
SOMEHOW GOTTEN OFF THEIR STATTEN

991
00:39:59,408 --> 00:40:00,777
HAVING GOOD BLOOD PRESSURE

992
00:40:00,777 --> 00:40:02,078
CONTROL WERE SEEN AGAIN AND THE

993
00:40:02,078 --> 00:40:04,380
PHYSICIAN IMPROVED THAT CARE.

994
00:40:04,380 --> 00:40:06,349
THESE WERE NONSIGNIFICANT BY

995
00:40:06,349 --> 00:40:09,786
LANGUAGE IN ANY COMBINATION.

996
00:40:09,786 --> 00:40:12,889
SO THAT IS REALLY AGAIN STARTING

997
00:40:12,889 --> 00:40:15,258
TO SHOW US THAT LANGUAGE

998
00:40:15,258 --> 00:40:17,560
BARRIERS IMPACT SOME CLINICAL

999
00:40:17,560 --> 00:40:20,296
OUTCOMES AND DON'T IMPACT OTHER

1000
00:40:20,296 --> 00:40:21,798
CLINICAL OUTCOMES.

1001
00:40:21,798 --> 00:40:23,733
AND THIS HAS IMPLICATIONS FOR

1002
00:40:23,733 --> 00:40:27,770
HOW WE MAY ORGANIZE OUR HEALTH

1003
00:40:27,770 --> 00:40:28,671
SERVICES.

1004
00:40:28,671 --> 00:40:29,172
WHAT ABOUT ADHERENCE?

1005
00:40:29,172 --> 00:40:32,341
WE LOOKED AT THAT AGAIN.

1006
00:40:32,341 --> 00:40:35,678
AND WHAT WE FOUND WAS THAT

1007
00:40:35,678 --> 00:40:38,447
ENGLISH SPEAKING LATINOS HAVE

1008
00:40:38,447 --> 00:40:41,551
MUCH WORSE ADHERENCE TO DIABETES

1009
00:40:41,551 --> 00:40:43,619
MEDS THAN THEIR WHITE PATIENTS,

1010
00:40:43,619 --> 00:40:48,224
MUCH MORE LIKELY TO BE POOR

1011
00:40:48,224 --> 00:40:48,958
ADHERENCE.

1012
00:40:48,958 --> 00:40:51,694
LEP PATIENTS WERE EVEN MORE

1013
00:40:51,694 --> 00:40:53,429
LIKELY TO HAVE POOR.

1014
00:40:53,429 --> 00:40:56,666
BUT THAT ADHERENCE DID NOT

1015
00:40:56,666 --> 00:40:58,201
DIFFER BY VIRTUAL WHETHER OR NOT

1016
00:40:58,201 --> 00:41:00,570
THE DOCTOR SPOKE THEIR LANGUAGE.

1017
00:41:00,570 --> 00:41:05,274
SO YOU CAN SAY WAIT A MINUTE.

1018
00:41:05,274 --> 00:41:07,977
ADHERENCE DOESN'T DIFFER.

1019
00:41:07,977 --> 00:41:09,212
THIS STUDY DOESN'T GIVE US THE

1020
00:41:09,212 --> 00:41:10,379
ANSWER TO THAT.

1021
00:41:10,379 --> 00:41:12,882
IN MY VIEW IT'S BECAUSE OF TWO

1022
00:41:12,882 --> 00:41:13,449
THINGS.

1023
00:41:13,449 --> 00:41:15,184
ONE, WE WERE UNABLE TO LOOK AT

1024
00:41:15,184 --> 00:41:18,020
INSULIN AND I THINK THAT WHEN

1025
00:41:18,020 --> 00:41:21,357
THE PHYSICIAN SPEAKS THEIR

1026
00:41:21,357 --> 00:41:23,125
LANGUAGE, THEY CAN -- IT'S

1027
00:41:23,125 --> 00:41:25,161
EASIER TO PERSUADE PATIENTS TO

1028
00:41:25,161 --> 00:41:26,295
USE INSULIN.

1029
00:41:26,295 --> 00:41:28,030
AND SECOND THAT WHEN PEOPLE

1030
00:41:28,030 --> 00:41:29,732
SPEAK THE LANGUAGE, THERE IS

1031
00:41:29,732 --> 00:41:31,601
BOTH MORE TIME AND INTEREST IN

1032
00:41:31,601 --> 00:41:35,271
BEING ABLE TO ADDRESS DIET AND

1033
00:41:35,271 --> 00:41:38,608
LIFESTYLE MODIFICATION SUCH AS

1034
00:41:38,608 --> 00:41:39,675
PHYSICAL ACTIVITY.

1035
00:41:39,675 --> 00:41:43,279
AND ONE OF THE THINGS THAT WE

1036
00:41:43,279 --> 00:41:46,349
SEE IS AGAIN, BACK TO MY

1037
00:41:46,349 --> 00:41:48,718
EXPERIENCE WITH NON-SPANISH

1038
00:41:48,718 --> 00:41:51,187
SPEAKING PEOPLE WITH PATIENTS

1039
00:41:51,187 --> 00:41:53,756
WITH DIABETES, WE BECOME MORE

1040
00:41:53,756 --> 00:41:56,058
BIO MEDICALLY FOCUSED, WE PUSH

1041
00:41:56,058 --> 00:41:57,293
DRUGS MORE AND TALK TO THE

1042
00:41:57,293 --> 00:42:00,329
PATIENT A LOT LESS AND EXPRESS

1043
00:42:00,329 --> 00:42:03,332
AND ELICIT A LOT LESS THEIR

1044
00:42:03,332 --> 00:42:04,033
QUESTIONS ABOUT DIET.

1045
00:42:04,033 --> 00:42:06,569
IT IS IN THIS WAY WHERE I THINK

1046
00:42:06,569 --> 00:42:09,472
ALSO THAT CULTURAL COMPETENCE

1047
00:42:09,472 --> 00:42:11,307
BECOMES VERY HELPFUL IN TERMS OF

1048
00:42:11,307 --> 00:42:14,510
FOR EXAMPLE ELIMINATING OR

1049
00:42:14,510 --> 00:42:16,312
REDUCING SUGAR SWEETENED

1050
00:42:16,312 --> 00:42:23,019
BEVERAGES FOR PEOPLE WITH

1051
00:42:23,019 --> 00:42:23,786
DIABETES.

1052
00:42:23,786 --> 00:42:28,557
WHERE WE CAN SAY YOU SHOULD NOT

1053
00:42:28,557 --> 00:42:31,193
DRINK SODA, ETC. THAT PEOPLE USE

1054
00:42:31,193 --> 00:42:35,498
WITHOUT THINKING ABOUT IT AS

1055
00:42:35,498 --> 00:42:36,065
BAD.

1056
00:42:36,065 --> 00:42:41,537
HOW TO SUM MARRIZE THIS,

1057
00:42:41,537 --> 00:42:43,906
ADHERENCE ORAL MS IS NOT

1058
00:42:43,906 --> 00:42:45,541
DIFFERENT BUT GLUCOSE CONTROL IS

1059
00:42:45,541 --> 00:42:49,078
BETTER LIKELY COMBINATION TO

1060
00:42:49,078 --> 00:42:51,714
MAKE MORE CHANGES, MORE MEDICAL

1061
00:42:51,714 --> 00:42:52,848
CHANGES.

1062
00:42:52,848 --> 00:42:54,717
OVERALL WHAT WE FIND IN PATIENTS

1063
00:42:54,717 --> 00:42:56,652
WITH DIABETES WHO AS IT IS

1064
00:42:56,652 --> 00:42:59,889
SUFFER FROM DEPRESSION AND

1065
00:42:59,889 --> 00:43:00,723
DIABETES TREMENDOUS, IT IS CLEAR

1066
00:43:00,723 --> 00:43:05,561
FROM STUDIES THAT THERE IS LESS

1067
00:43:05,561 --> 00:43:08,864
STRESS TRUST, LESS COMPREHENSION

1068
00:43:08,864 --> 00:43:10,366
WITH THEIR CARE.

1069
00:43:10,366 --> 00:43:12,301
WHAT DO WE NEED TO DO?

1070
00:43:12,301 --> 00:43:14,136
INTENTIONALLY ADDRESS THAT BY

1071
00:43:14,136 --> 00:43:15,671
ASSESSING COMPREHENSION TO

1072
00:43:15,671 --> 00:43:16,539
THINGS LIKE TEACH BACK.

1073
00:43:16,539 --> 00:43:19,642
WE NEED TO INTENTIONALLY ADDRESS

1074
00:43:19,642 --> 00:43:20,743
MAKING IMPACT STATEMENT.

1075
00:43:20,743 --> 00:43:23,145
WE NEED TO ELICIT PATIENT POINT

1076
00:43:23,145 --> 00:43:24,180
OF VIEWS ON RECOMMENDATION.

1077
00:43:24,180 --> 00:43:26,282
AND LET ME TAKE A MINUTE TO SAY

1078
00:43:26,282 --> 00:43:28,851
THIS IS NOT ONLY TRUE WITH

1079
00:43:28,851 --> 00:43:32,154
GLUCOSE CONTROL, IT'S TRUE WITH

1080
00:43:32,154 --> 00:43:34,924
OTHER HEALTH SERVICES THAT ARE

1081
00:43:34,924 --> 00:43:36,559
EASIER AND ALSO REQUIRE TRUST

1082
00:43:36,559 --> 00:43:38,894
AND MOTIVATION.

1083
00:43:38,894 --> 00:43:40,997
IN SAN FRANCISCO, WE DID THE

1084
00:43:40,997 --> 00:43:43,733
CITY DID COVID CONTACT TRACING.

1085
00:43:43,733 --> 00:43:46,469
AND THEY TOOK LIBRARIANS AND

1086
00:43:46,469 --> 00:43:50,106
THEY HAD LIBRARIANS DO A LOT OF

1087
00:43:50,106 --> 00:43:50,740
THE CONTACT TRACING.

1088
00:43:50,740 --> 00:43:53,342
SO HIGHLY EDUCATED, VERY

1089
00:43:53,342 --> 00:43:54,543
INTELLIGENT PEOPLE, CARING

1090
00:43:54,543 --> 00:43:54,777
PEOPLE.

1091
00:43:54,777 --> 00:43:57,279
AND SOME OF THEM SPOKE SPANISH

1092
00:43:57,279 --> 00:44:01,484
AND SOME OF THEM DID NOT.

1093
00:44:01,484 --> 00:44:02,051
AT THE SAME TIME WE ALSO PUT

1094
00:44:02,051 --> 00:44:02,685
INTO THE FIELD AND MY GROUP WAS

1095
00:44:02,685 --> 00:44:05,287
THE ONE THAT DID THIS, I'M VERY

1096
00:44:05,287 --> 00:44:05,621
PROUD OF THAT.

1097
00:44:05,621 --> 00:44:08,157
WE WORKED WITH COMMUNITY BASED

1098
00:44:08,157 --> 00:44:09,558
ORGANIZATIONS TO CREATE -- TO

1099
00:44:09,558 --> 00:44:11,494
TEACH SPANISH SPEAKERS TO DO

1100
00:44:11,494 --> 00:44:12,928
CONTACT TRACING.

1101
00:44:12,928 --> 00:44:14,463
WHAT WE FOUND IS WHEN THE

1102
00:44:14,463 --> 00:44:15,865
SPANISH SPEAKING LIBRARIANS OR

1103
00:44:15,865 --> 00:44:18,501
THE COMMUNITY BASED FOLKS THAT

1104
00:44:18,501 --> 00:44:21,137
SPOKE SPANISH WERE THE ONES WHO

1105
00:44:21,137 --> 00:44:22,738
APPROACH AID PATIENT, IT TURNED

1106
00:44:22,738 --> 00:44:25,574
OUT THAT MANY MORE OF THE

1107
00:44:25,574 --> 00:44:27,309
PATIENTS WENT ON AND THEIR

1108
00:44:27,309 --> 00:44:28,744
FAMILY MEMBERS WENT ON TO GET

1109
00:44:28,744 --> 00:44:33,349
TESTED THEMSELVES.

1110
00:44:33,349 --> 00:44:34,150
THE LIBRARIANS, PEOPLE WHO SPOKE

1111
00:44:34,150 --> 00:44:36,652
ONLY ENGLISH AND DID THIS

1112
00:44:36,652 --> 00:44:39,688
INTERACTION VIA INTERPRETER,

1113
00:44:39,688 --> 00:44:40,389
PEOPLE LISTENED TO THEM BUT THEY

1114
00:44:40,389 --> 00:44:43,192
WERE MUCH LESS LIKELY TO ACT ON

1115
00:44:43,192 --> 00:44:43,492
THEM.

1116
00:44:43,492 --> 00:44:48,898
I THAT'S A NICE EXAMPLE IN A

1117
00:44:48,898 --> 00:44:49,498
MUCH MORE STRAIGHTFORWARD, 15,

1118
00:44:49,498 --> 00:44:50,132
20 MINUTE INTERACTION.

1119
00:44:50,132 --> 00:44:53,502
BUT STILL AN INTERACTION THAT

1120
00:44:53,502 --> 00:44:55,771
REQUIRES TRUST AND REQUIRES

1121
00:44:55,771 --> 00:44:56,439
MOTIVATION.

1122
00:44:56,439 --> 00:44:59,041
A PATIENT MOTIVATION OF THE

1123
00:44:59,041 --> 00:45:04,847
IMPORTANCE OF LANGUAGE

1124
00:45:04,847 --> 00:45:07,817
CONQUERENS AND HOW IMPORTANT IT

1125
00:45:07,817 --> 00:45:11,053
IS THAN EVEN PROFESSIONALLY

1126
00:45:11,053 --> 00:45:18,461
MEDIATED INTERPRETER

1127
00:45:18,461 --> 00:45:19,128
INTERACTION.

1128
00:45:19,128 --> 00:45:29,738
WHERE DOES THAT LEAVE US?

1129
00:45:29,738 --> 00:45:40,216
I'VE BEEN INTERESTED IN LOOKING

1130
00:45:40,916 --> 00:45:42,751
AT MACHINE INTERPRETATION AND

1131
00:45:42,751 --> 00:45:43,385
SPOKEN LANGUAGE.

1132
00:45:43,385 --> 00:45:45,087
WHEN I THOUGHT ABOUT WHAT IS IT

1133
00:45:45,087 --> 00:45:46,188
WE WANT.

1134
00:45:46,188 --> 00:45:48,157
WHAT IS THE GREAT TOOL?

1135
00:45:48,157 --> 00:45:51,227
WHAT SHOULD WE REALLY WANT?

1136
00:45:51,227 --> 00:45:52,795
IT BECAME CLEAR WHAT WE WANTED

1137
00:45:52,795 --> 00:45:53,362
WAS THIS.

1138
00:45:53,362 --> 00:45:55,598
I HOPE THERE IS A FEW OF YOU

1139
00:45:55,598 --> 00:45:58,033
THAT ARE STAR TREK FANS OUT

1140
00:45:58,033 --> 00:45:58,801
THERE.

1141
00:45:58,801 --> 00:46:00,636
I LOVED STAR TREK OF ALL THE

1142
00:46:00,636 --> 00:46:01,971
STAR TREKS.

1143
00:46:01,971 --> 00:46:06,876
AND THIS IS WHAT CAPTAIN KIRK IS

1144
00:46:06,876 --> 00:46:13,382
HOLDING HERE IS A UNIVERSAL

1145
00:46:13,382 --> 00:46:13,883
TRANSLATOR.

1146
00:46:13,883 --> 00:46:16,085
WHEN THEY ENCOUNTER A NEW

1147
00:46:16,085 --> 00:46:18,454
SPECIES IT WOULD START WORKING

1148
00:46:18,454 --> 00:46:19,355
AND WHATEVER LANGUAGE THE

1149
00:46:19,355 --> 00:46:20,489
SPECIES SPOKE IT WOULD COME OUT

1150
00:46:20,489 --> 00:46:23,058
IN ENGLISH AND WHATEVER THE TEAM

1151
00:46:23,058 --> 00:46:28,797
WANTED TO SAY WOULD COME OUT IN

1152
00:46:28,797 --> 00:46:29,565
PERFECT CLING ON.

1153
00:46:29,565 --> 00:46:31,367
THIS IS WHAT WE WANT.

1154
00:46:31,367 --> 00:46:33,369
WE WANT TO HOLD SOMETHING IN OUR

1155
00:46:33,369 --> 00:46:35,671
HANDS AND MAKE IT WORK

1156
00:46:35,671 --> 00:46:35,971
FLAWLESSLY.

1157
00:46:35,971 --> 00:46:38,340
HOW FAR AWAY ARE WE?

1158
00:46:38,340 --> 00:46:39,942
WELL, WE DID THIS STUDY AND

1159
00:46:39,942 --> 00:46:42,711
AGAIN THIS IS AN UNFUNDED STUDY.

1160
00:46:42,711 --> 00:46:46,849
MANY OF THEM ARE OF MY STUDIES.

1161
00:46:46,849 --> 00:46:55,658
ALL THE KAISER WORK WAS FUNDED.

1162
00:46:55,658 --> 00:46:57,660
BUT IN TERMS OF FUNDING FOR

1163
00:46:57,660 --> 00:46:59,195
BASIC RESEARCH INTO

1164
00:46:59,195 --> 00:47:02,464
COMMUNICATION, THAT HAS REALLY

1165
00:47:02,464 --> 00:47:03,899
NOT BEEN THERE.

1166
00:47:03,899 --> 00:47:07,203
AND HERE WHAT WE DID IS THAT WE

1167
00:47:07,203 --> 00:47:13,542
WENT TO OUR CLINICAL RECORDS AND

1168
00:47:13,542 --> 00:47:19,048
WE TOOK 100 DISCHARGE

1169
00:47:19,048 --> 00:47:19,582
INSTRUCTIONS.

1170
00:47:19,582 --> 00:47:21,984
SOME FROM OUR EMERGENCY ROOM

1171
00:47:21,984 --> 00:47:23,152
HERE AT SAN FRANCISCO GENERAL

1172
00:47:23,152 --> 00:47:25,654
AND SOME FROM OUR EMERGENCY ROOM

1173
00:47:25,654 --> 00:47:29,692
AT UCSF HEALTH WHICH IS MORE OF

1174
00:47:29,692 --> 00:47:31,594
A CLASSIC ACADEMIC CENTER.

1175
00:47:31,594 --> 00:47:35,731
AND WE PUT ALL OF THESE

1176
00:47:35,731 --> 00:47:37,166
INSTRUCTIONS INTO A GLOBAL

1177
00:47:37,166 --> 00:47:38,801
TRANSLATE IN SPANISH.

1178
00:47:38,801 --> 00:47:45,374
AND WE PUT THEM ALL THROUGH INTO

1179
00:47:45,374 --> 00:47:45,608
CHINESE.

1180
00:47:45,608 --> 00:47:50,279
AND THEN WE ASKED PROFESSIONAL

1181
00:47:50,279 --> 00:47:53,048
INTERPRETERS WHO WERE BLINDED TO

1182
00:47:53,048 --> 00:47:54,984
BACK TRANSLATE FROM THE SPANISH

1183
00:47:54,984 --> 00:47:56,885
OR BACK TRANSLATE FROM THE

1184
00:47:56,885 --> 00:47:57,119
CHINESE.

1185
00:47:57,119 --> 00:48:00,823
AND THIS IS WHAT THEY TOLD US.

1186
00:48:00,823 --> 00:48:04,460
IN THE ORIGINAL SENTENCE FOR

1187
00:48:04,460 --> 00:48:06,128
EXAMPLE IT SAYS TOLD KIDNEY

1188
00:48:06,128 --> 00:48:07,463
MEDICINE UNTIL YOU HAVE A CHANCE

1189
00:48:07,463 --> 00:48:10,466
TO SPEAK WITH YOUR KIDNEY

1190
00:48:10,466 --> 00:48:11,533
DOCTOR.

1191
00:48:11,533 --> 00:48:15,137
THE SPANISH SAID KEEP THE

1192
00:48:15,137 --> 00:48:16,672
MEDICINE FOR THE KIDNEY UNTIL

1193
00:48:16,672 --> 00:48:18,607
YOU HAVE A CHANCE TO TALK WITH

1194
00:48:18,607 --> 00:48:20,876
YOUR KIDNEY DOCTOR BECAUSE THEY

1195
00:48:20,876 --> 00:48:31,353
TRANCE ITED HOLD AS HOLD ON,

1196
00:48:33,155 --> 00:48:33,656
KEEP.

1197
00:48:33,656 --> 00:48:34,590
GOOGLE TRANSLATE DID.

1198
00:48:34,590 --> 00:48:38,494
THAT WAS PROPOTENTIALLY LIFE

1199
00:48:38,494 --> 00:48:41,363
THREATENING AND THAT WAS ALSO

1200
00:48:41,363 --> 00:48:46,735
TRUE FOR THE CHINESE.

1201
00:48:46,735 --> 00:48:49,872
ADDITIONALLY IT WORKS LESS WELL

1202
00:48:49,872 --> 00:48:50,973
IN CHINESE.

1203
00:48:50,973 --> 00:48:53,242
BUT IT DOESN'T WORK WHEN THE

1204
00:48:53,242 --> 00:48:57,613
PHYSICIAN USES A NORMAL WORD

1205
00:48:57,613 --> 00:49:00,149
LIKE HOLD IN AN ATYPICAL MANNER.

1206
00:49:00,149 --> 00:49:01,517
THE PROBLEM HERE IS NOT THE

1207
00:49:01,517 --> 00:49:02,384
GOOGLE TRANSLATE.

1208
00:49:02,384 --> 00:49:04,353
THE PROBLEM HERE IS THE DOCTOR.

1209
00:49:04,353 --> 00:49:05,721
THEY SHOULDN'T HAVE WRITTEN THE

1210
00:49:05,721 --> 00:49:06,355
KIDNEY MEDICINE.

1211
00:49:06,355 --> 00:49:08,357
BUT THE POINT IS THAT'S WHAT

1212
00:49:08,357 --> 00:49:09,692
THEY DID.

1213
00:49:09,692 --> 00:49:12,728
IT ALSO CAN'T HANDLE

1214
00:49:12,728 --> 00:49:15,030
ABBREVIATIONS OR SMELLING AND

1215
00:49:15,030 --> 00:49:16,965
GRAMMATICAL ERRORS.

1216
00:49:16,965 --> 00:49:18,267
FAIRLY STRAIGHTFORWARD.

1217
00:49:18,267 --> 00:49:19,768
THE CLINICIAN WROTE PLEASE TAKE

1218
00:49:19,768 --> 00:49:23,605
THIS MEDICATION AS FOLLOWS.

1219
00:49:23,605 --> 00:49:29,411
AND HERE THE SPAWNISH IS PRETTY

1220
00:49:29,411 --> 00:49:32,247
GOOD BUT THE LIED CAIN PATCHES

1221
00:49:32,247 --> 00:49:36,785
ARE NOT ON FOR 12 HOURS.

1222
00:49:36,785 --> 00:49:38,253
AND SO.

1223
00:49:38,253 --> 00:49:42,524
AND IN THE CHINESE IT REALLY

1224
00:49:42,524 --> 00:49:45,794
ALSO HAD A LOT OF DIFFICULTY

1225
00:49:45,794 --> 00:49:46,295
TRANSLATING.

1226
00:49:46,295 --> 00:49:48,997
WE RECOMMENDED THAT PEOPLE NOT

1227
00:49:48,997 --> 00:49:52,601
USE GOOGLE TRANSLATE EXCEPT IF

1228
00:49:52,601 --> 00:49:54,970
THEY ARE VERY CAREFUL TO USE

1229
00:49:54,970 --> 00:49:56,572
SIMPLE PLAIN LANGUAGE AND IF

1230
00:49:56,572 --> 00:50:00,909
THEY DO, TO ALWAYS DROP IN HAVE

1231
00:50:00,909 --> 00:50:03,212
AN AUTOMATIC DROP IN THIS WAS

1232
00:50:03,212 --> 00:50:05,714
MACHINE TRANSLATED AND THAT THE

1233
00:50:05,714 --> 00:50:07,416
ENGLISH IS THE REAL VERSION.

1234
00:50:07,416 --> 00:50:09,151
SO WHEN PEOPLE TAKE HOME THINGS,

1235
00:50:09,151 --> 00:50:10,652
IF IT DOESN'T MAKE SENSE THEY

1236
00:50:10,652 --> 00:50:12,121
CAN GET SOMEONE TO READ IT FOR

1237
00:50:12,121 --> 00:50:14,156
THEM IN ENGLISH.

1238
00:50:14,156 --> 00:50:18,494
RIGHT NOW WE ARE REPEATING THIS

1239
00:50:18,494 --> 00:50:21,830
STUDY WITH CHAT GPT TO SEE

1240
00:50:21,830 --> 00:50:23,432
WHETHER OR NOT THAT MAKE ACE

1241
00:50:23,432 --> 00:50:27,336
DIFFERENCE WHEN WE USE A MORE

1242
00:50:27,336 --> 00:50:29,371
ACTIVE ARTIFICIAL INTELLIGENCE

1243
00:50:29,371 --> 00:50:33,609
MACHINE TRANSLATION MODEL.

1244
00:50:33,609 --> 00:50:40,015
AND THEN I MENTOR ANOASOLOGIST,

1245
00:50:40,015 --> 00:50:42,084
A YOUNG SCIENTIST WHO IS IS

1246
00:50:42,084 --> 00:50:43,652
INTERESTED IN BEING ABLE TO USE

1247
00:50:43,652 --> 00:50:51,326
PHONE INTERPRETERS IN THE OR

1248
00:50:51,326 --> 00:50:51,560
ITSELF.

1249
00:50:51,560 --> 00:50:53,028
THESE ARE AREAS WHERE THE

1250
00:50:53,028 --> 00:50:57,032
INTERACTIONS ARE VERY BRIEF AND

1251
00:50:57,032 --> 00:50:59,067
WHERE OFTEN THE DEFAULT IS TO

1252
00:50:59,067 --> 00:51:00,936
USE NOTHING AT ALL AND NOT TALK

1253
00:51:00,936 --> 00:51:04,706
WITH THE PATIENT AT ALL RATHER

1254
00:51:04,706 --> 00:51:06,875
THAN THEY DON'T SEE IT AS WORTH

1255
00:51:06,875 --> 00:51:09,011
THEIR TIME TO CALL A

1256
00:51:09,011 --> 00:51:10,145
PROFESSIONAL INTERPRETER AND IT

1257
00:51:10,145 --> 00:51:13,348
CAN BE HARD TO GET PHONES GENTOO

1258
00:51:13,348 --> 00:51:14,082
THE O R.

1259
00:51:14,082 --> 00:51:16,118
WE AGAIN LOOKED AT SPANISH AND

1260
00:51:16,118 --> 00:51:18,954
HERE WE LOOKED AT MANDARIN.

1261
00:51:18,954 --> 00:51:23,425
AND WE TOOK SENTENCES FROM THESE

1262
00:51:23,425 --> 00:51:25,894
WERE ALL LOW RISK SENTS SUCH AS

1263
00:51:25,894 --> 00:51:30,032
CAN I GO TO THE BATHROOM NOW OR

1264
00:51:30,032 --> 00:51:32,868
WIGGLE YOUR TOES OR OTHER THINGS

1265
00:51:32,868 --> 00:51:34,169
THAT EITHER TER PATIENT WANTS TO

1266
00:51:34,169 --> 00:51:36,738
SAY OR THAT THE CLINICIAN WANTS

1267
00:51:36,738 --> 00:51:41,009
TO SAY.

1268
00:51:41,009 --> 00:51:41,944
AND WE LOOKED AT THREE MODELS,

1269
00:51:41,944 --> 00:51:43,812
APPLE, GOOGLE AND MICROSOFT AND

1270
00:51:43,812 --> 00:51:46,315
COMPARED IT TO A HUGE

1271
00:51:46,315 --> 00:51:46,849
INTERPRETATION.

1272
00:51:46,849 --> 00:51:49,218
AND THEN WE HAD THOSE

1273
00:51:49,218 --> 00:51:50,886
INTERPRETATIONS RATED BY PEOPLE

1274
00:51:50,886 --> 00:51:54,223
WHO ARE BILINGUAL SPEAKERS AND

1275
00:51:54,223 --> 00:51:55,624
PROFESSIONALS WHO WERE BLINDED

1276
00:51:55,624 --> 00:51:59,862
AS TO HOW THE INTERPRETATION WAS

1277
00:51:59,862 --> 00:52:00,629
MADE.

1278
00:52:00,629 --> 00:52:04,900
AND WHAT WE FOUND IS WE SET UP

1279
00:52:04,900 --> 00:52:05,868
PARAMETERS FOR ACCEPTABILITY.

1280
00:52:05,868 --> 00:52:08,637
AND WHAT WE FOUND IS THAT THE

1281
00:52:08,637 --> 00:52:11,106
THREE PROGRAMS WERE ABOUT

1282
00:52:11,106 --> 00:52:12,975
70 PERCENT ACCEPTABLE WHICH IS

1283
00:52:12,975 --> 00:52:17,012
NOT BAD IN ENGLISH TO SPANISH.

1284
00:52:17,012 --> 00:52:21,450
THOUGH IT DOESN'T I DON'T SAY A

1285
00:52:21,450 --> 00:52:21,683
MARGIN.

1286
00:52:21,683 --> 00:52:23,952
THEY WERE LOUSY AT INTERPRETING

1287
00:52:23,952 --> 00:52:25,521
SPANISH TO ENGLISH.

1288
00:52:25,521 --> 00:52:26,855
LET ME TELL YOU WHY.

1289
00:52:26,855 --> 00:52:29,491
IT TURNS OUT WHEN WE LOOKED AT

1290
00:52:29,491 --> 00:52:31,793
THE SENTENCE AND AT THE OTHERS,

1291
00:52:31,793 --> 00:52:34,029
WHAT HAPPENED IS IF THE PATIENT

1292
00:52:34,029 --> 00:52:38,767
SAID WHY DOES MY LEG HURT.

1293
00:52:38,767 --> 00:52:44,239
THE MACHINE WOULD INTERPRET THAT

1294
00:52:44,239 --> 00:52:47,376
AS AND WOULD SAY BECAUSE MY LEG

1295
00:52:47,376 --> 00:52:47,609
HURTS.

1296
00:52:47,609 --> 00:52:49,545
INSTEAD OF ASKING WHY DOES MY

1297
00:52:49,545 --> 00:52:50,379
LEG HURT.

1298
00:52:50,379 --> 00:52:52,948
THE PATIENT WOULD BE SAYING

1299
00:52:52,948 --> 00:52:54,249
BECAUSE MY LEG HURTS.

1300
00:52:54,249 --> 00:52:57,819
AND THAT IS CLEARLY NOT

1301
00:52:57,819 --> 00:52:58,353
ACCEPTABLE.

1302
00:52:58,353 --> 00:53:03,258
AND THIS WAS EVEN IN ENGLISH TO

1303
00:53:03,258 --> 00:53:06,428
MANDARIN WAS LESS GOOD THAN

1304
00:53:06,428 --> 00:53:08,463
ENGLISH TO SPANISH.

1305
00:53:08,463 --> 00:53:11,066
BUT AGAIN, LITTLE BIT BETTER

1306
00:53:11,066 --> 00:53:14,102
THAN A LOT BETTER THAN MANDARIN

1307
00:53:14,102 --> 00:53:16,572
TO ENGLISH WHERE THE

1308
00:53:16,572 --> 00:53:19,041
ACCEPTABILITY RANGED FROM 30 TO

1309
00:53:19,041 --> 00:53:21,009
40 PERCENT.

1310
00:53:21,009 --> 00:53:25,781
UNFORTUNATELY THE UNIVERSAL

1311
00:53:25,781 --> 00:53:26,348
TRANSLATOR IS NOT HERE YET.

1312
00:53:26,348 --> 00:53:27,950
WE ARE TRYING TO FIGURE OUT AND

1313
00:53:27,950 --> 00:53:29,718
OTHER PEOPLE ARE WORKING THIS AS

1314
00:53:29,718 --> 00:53:31,787
A GROUP IN BOSTON WORKING ON

1315
00:53:31,787 --> 00:53:33,755
THIS TO SEE WHETHER OR NOT THERE

1316
00:53:33,755 --> 00:53:38,794
IS A WAY IN WHICH FOR VERY LOW

1317
00:53:38,794 --> 00:53:41,630
RISK SITUATIONS PATIENTS SIGN

1318
00:53:41,630 --> 00:53:42,230
IN.

1319
00:53:42,230 --> 00:53:44,099
PATIENTS GOING TO RAIDOLOGIST

1320
00:53:44,099 --> 00:53:46,068
WHERE THE TECH HAS TO SAY

1321
00:53:46,068 --> 00:53:47,502
WELCOME, PUT YOUR THINGS DOWN

1322
00:53:47,502 --> 00:53:49,471
HERE, TURN AROUND FOR THE X-RAY.

1323
00:53:49,471 --> 00:53:53,375
AND INSTEAD OF SHOVING PEOPLE

1324
00:53:53,375 --> 00:53:56,945
AROUND, WILL THERE BE A USE FOR

1325
00:53:56,945 --> 00:53:58,880
THESE MACHINE INTERPRETATIONS?

1326
00:53:58,880 --> 00:54:00,649
I'M CONFIDENT THAT THE TIME WILL

1327
00:54:00,649 --> 00:54:02,618
COME WHEN THIS WILL WORK OUT.

1328
00:54:02,618 --> 00:54:06,822
BUT WE ARE NOT ANYWHERE NEAR

1329
00:54:06,822 --> 00:54:07,356
THERE YET.

1330
00:54:07,356 --> 00:54:10,158
SO IN SUMMARY, I HOPE I'VE SHOWN

1331
00:54:10,158 --> 00:54:13,362
THAT YOU LANGUAGE BARRIERS

1332
00:54:13,362 --> 00:54:14,863
REALLY CONTRIBUTED TO HEALTHCARE

1333
00:54:14,863 --> 00:54:15,397
DISPARITIES.

1334
00:54:15,397 --> 00:54:18,000
AND HERE THE CLINICAL MOD UNTIL

1335
00:54:18,000 --> 00:54:21,370
DIABETES WORKS WELL BOTH IN

1336
00:54:21,370 --> 00:54:22,904
CONTRIBUTION TO POOR GLUCOSE

1337
00:54:22,904 --> 00:54:24,473
CONTROL AND ALSO IN

1338
00:54:24,473 --> 00:54:25,974
CONTRIBUTIONS TO THE PATIENT

1339
00:54:25,974 --> 00:54:26,441
EXPERIENCE.

1340
00:54:26,441 --> 00:54:29,878
THAT WHEN YOU DO USE IN

1341
00:54:29,878 --> 00:54:31,813
PROFESSIONAL INTERPRETER HEALTH

1342
00:54:31,813 --> 00:54:33,849
CARE TEND TO BE LESS PATIENT

1343
00:54:33,849 --> 00:54:36,018
CENTERED AND MANY COMPLEX

1344
00:54:36,018 --> 00:54:37,653
OUTCOMES THAT REQUIRE PATIENT

1345
00:54:37,653 --> 00:54:39,855
UNDERSTANDING, BUY IN AND TRUST

1346
00:54:39,855 --> 00:54:41,356
ARE MUCH WORSE.

1347
00:54:41,356 --> 00:54:45,360
WHERE AS OTHERS APPEAR NOT TO BE

1348
00:54:45,360 --> 00:54:45,727
AFFECTED.

1349
00:54:45,727 --> 00:54:47,963
WE NEED DO A LOT MORE TO

1350
00:54:47,963 --> 00:54:49,498
FACILITATE LANGUAGE ACCESS AND

1351
00:54:49,498 --> 00:54:52,234
ALSO WE NEED A LOT MORE RESEARCH

1352
00:54:52,234 --> 00:54:55,070
TO DETERMINE HOW TO IMPROVE IT

1353
00:54:55,070 --> 00:54:57,272
AND HOW LANGUAGE BARRIERS AFFECT

1354
00:54:57,272 --> 00:54:58,707
PATIENT OUTCOMES AND PATIENT

1355
00:54:58,707 --> 00:54:59,007
EXPERIENCE.

1356
00:54:59,007 --> 00:55:03,178
JUST TO NAME A FEW, WHEN IS

1357
00:55:03,178 --> 00:55:05,180
LANGUAGE CONCORDANCE NEEDED?

1358
00:55:05,180 --> 00:55:07,315
CAN WE GET BY WITH JUST

1359
00:55:07,315 --> 00:55:08,650
PROFESSIONAL INTERPRETERS.

1360
00:55:08,650 --> 00:55:10,852
WHAT ABOUT AT DISCHARGE, WHAT

1361
00:55:10,852 --> 00:55:12,054
ABOUT BEHAVIORAL COUNSELING?

1362
00:55:12,054 --> 00:55:13,288
WE DON'T KNOW THE ANSWER TO

1363
00:55:13,288 --> 00:55:13,488
THAT.

1364
00:55:13,488 --> 00:55:16,124
WE DON'T KNOW THE ANSWER TO

1365
00:55:16,124 --> 00:55:17,893
WHERE MACHINE TRANSLATION CAN

1366
00:55:17,893 --> 00:55:20,362
IMPROVE THE PATIENT EXPERIENCE.

1367
00:55:20,362 --> 00:55:22,431
MAYBE THE TRANSLATOR IS NOT VERY

1368
00:55:22,431 --> 00:55:25,233
GOOD OR MACHINE INTERPRETATION

1369
00:55:25,233 --> 00:55:26,768
IS NOT GOOD BUT MAYBE IT CAN

1370
00:55:26,768 --> 00:55:28,937
IMPROVE EXPERIENCE IN RIDE

1371
00:55:28,937 --> 00:55:30,105
RAYEDOLOGY.

1372
00:55:30,105 --> 00:55:32,340
FINALLY WE NEED FUNDAMENTAL

1373
00:55:32,340 --> 00:55:33,075
VERGE INTO PATIENT CLINICIAN

1374
00:55:33,075 --> 00:55:36,144
COMMUNICATION AND WHAT IS THE

1375
00:55:36,144 --> 00:55:37,979
ARCHITECTURE OF INTERPRETER

1376
00:55:37,979 --> 00:55:39,481
COMMUNICATIONS AND WHAT

1377
00:55:39,481 --> 00:55:41,383
INTERVENTIONS CAN WE USE TO

1378
00:55:41,383 --> 00:55:43,418
IMPROVE THE PATIENT CENTEREDNESS

1379
00:55:43,418 --> 00:55:47,289
AND THE EFFECTIVENESS OF THOSE

1380
00:55:47,289 --> 00:55:47,656
COMMUNICATIONS?

1381
00:55:47,656 --> 00:55:50,625
WITH THAT LET ME JUST STOP HERE.

1382
00:55:50,625 --> 00:55:53,428
AND I HOPE THAT YOU'VE ENJOYED

1383
00:55:53,428 --> 00:55:57,032
THIS AND THAT WE CAN HAVE A

1384
00:55:57,032 --> 00:56:00,335
LITTLE BIT OF CONVERSATION.

1385
00:56:00,335 --> 00:56:01,236
>> THANK YOU SO MUCH.

1386
00:56:01,236 --> 00:56:03,371
THAT WAS OUTSTANDING.

1387
00:56:03,371 --> 00:56:06,274
REALLY GREAT TO HEAR YOUR

1388
00:56:06,274 --> 00:56:08,577
PERSPECTIVE ON THIS RELATIVELY

1389
00:56:08,577 --> 00:56:09,845
NARROW TOPIC BUT REALLY

1390
00:56:09,845 --> 00:56:13,248
IMPORTANT AND ONE THAT WE'VE

1391
00:56:13,248 --> 00:56:15,217
SHARED INTEREST IN AND

1392
00:56:15,217 --> 00:56:16,752
COLLABORATED ON A COUPLE OF

1393
00:56:16,752 --> 00:56:17,719
TIMES ON THIS.

1394
00:56:17,719 --> 00:56:19,588
I WANTED TO START US OFF WAY

1395
00:56:19,588 --> 00:56:22,090
COUPLE OF QUESTIONS AND SHELLY

1396
00:56:22,090 --> 00:56:23,325
IS GOING TO GATHER QUESTIONS

1397
00:56:23,325 --> 00:56:27,129
FROM THE VIDEO CAST SO WE'LL GO

1398
00:56:27,129 --> 00:56:29,264
TO HER AND SEE WHAT WE HAVE.

1399
00:56:29,264 --> 00:56:32,467
WE TECHNICALLY HAVE UNTIL 3:30.

1400
00:56:32,467 --> 00:56:35,537
SO WE WON'T HOLD YOU UNTIL THEN

1401
00:56:35,537 --> 00:56:36,905
UNLESS THERE IS LOTS OF

1402
00:56:36,905 --> 00:56:44,579
QUESTIONS THAT REQUIRE THAT.

1403
00:56:44,579 --> 00:56:46,648
>> YES WE GO UNTIL 3:30
AND WE

1404
00:56:46,648 --> 00:56:47,983
DO HAVE QUESTIONS.

1405
00:56:47,983 --> 00:56:50,252
>> I LOVE THE FACT HOW YOU
ENDED

1406
00:56:50,252 --> 00:56:50,485
IT.

1407
00:56:50,485 --> 00:56:57,359
I THINK I'LL PUT A PLUG IN FOR A

1408
00:56:57,359 --> 00:56:58,994
OPPORTUNITY THAT NIMHD HAS OUT

1409
00:56:58,994 --> 00:57:00,295
ON PATIENT CLINICIAN

1410
00:57:00,295 --> 00:57:00,762
COMMUNICATION.

1411
00:57:00,762 --> 00:57:02,998
THIS IS THE KIND OF RESEARCH I

1412
00:57:02,998 --> 00:57:07,068
THINK THAT IN THE PAST PEOPLE

1413
00:57:07,068 --> 00:57:07,769
HAVE CONSIDERED EITHERRER NOT

1414
00:57:07,769 --> 00:57:10,272
SCIENTIFIC ENOUGH OR SOFT.

1415
00:57:10,272 --> 00:57:15,844
WE REALLY THINK IT'S AT THE CORE

1416
00:57:15,844 --> 00:57:16,745
CONTRIBUTOR TO HEALTHCARE

1417
00:57:16,745 --> 00:57:17,512
DISPARITIES.

1418
00:57:17,512 --> 00:57:19,514
SO NOT JUST IN THE LANGUAGE

1419
00:57:19,514 --> 00:57:22,150
BARRIERS WHERE YOU HAVE VERY

1420
00:57:22,150 --> 00:57:23,351
QUAN QUANTITATIVE THINGS TO

1421
00:57:23,351 --> 00:57:26,721
MEASURE BUT ALSO IN GENERAL THAT

1422
00:57:26,721 --> 00:57:31,059
WHOLE IDEA OF TRUSTING EXAMPLES

1423
00:57:31,059 --> 00:57:33,461
YOU GAVE I THINK WERE QUITE

1424
00:57:33,461 --> 00:57:34,963
ILLUSTRATIVE IN THAT WAY.

1425
00:57:34,963 --> 00:57:37,098
YOU MENTIONED TECHNOLOGY QUITE A

1426
00:57:37,098 --> 00:57:37,432
BIT.

1427
00:57:37,432 --> 00:57:40,435
I'M GLAD YOU SHARED THE WORK YOU

1428
00:57:40,435 --> 00:57:43,371
DID WITH THE TRANSLATORS.

1429
00:57:43,371 --> 00:57:44,673
I KNEW THAT HAPPENED.

1430
00:57:44,673 --> 00:57:46,675
I DIDN'T REMEMBER THE OUTCOME.

1431
00:57:46,675 --> 00:57:48,677
AND IT'S BETTER THAN NOTHING SI

1432
00:57:48,677 --> 00:57:51,079
GUESS WHAT WE'RE SAYING.

1433
00:57:51,079 --> 00:57:54,216
BUT IT IS WAY INADEQUATE AND

1434
00:57:54,216 --> 00:57:55,951
POTENTIALLY COULD CAUSE HARM.

1435
00:57:55,951 --> 00:57:58,753
AND IN SOME WAYS THE

1436
00:57:58,753 --> 00:58:01,656
PROFESSIONAL INTERPRETERS ARE

1437
00:58:01,656 --> 00:58:02,691
DEFINITELY BETTER THAN NOTHING

1438
00:58:02,691 --> 00:58:06,094
AND THEY FILL A VOID BUT THEY

1439
00:58:06,094 --> 00:58:08,563
ARE FAR FROM THE IDEAL OR THE

1440
00:58:08,563 --> 00:58:10,332
GOLD STANDARD WHICH WOULD BE

1441
00:58:10,332 --> 00:58:12,701
TALK TO SOMEONE WHO DIRECTLY

1442
00:58:12,701 --> 00:58:13,368
UNDERSTANDS YOU.

1443
00:58:13,368 --> 00:58:16,304
WHAT ABOUT THE VIDEO ACCESS?

1444
00:58:16,304 --> 00:58:21,443
HAS THAT BEEN MORE PROMINENTLY

1445
00:58:21,443 --> 00:58:21,977
DISSEMINATED?

1446
00:58:21,977 --> 00:58:23,912
BECAUSE ONE OF THE LIMITATIONS

1447
00:58:23,912 --> 00:58:24,913
WITH INTERPRETERS WAS THEY HAD

1448
00:58:24,913 --> 00:58:26,882
TO RUN AROUND, THE COST AND THEY

1449
00:58:26,882 --> 00:58:28,483
ARE SITTING AROUND WAITING FOR

1450
00:58:28,483 --> 00:58:30,552
TO YOU FINISH.

1451
00:58:30,552 --> 00:58:32,687
WHAT HAS BEEN YOUR EXPERIENCE

1452
00:58:32,687 --> 00:58:37,025
WITH THE EITHER VIDEO OR PHONE

1453
00:58:37,025 --> 00:58:37,325
TRANSLATORS?

1454
00:58:37,325 --> 00:58:38,894
>> THERE HAS BEEN A FAIR
NUMBER

1455
00:58:38,894 --> 00:58:41,997
OF STUDIES ON THE USE OF VIDEO

1456
00:58:41,997 --> 00:58:44,266
COMPARING VIDEO, PHONE AND IN

1457
00:58:44,266 --> 00:58:45,567
PERSON INTERPRETATIONS.

1458
00:58:45,567 --> 00:58:48,303
AND VIDEO AND IN PERSON ARE

1459
00:58:48,303 --> 00:58:50,672
RANKED EQUALLY WHICH IS

1460
00:58:50,672 --> 00:58:52,674
FANTASTIC BY PATIENTS AND BY

1461
00:58:52,674 --> 00:58:52,974
CLINICIANS.

1462
00:58:52,974 --> 00:58:54,409
THAT IS FANTASTIC NEWS.

1463
00:58:54,409 --> 00:58:58,546
BECAUSE VIDEO IS MUCH MORE

1464
00:58:58,546 --> 00:58:59,147
EFFICIENT.

1465
00:58:59,147 --> 00:59:00,482
INTERPRETER IS NOT RUNNING

1466
00:59:00,482 --> 00:59:01,383
AROUND THE HOSPITAL.

1467
00:59:01,383 --> 00:59:02,984
THEY ARE SITTING AT THEIR DESK

1468
00:59:02,984 --> 00:59:04,886
AND THEY CAN GO FROM ONE VIDEO

1469
00:59:04,886 --> 00:59:06,588
CALL TO ANOTHER INDIVIDUAL CROW

1470
00:59:06,588 --> 00:59:06,821
CALL.

1471
00:59:06,821 --> 00:59:09,624
WHY DO PATIENTS LOVE VIDEO

1472
00:59:09,624 --> 00:59:09,991
INTERPRETATION?

1473
00:59:09,991 --> 00:59:12,227
THEY LOVE IT BECAUSE IT'S LESS

1474
00:59:12,227 --> 00:59:13,061
INTRUSIVE.

1475
00:59:13,061 --> 00:59:17,465
THE PERSON IS LESS IN THE ROOM.

1476
00:59:17,465 --> 00:59:19,634
AND IT'S MORE A PART OF THE

1477
00:59:19,634 --> 00:59:20,669
HEALTHCARE TEAM WITHOUT BEING SO

1478
00:59:20,669 --> 00:59:21,503
IN THE ROOM.

1479
00:59:21,503 --> 00:59:23,805
AND I THINK THAT ALSO HAS BEEN

1480
00:59:23,805 --> 00:59:25,874
REALLY HELPFUL.

1481
00:59:25,874 --> 00:59:26,908
UNFORTUNATELY MOST HOSPITALS

1482
00:59:26,908 --> 00:59:31,046
DON'T HAVE ACCESS TO VIDEO

1483
00:59:31,046 --> 00:59:31,479
INTERPRETATION.

1484
00:59:31,479 --> 00:59:34,416
THAT'S CHANGING.

1485
00:59:34,416 --> 00:59:37,686
BECAUSE OF THE CLIMATE FOR TYPE

1486
00:59:37,686 --> 00:59:39,387
OF INTRANET, EITHER NET,

1487
00:59:39,387 --> 00:59:40,288
SOMETHING I DON'T UNDERSTAND IN

1488
00:59:40,288 --> 00:59:43,625
ORDER TO HAVE VIDEO

1489
00:59:43,625 --> 00:59:45,927
INTERPRETATION.

1490
00:59:45,927 --> 00:59:48,630
OR BECAUSE OF THERE SIMPLY

1491
00:59:48,630 --> 00:59:50,999
HASN'T BEEN THE INVESTMENT IN

1492
00:59:50,999 --> 00:59:51,800
IT.

1493
00:59:51,800 --> 00:59:53,702
EVEN THOUGH TECHNOLOGICAL

1494
00:59:53,702 --> 00:59:54,602
CHANNELS ARE NOT THERE.

1495
00:59:54,602 --> 00:59:56,004
ONE OF THE THINGS THAT HAPPENED

1496
00:59:56,004 --> 00:59:58,606
DURING THE PANDEMIC IS BECAUSE

1497
00:59:58,606 --> 01:00:00,241
INTERPRETERS -- AS YOU KNOW,

1498
01:00:00,241 --> 01:00:03,845
MANY IMMIGRANT PATIENTS

1499
01:00:03,845 --> 01:00:04,713
DISPROPORTIONATEDLY AFFECT BID

1500
01:00:04,713 --> 01:00:07,882
THE COVID PANDEMIC.

1501
01:00:07,882 --> 01:00:09,117
BECAUSE MANY PEOPLE -- BECAUSE

1502
01:00:09,117 --> 01:00:11,653
WE WERE TRYING TO BLOCK

1503
01:00:11,653 --> 01:00:12,220
HEALTHCARE WORK FREERS GOING

1504
01:00:12,220 --> 01:00:14,489
INTO THE ROOM AND EXPOSING

1505
01:00:14,489 --> 01:00:15,690
THEMSELVES WHEN IT WASN'T

1506
01:00:15,690 --> 01:00:16,157
NECESSARY.

1507
01:00:16,157 --> 01:00:18,526
MANY PLACES STARTING USING IPADS

1508
01:00:18,526 --> 01:00:20,962
WHERE WE GAVE THE PATIENT AN

1509
01:00:20,962 --> 01:00:21,629
IPAD AND THEN THE INTERPRETER

1510
01:00:21,629 --> 01:00:23,031
WAS OUTSIDE AND THEY WERE ABLE

1511
01:00:23,031 --> 01:00:24,899
TO COMMUNICATE THAT WAY.

1512
01:00:24,899 --> 01:00:27,068
AND AGAIN THAT WAS CLEARLY

1513
01:00:27,068 --> 01:00:27,635
BETTER.

1514
01:00:27,635 --> 01:00:31,306
THE QUESTION IS CAN WE TAKE THAT

1515
01:00:31,306 --> 01:00:34,976
THOSE ADVANCES AND MAKE THEM

1516
01:00:34,976 --> 01:00:38,213
STATE OF THE ART IN ALL

1517
01:00:38,213 --> 01:00:38,480
HOSPITALS?

1518
01:00:38,480 --> 01:00:40,615
AND THE ANSWER TO THAT IS THERE

1519
01:00:40,615 --> 01:00:42,951
HAS BEEN THAT WE CAN CLEARLY DO

1520
01:00:42,951 --> 01:00:44,819
THAT BUT THERE HAS BEEN NO

1521
01:00:44,819 --> 01:00:47,155
APPETITE TO DO THAT BY ANY

1522
01:00:47,155 --> 01:00:48,390
REGULATORY AGENCY.

1523
01:00:48,390 --> 01:00:52,027
BECAUSE OF THE COMBINATION OF

1524
01:00:52,027 --> 01:00:52,594
THINKING THAT IMMIGRANTS ARE

1525
01:00:52,594 --> 01:00:53,495
LESS IMPORTANT AND NOT BEING

1526
01:00:53,495 --> 01:00:56,331
FORCED TO DO IT BY A REGULATION,

1527
01:00:56,331 --> 01:00:59,034
AND THAT THIS IS AN UNFUNDED

1528
01:00:59,034 --> 01:01:01,002
MANDATE, MOST HOSPITALS INVEST

1529
01:01:01,002 --> 01:01:04,072
THE MINIMUM IN INTERPRETER

1530
01:01:04,072 --> 01:01:04,572
SERVICES.

1531
01:01:04,572 --> 01:01:06,107
SO IT'S A HUGE ISSUE.

1532
01:01:06,107 --> 01:01:09,044
BUT WE TO DO NOAH VIDEO

1533
01:01:09,044 --> 01:01:10,311
INTERPRETATION IS GREAT.

1534
01:01:10,311 --> 01:01:12,614
IT'S MUCH BETTER THAN OTHER

1535
01:01:12,614 --> 01:01:12,814
FORMS.

1536
01:01:12,814 --> 01:01:13,715
>> THANK YOU.

1537
01:01:13,715 --> 01:01:16,317
THIS WOULD BE ONE OF THE THINGS

1538
01:01:16,317 --> 01:01:19,154
THAT NEED TO BE THROUGH POLICY

1539
01:01:19,154 --> 01:01:23,191
CHANGES, AGENCIES THAT HAVE

1540
01:01:23,191 --> 01:01:26,594
LEVERAGE POWER IN THIS CASE CMS

1541
01:01:26,594 --> 01:01:30,665
MAKE IT A INDICATOR THEN IT

1542
01:01:30,665 --> 01:01:32,100
BECOMES -- WE DO KNOW SYSTEMS

1543
01:01:32,100 --> 01:01:33,568
CHANGE WHEN THAT HAPPENS.

1544
01:01:33,568 --> 01:01:35,904
THERE IS A QUESTION FROM THE

1545
01:01:35,904 --> 01:01:36,171
AUDIENCE.

1546
01:01:36,171 --> 01:01:37,872
CAN YOU EXPLAIN ABOUT FAMILY

1547
01:01:37,872 --> 01:01:43,511
BEING USED AS INTERPRETERS?

1548
01:01:43,511 --> 01:01:43,945
>> GREAT QUESTION.

1549
01:01:43,945 --> 01:01:44,546
SO THAT'S ACTUALLY BEEN LOOKED

1550
01:01:44,546 --> 01:01:50,885
AT A FAIR AMOUNT.

1551
01:01:50,885 --> 01:01:54,355
AND WHAT WE SEE IS THAT FAMILY

1552
01:01:54,355 --> 01:01:55,356
MEMBERS OBVIOUSLY HAVE THE BEST

1553
01:01:55,356 --> 01:01:56,658
OF INTENTION.

1554
01:01:56,658 --> 01:01:58,426
BUT THERE IS TWO ISSUES.

1555
01:01:58,426 --> 01:02:00,595
ONE IS FAMILY MEMBERS DON'T HAVE

1556
01:02:00,595 --> 01:02:02,197
THE KNOWLEDGE AND SKILLS TO WORK

1557
01:02:02,197 --> 01:02:05,133
AS PROFESSIONAL INTERPRETERS.

1558
01:02:05,133 --> 01:02:07,102
SO THAT MEANS THAT THEY DON'T

1559
01:02:07,102 --> 01:02:11,906
KNOW HOW THE SAY CERTAIN WORDS

1560
01:02:11,906 --> 01:02:14,943
BECAUSE THEY HAVE NEVER USED

1561
01:02:14,943 --> 01:02:15,777
THOSE WORDS.

1562
01:02:15,777 --> 01:02:19,147
AND THERE ZO THERE IS A LOT

1563
01:02:19,147 --> 01:02:21,616
OF -- THERE ARE MANY MISTAKES.

1564
01:02:21,616 --> 01:02:22,617
INTERESTINGLY THERE ARE ALSO A

1565
01:02:22,617 --> 01:02:25,954
LOT OF OMISSIONS.

1566
01:02:25,954 --> 01:02:29,557
SO YOU CAN ASK DOES DO YOU HAVE

1567
01:02:29,557 --> 01:02:31,626
ANY ALLERGIES AND THE FAMILY

1568
01:02:31,626 --> 01:02:34,429
MEMBER WILL SAY NO AND IT TURNS

1569
01:02:34,429 --> 01:02:35,463
OUT THAT FAMILY MEMBER DOESN'T

1570
01:02:35,463 --> 01:02:37,665
KNOW THAT THE PATIENT HAS

1571
01:02:37,665 --> 01:02:38,032
ALLERGIES.

1572
01:02:38,032 --> 01:02:40,401
AND THERE IS ALSO STRANGELY

1573
01:02:40,401 --> 01:02:42,470
ENOUGH ADDITIONS.

1574
01:02:42,470 --> 01:02:48,343
SO IN A FAMOUS SET OF STUDIES IN

1575
01:02:48,343 --> 01:02:50,979
PEDIATRICS WHERE THEY RAN AUDIO

1576
01:02:50,979 --> 01:02:53,214
TAPES WITH FAMILY MEMBERS

1577
01:02:53,214 --> 01:02:54,382
SERVING ADDS INTERPRETEDDERS,

1578
01:02:54,382 --> 01:02:56,017
FAMILY MEMBERS WOULD ADD

1579
01:02:56,017 --> 01:02:56,284
SOMETHING.

1580
01:02:56,284 --> 01:02:58,086
SO FOR EXAMPLE THE DOCTOR SAID

1581
01:02:58,086 --> 01:03:02,524
TAKE THE AMOXICILLIN TWICE A DAY

1582
01:03:02,524 --> 01:03:04,492
FOR THE KID'S EAR INFECTION.

1583
01:03:04,492 --> 01:03:06,928
AND WHAT THE INTERPRETER SAID IS

1584
01:03:06,928 --> 01:03:10,498
PUT THE AMOXICILLIN IN THE EAR

1585
01:03:10,498 --> 01:03:12,167
TWICE A DAY FOR THE EAR

1586
01:03:12,167 --> 01:03:12,767
INFECTION.

1587
01:03:12,767 --> 01:03:15,003
IT TURNS OUT AMOXICILLIN GOES IN

1588
01:03:15,003 --> 01:03:16,304
THE MOUTH AND NOT IN THE EAR.

1589
01:03:16,304 --> 01:03:17,639
IT WAS AN ADDITION.

1590
01:03:17,639 --> 01:03:20,975
SO WHAT WE SEE ARE MISTAKES,

1591
01:03:20,975 --> 01:03:23,611
OMISSIONS AND ADDITIONS.

1592
01:03:23,611 --> 01:03:26,781
SO IN SHORT, WE THERE IS

1593
01:03:26,781 --> 01:03:28,283
CONSENSUS THAT FAMILY MEMBERS

1594
01:03:28,283 --> 01:03:31,452
SHOULD NOT BE USED AS

1595
01:03:31,452 --> 01:03:31,786
INTERPRETERS.

1596
01:03:31,786 --> 01:03:32,987
I'LL ADD ONE MORE REASON THAT

1597
01:03:32,987 --> 01:03:35,323
DOESN'T HAVE TO DO WITH THE

1598
01:03:35,323 --> 01:03:36,858
ACCURACY OF INTERPRETED

1599
01:03:36,858 --> 01:03:37,158
INFORMATION.

1600
01:03:37,158 --> 01:03:38,159
AND THAT IS THAT EVERYONE

1601
01:03:38,159 --> 01:03:40,461
DESERVES TO HAVE THEIR FAMILY

1602
01:03:40,461 --> 01:03:42,096
MEMBER BE THERE AS A FAMILY

1603
01:03:42,096 --> 01:03:42,397
MEMBER.

1604
01:03:42,397 --> 01:03:43,965
SO WHEN PEOPLE BRING IN FAMILY

1605
01:03:43,965 --> 01:03:46,801
MEMBERS TO ME TO MY CLINIC I SAY

1606
01:03:46,801 --> 01:03:49,204
THANK YOU SO MUCH FOR BEING

1607
01:03:49,204 --> 01:03:49,404
HERE.

1608
01:03:49,404 --> 01:03:50,805
I'M DELIGHTED.

1609
01:03:50,805 --> 01:03:52,540
I'M GOING TO CALL THE

1610
01:03:52,540 --> 01:03:55,643
INTERPRETER BECAUSE THAT'S OUR

1611
01:03:55,643 --> 01:03:55,877
POLICY.

1612
01:03:55,877 --> 01:03:56,544
I'M SO GLAD YOU ARE HERE BECAUSE

1613
01:03:56,544 --> 01:03:57,579
IF YOU CATCH SOMETHING OR YOU

1614
01:03:57,579 --> 01:03:59,614
WANT TO EXPLAIN SOMETHING MORE

1615
01:03:59,614 --> 01:04:01,649
TO ME, YOU CAN DO THAT.

1616
01:04:01,649 --> 01:04:04,686
AND SO AGAIN, FAMILY MEMBERS

1617
01:04:04,686 --> 01:04:08,990
GREAT ADVOCATES, NOT SO GREAT AS

1618
01:04:08,990 --> 01:04:09,324
INTERPRETERS.

1619
01:04:09,324 --> 01:04:09,824
>> THANK YOU.

1620
01:04:09,824 --> 01:04:13,695
I WILL ADD THAT IT'S BEEN

1621
01:04:13,695 --> 01:04:15,630
ACTUALLY MADE ILLEGAL IN SOME

1622
01:04:15,630 --> 01:04:17,131
JURISDICTIONS TO HAVE CHILDREN

1623
01:04:17,131 --> 01:04:21,369
DO INTERPRETATIONS APPROPRIATELY

1624
01:04:21,369 --> 01:04:21,536
SO.

1625
01:04:21,536 --> 01:04:23,404
YOU CAN IMAGINE A NON-ENGLISH

1626
01:04:23,404 --> 01:04:27,108
SPEAKING ADULT BRINGING IN THEIR

1627
01:04:27,108 --> 01:04:28,509
15-YEAR-OLD AND THERE ARE BOUND

1628
01:04:28,509 --> 01:04:29,844
TO BE QUESTIONS NOT GOING TO BE

1629
01:04:29,844 --> 01:04:32,146
ASKED OR ANSWERED BECAUSE OF THE

1630
01:04:32,146 --> 01:04:35,750
PRESENCE OF AN ADOLESCENT OR

1631
01:04:35,750 --> 01:04:37,385
YOUNGER ADOLESCENT IN THE ROOM

1632
01:04:37,385 --> 01:04:39,354
ACTING AS AN INTERPRETER.

1633
01:04:39,354 --> 01:04:42,957
WE REALLY NEED TO AVOID THAT.

1634
01:04:42,957 --> 01:04:45,093
ANOTHER QUESTION FROM THE

1635
01:04:45,093 --> 01:04:48,663
AUDIENCE FROM ONE OF OUR STAFF

1636
01:04:48,663 --> 01:04:49,430
AT NIMHD.

1637
01:04:49,430 --> 01:04:53,034
THANKING YOU FOR YOUR VERY

1638
01:04:53,034 --> 01:04:55,270
INFORMATIVE PRESENTATION AS A

1639
01:04:55,270 --> 01:04:56,971
SCIENTIST, CLINICIAN.

1640
01:04:56,971 --> 01:04:59,507
WHAT I'VE NOTICED THAT THE

1641
01:04:59,507 --> 01:05:00,675
HEALTHCARE SYSTEM IS A BARRIER

1642
01:05:00,675 --> 01:05:03,311
TO PROVIDING QUALITY CARE TO

1643
01:05:03,311 --> 01:05:05,613
THESE PATIENTS WHEN THERE IS

1644
01:05:05,613 --> 01:05:07,582
PRESSURE TO SEE A LARGE VOLUME

1645
01:05:07,582 --> 01:05:10,251
OF PATIENTS THERE IS CONCERNS TO

1646
01:05:10,251 --> 01:05:12,520
NOT BE PROPERLY HEARD OR

1647
01:05:12,520 --> 01:05:12,820
UNDERSTOOD.

1648
01:05:12,820 --> 01:05:14,589
ALSO THE PROVIDERS MAY NOT BE

1649
01:05:14,589 --> 01:05:17,425
GIVEN EXTRA TIME DURING CLINICAL

1650
01:05:17,425 --> 01:05:20,261
MEETINGS TO PROVIDE GOOD QUALITY

1651
01:05:20,261 --> 01:05:20,928
OF CARE.

1652
01:05:20,928 --> 01:05:23,298
TO ADD ARE ISSUES OF HEALTHCARE

1653
01:05:23,298 --> 01:05:24,365
WORKER BURNOUT.

1654
01:05:24,365 --> 01:05:26,701
THIS CALLS FOR POLICY LEVEL

1655
01:05:26,701 --> 01:05:26,934
CHANGES.

1656
01:05:26,934 --> 01:05:29,404
THAT'S MORE OF A COMMENT THAN A

1657
01:05:29,404 --> 01:05:29,837
QUESTION.

1658
01:05:29,837 --> 01:05:31,806
>> THAT'S A GREAT COMMENT
I

1659
01:05:31,806 --> 01:05:39,147
COULD COMPLETELY AGREE.

1660
01:05:39,147 --> 01:05:42,283
UCSF IS MADE UP OF THREE LARGE

1661
01:05:42,283 --> 01:05:42,917
HOSPITAL SYSTEMS.

1662
01:05:42,917 --> 01:05:45,186
ONE OF THE THREE NOT THE ONE I

1663
01:05:45,186 --> 01:05:46,587
WORK, IN PRIMARY CARE THEY HAVE

1664
01:05:46,587 --> 01:05:48,456
DOUBLE THE AMOUNT OF TIME GIVEN

1665
01:05:48,456 --> 01:05:50,825
TO PATIENTS TO CLINICIANS WHO

1666
01:05:50,825 --> 01:05:53,094
ARE TREATING A PATIENT WITH AN

1667
01:05:53,094 --> 01:05:55,296
INTERPRETER PRECISELY BECAUSE OF

1668
01:05:55,296 --> 01:05:55,630
THIS.

1669
01:05:55,630 --> 01:05:57,932
WE AT SAN FRANCISCO GENERAL HAVE

1670
01:05:57,932 --> 01:05:58,700
NOT DONE THAT.

1671
01:05:58,700 --> 01:05:59,901
WHY IS THAT?

1672
01:05:59,901 --> 01:06:01,669
BECAUSE OVER 30 PERCENT OF OUR

1673
01:06:01,669 --> 01:06:03,071
PATIENTS -- I THINK IT'S MORE

1674
01:06:03,071 --> 01:06:06,341
THE PRIMARY CARE IT'S MORE LIKE

1675
01:06:06,341 --> 01:06:09,210
50 PERCENT OF OUR PATIENTS DO

1676
01:06:09,210 --> 01:06:09,610
NOT SPEAK ENGLISH.

1677
01:06:09,610 --> 01:06:10,578
WE CAN'T DO OUR JOB OF TAKING

1678
01:06:10,578 --> 01:06:11,879
CARE OF PATIENTS IF WE DOUBLE

1679
01:06:11,879 --> 01:06:13,915
THE TIME.

1680
01:06:13,915 --> 01:06:14,549
IN THE SYSTEMS THAT HAVE SMALLER

1681
01:06:14,549 --> 01:06:16,851
NUMBER OF PATIENTS THAT DON'T

1682
01:06:16,851 --> 01:06:18,686
SPEAK ENGLISH IT MAKES A LOT OF

1683
01:06:18,686 --> 01:06:20,421
SENSE TO GRANT MORE TIME TO

1684
01:06:20,421 --> 01:06:23,324
THOSE INTERACTIONS AND HAVE THAT

1685
01:06:23,324 --> 01:06:25,827
REFLECTED IN HOWEVER THE

1686
01:06:25,827 --> 01:06:30,331
PHYSICIAN'S WORK IS AUDITED.

1687
01:06:30,331 --> 01:06:32,967
SO I COMPLETELY AGREE AND THIS

1688
01:06:32,967 --> 01:06:33,901
IS POLICY.

1689
01:06:33,901 --> 01:06:38,072
I ALSO THINK THAT AGAIN I AGREE

1690
01:06:38,072 --> 01:06:42,110
CMS COULD DO A LOT HERE TO ALIGN

1691
01:06:42,110 --> 01:06:46,681
ON THIS AND MAKE BETTER CARE FOR

1692
01:06:46,681 --> 01:06:48,916
PATIENTS FOR TAKING CARE OF

1693
01:06:48,916 --> 01:06:52,820
PATIENTS WITH LANGUAGE BARRIERS.

1694
01:06:52,820 --> 01:06:53,721
>> PARTICULARLY IN AREAS
WHERE

1695
01:06:53,721 --> 01:06:57,158
THERE IS A THRESHOLD NUMBER OF

1696
01:06:57,158 --> 01:07:00,561
PEOPLE WHO ARE LIMBED ENGLISH

1697
01:07:00,561 --> 01:07:01,429
PROFICIENCY.

1698
01:07:01,429 --> 01:07:03,331
YOU SHOWED THE WHOLE COUNTRY.

1699
01:07:03,331 --> 01:07:05,266
THERE IS SEMITRITHERE AND IF

1700
01:07:05,266 --> 01:07:08,836
IT'S A REQUIREMENT IT COULD BE

1701
01:07:08,836 --> 01:07:09,270
TARGETED.

1702
01:07:09,270 --> 01:07:11,773
I THINK YOU SHOWED THE EMPIRICAL

1703
01:07:11,773 --> 01:07:12,173
EVIDENCE.

1704
01:07:12,173 --> 01:07:13,975
BUT IN ADDITION IF YOU HAVE

1705
01:07:13,975 --> 01:07:15,710
SOMEONE WITH AN INTERPRETER, YOU

1706
01:07:15,710 --> 01:07:17,245
DO HALF AS MUCH BECAUSE YOU HAVE

1707
01:07:17,245 --> 01:07:19,747
HALF THE TIME.

1708
01:07:19,747 --> 01:07:22,183
AND AS CLINICIANS YOU REALLY

1709
01:07:22,183 --> 01:07:26,320
WORK ON THE GET THE TECHNICAL

1710
01:07:26,320 --> 01:07:27,355
THINGS DONE.

1711
01:07:27,355 --> 01:07:29,891
YOU CALL THE MEDICAL APPROACH OR

1712
01:07:29,891 --> 01:07:30,591
BIO MEDICAL.

1713
01:07:30,591 --> 01:07:32,326
TAKE YOUR MEDICINE, MAKE SURE

1714
01:07:32,326 --> 01:07:34,228
YOU GET THE TEST.

1715
01:07:34,228 --> 01:07:36,597
THAT GENERALLY HAS BEEN SHOWN TO

1716
01:07:36,597 --> 01:07:40,334
BE DONE REASONABLY WELL IN THESE

1717
01:07:40,334 --> 01:07:40,735
ENCOUNTERS.

1718
01:07:40,735 --> 01:07:44,272
BUT YOU TOTALLY LOSE OUT ON

1719
01:07:44,272 --> 01:07:45,740
BUILDING RELATIONSHIP, CREATING

1720
01:07:45,740 --> 01:07:47,708
TRUST AND WHAT I WOULD CALL THE

1721
01:07:47,708 --> 01:07:50,178
SOFT PART OF THIS AND

1722
01:07:50,178 --> 01:07:52,113
PARTICULARLY IN A PRIMARY CARE

1723
01:07:52,113 --> 01:07:53,548
SETTING WHERE YOU ARE NOT

1724
01:07:53,548 --> 01:07:55,483
DEALING WITH ONE PROBLEM IN THE

1725
01:07:55,483 --> 01:07:57,752
EMERGENCY ROOM AND SO THIS

1726
01:07:57,752 --> 01:08:00,121
REALLY MATTERS.

1727
01:08:00,121 --> 01:08:01,022
ANOTHER QUESTION THAT WE HAD

1728
01:08:01,022 --> 01:08:04,025
FROM AN OUTSIDE AUDIENCE, YOUR

1729
01:08:04,025 --> 01:08:06,427
STATEMENT ON LANGUAGE ACCESS IS

1730
01:08:06,427 --> 01:08:09,497
AN EXAMPLE OF STRUCTURAL RACISM.

1731
01:08:09,497 --> 01:08:11,899
IT'S SO TRUE AND RESOUNDING.

1732
01:08:11,899 --> 01:08:13,768
TALK MORE ABOUT IF TIME ALLOWS.

1733
01:08:13,768 --> 01:08:15,603
FOR EXAMPLE HOW CAN WE COMPARE

1734
01:08:15,603 --> 01:08:17,038
OTHER SERVICES THAT ARE SIMILAR

1735
01:08:17,038 --> 01:08:19,207
THAT ARE PROVIDED WITHOUT

1736
01:08:19,207 --> 01:08:22,710
QUESTION VERSUS LANGUAGE ACCESS

1737
01:08:22,710 --> 01:08:22,910
ETC.?

1738
01:08:22,910 --> 01:08:27,181
FROM ANOTHER PERSPECTIVE, WOULD

1739
01:08:27,181 --> 01:08:29,116
WOULD THERE BE MORE ADHERENCE

1740
01:08:29,116 --> 01:08:33,154
AND QUALITY OUTCOMES, HOSPITAL

1741
01:08:33,154 --> 01:08:33,588
REIMBURSEMENT ETC.?

1742
01:08:33,588 --> 01:08:35,890
THIS IS ONE OF YOUR COLLEAGUES

1743
01:08:35,890 --> 01:08:39,794
FROM UCSF.

1744
01:08:39,794 --> 01:08:44,298
>> THAT'S A COLLEAGUE FROM
UC

1745
01:08:44,298 --> 01:08:45,633
SAN DIEGO.

1746
01:08:45,633 --> 01:08:49,537
I SEE THIS AS STRUCTURAL RACISM.

1747
01:08:49,537 --> 01:08:53,908
LET ME GIVE YOU AN EXAMPLE.

1748
01:08:53,908 --> 01:08:54,242
PHLEBOTOMY.

1749
01:08:54,242 --> 01:08:58,346
IT COST MONEY TO HAVE SOMEONE

1750
01:08:58,346 --> 01:09:00,014
THERE TO DRAW LABS OR DRAW BLOOD

1751
01:09:00,014 --> 01:09:00,348
CULTURES.

1752
01:09:00,348 --> 01:09:03,851
BACK IN MY DAY AND CERTAINLY ALL

1753
01:09:03,851 --> 01:09:05,353
THE OLDER CLINICIANS WILL

1754
01:09:05,353 --> 01:09:10,858
REMEMBER THIS, THE INTERNS DREW

1755
01:09:10,858 --> 01:09:11,392
LABS AND BLOOD CULTURES.

1756
01:09:11,392 --> 01:09:12,793
RIGHT NOW THAT DOESN'T HAPPEN.

1757
01:09:12,793 --> 01:09:14,128
WE HAVE TEAMS OF PEOPLE GOING

1758
01:09:14,128 --> 01:09:15,897
AROUND THE HOSPITAL DRAWING LABS

1759
01:09:15,897 --> 01:09:17,899
AND BLOOD CULTURES.

1760
01:09:17,899 --> 01:09:20,668
THEY NEED TO BE PAID.

1761
01:09:20,668 --> 01:09:27,174
WE HAVE ROLLED PAYMENT COST OF

1762
01:09:27,174 --> 01:09:29,143
THOSE FOLKS UP INTO THE TEST.

1763
01:09:29,143 --> 01:09:31,579
WE NEED TO GET THE LABS AND THAT

1764
01:09:31,579 --> 01:09:34,115
MEANS SOMEONE NEEDS TO DRAW THE

1765
01:09:34,115 --> 01:09:34,315
BLOOD.

1766
01:09:34,315 --> 01:09:40,321
IN THE SAME WAY I CALL THIS

1767
01:09:40,321 --> 01:09:43,391
RACISM AS OPPOSED TO SIMPLY BAD

1768
01:09:43,391 --> 01:09:44,492
MEDICAL CARE BECAUSE IT'S

1769
01:09:44,492 --> 01:09:46,827
OBVIOUS THAT WE NEED TO FULLY

1770
01:09:46,827 --> 01:09:49,030
FUND LANGUAGE ACCESS SERVICES TO

1771
01:09:49,030 --> 01:09:51,832
MAKE IT MUCH MORE SEAMLESS SUCH

1772
01:09:51,832 --> 01:09:55,603
AS WE WERE SAYING WITH IPADS

1773
01:09:55,603 --> 01:09:57,838
ETC. FOR BOTH MORE SEAMLESS FOR

1774
01:09:57,838 --> 01:09:59,206
THE DOCTOR AND THE PATIENT.

1775
01:09:59,206 --> 01:10:01,242
AND SOMEONE HAS TO PAY FOR IT.

1776
01:10:01,242 --> 01:10:02,810
AT THE END OF THE DAY SOMEONE

1777
01:10:02,810 --> 01:10:04,111
HAS TO PAY FOR IT.

1778
01:10:04,111 --> 01:10:06,814
BUT IN THE SAME WAY THAT WE

1779
01:10:06,814 --> 01:10:08,416
FIGURE OUT HOW THE PAY FOR THE

1780
01:10:08,416 --> 01:10:12,453
HOSPITAL LIGHTS, HOW TO PAY FOR

1781
01:10:12,453 --> 01:10:12,954
THE PHLEBOTOMIST.

1782
01:10:12,954 --> 01:10:15,156
WE CAN FIGURE OUT HOW TO PAY FOR

1783
01:10:15,156 --> 01:10:17,058
ROBUST LANGUAGE ACCESS SERVICES.

1784
01:10:17,058 --> 01:10:18,993
THE FACT THAT WE DON'T DO THIS,

1785
01:10:18,993 --> 01:10:22,797
THE FACT THAT ALMOST ALL REALLY

1786
01:10:22,797 --> 01:10:24,231
STRONG INTERPRETATION SYSTEM

1787
01:10:24,231 --> 01:10:25,866
VERSUS BEEN PUT THIS PLACE AS A

1788
01:10:25,866 --> 01:10:28,102
RESULT OF LAWSUITS NOT AS A

1789
01:10:28,102 --> 01:10:34,709
RESULT OF PRACTICE SPEAKS TO A

1790
01:10:34,709 --> 01:10:37,912
CERTAIN LACK OF UNDERSTANDING,

1791
01:10:37,912 --> 01:10:40,514
LACK OF APPRECIATION OF THESE

1792
01:10:40,514 --> 01:10:42,049
PATIENTS EXPERIENCE AND NEEDS.

1793
01:10:42,049 --> 01:10:45,419
AND THAT IS NOT A SCIENTIFIC

1794
01:10:45,419 --> 01:10:45,753
BLOCK.

1795
01:10:45,753 --> 01:10:47,722
THAT IS SOMETHING ELSE.

1796
01:10:47,722 --> 01:10:50,458
AND THERE WAS A MOMENT HERE IN

1797
01:10:50,458 --> 01:10:52,493
THE PANDEMIC WHEN LOOKING AROUND

1798
01:10:52,493 --> 01:10:54,929
THE COUNTRY AND GETTING THE

1799
01:10:54,929 --> 01:10:56,797
REPORTS OF HOW DISPROPORTIONATE

1800
01:10:56,797 --> 01:10:59,500
THE IMPACT OF THE PANDEMIC WAS

1801
01:10:59,500 --> 01:11:02,236
ON IMMIGRANT LATINOS AND OTHER

1802
01:11:02,236 --> 01:11:03,804
IMMIGRANTS AS WELL AS

1803
01:11:03,804 --> 01:11:05,673
AFRICAN-AMERICANS, I TURNED TO A

1804
01:11:05,673 --> 01:11:06,874
COLLEAGUE AND SAID WE'RE GOING

1805
01:11:06,874 --> 01:11:09,010
TO GET LANGUAGE SERVICES OUT OF.

1806
01:11:09,010 --> 01:11:10,811
THIS PEOPLE ARE GOING TO SEE

1807
01:11:10,811 --> 01:11:13,781
THESE ESSENTIAL WORKERS DESERVE

1808
01:11:13,781 --> 01:11:15,816
THE MINIMUM INFRASTRUCTURE TO BE

1809
01:11:15,816 --> 01:11:19,620
ABLE TO GET GOOD CARE.

1810
01:11:19,620 --> 01:11:21,155
I DON'T THINK WE'RE GOING TO GET

1811
01:11:21,155 --> 01:11:21,922
LANGUAGE SERVICES.

1812
01:11:21,922 --> 01:11:25,760
I THINK THE PANDEMIC IS FOR NOW

1813
01:11:25,760 --> 01:11:29,196
LOOKS MUCH MORE MANAGEABLE.

1814
01:11:29,196 --> 01:11:32,033
AND THAT PEOPLE DID NOT -- THERE

1815
01:11:32,033 --> 01:11:36,637
HASN'T BEEN A SOCIAL ACCOUNTING

1816
01:11:36,637 --> 01:11:37,171
FOR WHO ALL ENDED UP DYING

1817
01:11:37,171 --> 01:11:41,308
DURING THIS PANDEMIC.

1818
01:11:41,308 --> 01:11:42,043
BECAUSE THEY WERE ESSENTIAL

1819
01:11:42,043 --> 01:11:44,879
WORKERS AND HOW THE HEALTHCARE

1820
01:11:44,879 --> 01:11:45,813
SYSTEM SHOULD RESPOND.

1821
01:11:45,813 --> 01:11:47,415
I WAS WRONG ABOUT THAT.

1822
01:11:47,415 --> 01:11:49,717
BUT I THINK THAT IS WHAT IS

1823
01:11:49,717 --> 01:11:50,217
HAPPENING.

1824
01:11:50,217 --> 01:11:52,119
AND IF PEOPLE DON'T DO IT

1825
01:11:52,119 --> 01:11:53,220
BECAUSE OF HOSPITAL SYSTEMS

1826
01:11:53,220 --> 01:11:55,756
DON'T PUT IT INTO PLACE BECAUSE

1827
01:11:55,756 --> 01:11:57,124
IT'S BETTER CARE AND SHOULD JUST

1828
01:11:57,124 --> 01:11:59,260
BE PART OF CARE, THEN ONLY WAY

1829
01:11:59,260 --> 01:12:01,195
THIS WILL HAPPEN IS ON THE

1830
01:12:01,195 --> 01:12:01,762
REGULATORY SIDE.

1831
01:12:01,762 --> 01:12:04,098
ON THE REGULATORY SIDE PEOPLE

1832
01:12:04,098 --> 01:12:07,668
HAVE BEEN RELUCTANT, REGULATORY

1833
01:12:07,668 --> 01:12:10,805
ORGANIZATION ARE RELUCTANT.

1834
01:12:10,805 --> 01:12:13,874
FOR EXAMPLE MY WORK WAS PART OF

1835
01:12:13,874 --> 01:12:16,977
THE IMPETUS FOR THIS.

1836
01:12:16,977 --> 01:12:19,280
THEY DO MONITOR WHETHER OR NOT

1837
01:12:19,280 --> 01:12:21,782
INTERPRETERS ARE USED FOR

1838
01:12:21,782 --> 01:12:22,983
INFORMED CONSENT.

1839
01:12:22,983 --> 01:12:25,386
WHEN IT GOES INTO A HOSPITAL

1840
01:12:25,386 --> 01:12:27,021
VISIT THEY WILL PULL A CERTAIN

1841
01:12:27,021 --> 01:12:28,289
NUMBER OF CHARTS AND LOOK AT

1842
01:12:28,289 --> 01:12:29,557
WHETHER OR NOT THERE IS

1843
01:12:29,557 --> 01:12:30,858
DOCUMENTATION OF INTERPRETER

1844
01:12:30,858 --> 01:12:31,692
USE.

1845
01:12:31,692 --> 01:12:32,226
FANTASTIC.

1846
01:12:32,226 --> 01:12:35,763
BUT THEY ARE NOT MONITORING FOR

1847
01:12:35,763 --> 01:12:37,031
EXAMPLE A PATIENT SPENT FIVE

1848
01:12:37,031 --> 01:12:38,666
DAYS IN THE HOSPITAL, ON HOW

1849
01:12:38,666 --> 01:12:41,135
MANY DAYS DID A CLINICIAN

1850
01:12:41,135 --> 01:12:44,538
ACTUALLY TALK WITH A PATIENT

1851
01:12:44,538 --> 01:12:45,072
USING AN INTERPRETER.

1852
01:12:45,072 --> 01:12:48,876
WE SHOULD BE ABLE TO MONITOR

1853
01:12:48,876 --> 01:12:49,076
THAT.

1854
01:12:49,076 --> 01:12:49,710
>> THANK YOU.

1855
01:12:49,710 --> 01:13:00,154
AND JUST FOR THE AUDIENCE.

1856
01:13:01,288 --> 01:13:02,089
ANOTHER YES I REALLY APPRECIATE

1857
01:13:02,089 --> 01:13:05,993
ALL THE INSIGHTS INTO CHRONIC

1858
01:13:05,993 --> 01:13:08,295
DISEASE MANAGEMENT MADE FOR

1859
01:13:08,295 --> 01:13:09,029
PRIORITIZATION FOR PERSONAL

1860
01:13:09,029 --> 01:13:11,031
CONNECTION, IS THERE ANY MODELS

1861
01:13:11,031 --> 01:13:12,633
ORGANIZATION, INSTITUTIONS THAT

1862
01:13:12,633 --> 01:13:15,436
LEAD OR RESEARCH THE EFFICACY OR

1863
01:13:15,436 --> 01:13:22,576
POLICIES OR PRACTICE?

1864
01:13:22,576 --> 01:13:22,910
>> OK.

1865
01:13:22,910 --> 01:13:24,211
YOUR QUESTION ARE THERE

1866
01:13:24,211 --> 01:13:26,147
ORGANIZATIONS THAT STAND OUT FOR

1867
01:13:26,147 --> 01:13:27,448
THE WORK THEY DO?

1868
01:13:27,448 --> 01:13:29,617
I THINK PROBABLY ONE OF THE

1869
01:13:29,617 --> 01:13:34,288
GROUPS THAT IS DOING A REALLY

1870
01:13:34,288 --> 01:13:36,557
GOOD JOB IS MASS GENERAL

1871
01:13:36,557 --> 01:13:36,824
HOSPITAL.

1872
01:13:36,824 --> 01:13:39,393
DURING PANDEMIC THEY DID A

1873
01:13:39,393 --> 01:13:42,396
REALLY GREAT JOB EMBEDDING

1874
01:13:42,396 --> 01:13:43,798
LANGUAGE CONCORDANT STAFF INTO

1875
01:13:43,798 --> 01:13:45,866
THE TEAMS TAKING CARE OF COVID.

1876
01:13:45,866 --> 01:13:48,135
THEY WERE SOME OF THE TEAMS THAT

1877
01:13:48,135 --> 01:13:49,670
EXPERIMENTED WITH IPADS.

1878
01:13:49,670 --> 01:13:53,841
I'M SURE I'M NOT AN EXPERT AT

1879
01:13:53,841 --> 01:13:55,543
MGH BUT THEY HAVE MORE TO DO AND

1880
01:13:55,543 --> 01:13:56,577
THERE ARE PEOPLE THERE WORKING

1881
01:13:56,577 --> 01:13:59,180
ON THIS.

1882
01:13:59,180 --> 01:14:03,951
BUT THAT SAID, THEY HAVE HAD

1883
01:14:03,951 --> 01:14:04,718
HOSPITAL LEADERSHIP FROM THE

1884
01:14:04,718 --> 01:14:07,021
VERY TOP DOWN THAT HAS BEEN

1885
01:14:07,021 --> 01:14:12,793
COMMITTED TO ENDING DISTIS.

1886
01:14:12,793 --> 01:14:15,896
HEALTHCARE DISPARITIES.

1887
01:14:15,896 --> 01:14:16,931
UNFORTUNATELY VERY FEW C.E.O.S

1888
01:14:16,931 --> 01:14:18,132
OF HOSPITAL VERSUS BEEN THAT

1889
01:14:18,132 --> 01:14:21,502
COMMITTED TO ENDING HEALTHCARE

1890
01:14:21,502 --> 01:14:22,169
DISPARITIES.

1891
01:14:22,169 --> 01:14:23,871
DISPARITIES ARE NOT SHOWN ON

1892
01:14:23,871 --> 01:14:26,407
HOSPITAL C.E.O. DASH BOARDS.

1893
01:14:26,407 --> 01:14:28,709
USUALLY SO AND SO IS A NICE GUY

1894
01:14:28,709 --> 01:14:31,445
OR WOMAN AS OPPOSED TO ARE THEY

1895
01:14:31,445 --> 01:14:33,714
TRULY COMMITTED TO HENNING

1896
01:14:33,714 --> 01:14:34,715
HEALTHCARE DISPARITIES.

1897
01:14:34,715 --> 01:14:35,950
I THINK THAT IS WHERE YOU KNOW

1898
01:14:35,950 --> 01:14:38,719
OF THE REASONS WHY MGH HAS BEEN

1899
01:14:38,719 --> 01:14:40,888
HEAD AND SHOULDERS ABOVE OTHER

1900
01:14:40,888 --> 01:14:42,590
INSTITUTIONS WHICH ISN'T TO SAY

1901
01:14:42,590 --> 01:14:47,061
THAT THEY HAVE A LOT OF WORK TO

1902
01:14:47,061 --> 01:14:47,228
DO.

1903
01:14:47,228 --> 01:14:48,395
>> THANK YOU.

1904
01:14:48,395 --> 01:14:50,264
AND I'M BEING TOLD WE HAVE LOTS

1905
01:14:50,264 --> 01:14:50,898
OF QUESTIONS.

1906
01:14:50,898 --> 01:14:54,969
WE'RE NOT GOING TO GET TO ALL OF

1907
01:14:54,969 --> 01:14:55,369
THEM.

1908
01:14:55,369 --> 01:14:57,338
WE'LL SEE WHAT WE CAN PLOW

1909
01:14:57,338 --> 01:14:57,705
THROUGH.

1910
01:14:57,705 --> 01:14:59,874
I'LL PAUSE TWO OR THREE MINUTES

1911
01:14:59,874 --> 01:15:01,308
BEFORE 3:30.

1912
01:15:01,308 --> 01:15:04,311
THIS IS A COMMENT FROM BREN DA

1913
01:15:04,311 --> 01:15:06,247
WHO IS THE MANAGER OF THE

1914
01:15:06,247 --> 01:15:08,716
LANGUAGE INTERPRETER PROGRAM AT

1915
01:15:08,716 --> 01:15:11,986
THE NI H.

1916
01:15:11,986 --> 01:15:13,354
SHE SAYS WE PROVIDE SERVICES ON

1917
01:15:13,354 --> 01:15:16,223
SITE BY TELEPHONE AND TELEHEALTH

1918
01:15:16,223 --> 01:15:18,025
LANGUAGE ACCESS IS A PATIENT

1919
01:15:18,025 --> 01:15:20,394
RIGHT AND NOT PROVIDING SERVICES

1920
01:15:20,394 --> 01:15:23,831
DOES CONSTITUTE A HEALTHCARE

1921
01:15:23,831 --> 01:15:24,198
DISPARITIES.

1922
01:15:24,198 --> 01:15:26,834
THANK YOU BREN DA.

1923
01:15:26,834 --> 01:15:31,238
YOU HAVE ANOTHER QUESTION

1924
01:15:31,238 --> 01:15:31,572
SHELLY?

1925
01:15:31,572 --> 01:15:32,806
>> HOW MIGHT TRAIN
COMMUNITY

1926
01:15:32,806 --> 01:15:35,509
PEER EDUCATORS HELP COORDINATE

1927
01:15:35,509 --> 01:15:37,845
TEACHING IN THE FACILITY AND THE

1928
01:15:37,845 --> 01:15:44,718
HOME OF THE MEMBER VIDEO OR IN

1929
01:15:44,718 --> 01:15:44,952
PERSON?

1930
01:15:44,952 --> 01:15:45,719
THESE COURSES COULD BE TAUGHT BY

1931
01:15:45,719 --> 01:15:46,921
SPEAKERS OF THE LANGUAGE,

1932
01:15:46,921 --> 01:15:48,856
TRAINED AND AVAILABLE TO TEACH A

1933
01:15:48,856 --> 01:15:51,058
STANDARD COURSE OF INFORMATION.

1934
01:15:51,058 --> 01:15:54,194
THEY DO NOT GIVE MEDICAL ADVICE,

1935
01:15:54,194 --> 01:15:55,095
ONLY INFORMATION.

1936
01:15:55,095 --> 01:15:57,164
>> I THINK THAT WHAT THE

1937
01:15:57,164 --> 01:16:01,201
QUESTIONER IS DESCRIBING IS

1938
01:16:01,201 --> 01:16:05,873
COMMUNITY HEALTH FIRST.

1939
01:16:05,873 --> 01:16:06,607
I'M A FINAL FAN.

1940
01:16:06,607 --> 01:16:11,745
PEOPLE CAN GO INTO THE HOME AND

1941
01:16:11,745 --> 01:16:13,113
GIVE LANGUAGE CONCORDANT

1942
01:16:13,113 --> 01:16:23,524
INFORMATION TO PATIENTS.

1943
01:16:27,661 --> 01:16:31,632
THE COCHRAN COLLABORATIVE MORE

1944
01:16:31,632 --> 01:16:35,536
RESEARCH NOT NEEDED IN TERMS OF

1945
01:16:35,536 --> 01:16:36,837
WORKERS FOR TEACHING PEOPLE

1946
01:16:36,837 --> 01:16:40,274
ABOUT DIABETES CONTROL AND EVEN

1947
01:16:40,274 --> 01:16:40,808
FOR HYPERTENSION CONTROL.

1948
01:16:40,808 --> 01:16:46,280
AND COMMUNITY HEALTH WORKERS ARE

1949
01:16:46,280 --> 01:16:48,048
PARTICULARLY EFFICACIOUS,

1950
01:16:48,048 --> 01:16:49,483
EFFECTIVE IN WORKING WITH

1951
01:16:49,483 --> 01:16:51,285
SPANISH SPEAKING COMMUNITIES.

1952
01:16:51,285 --> 01:16:54,088
NEED MORE RESEARCH ON OTHER

1953
01:16:54,088 --> 01:16:54,421
LANGUAGES.

1954
01:16:54,421 --> 01:16:56,924
I COULDN'T AGREE WITH YOU MORE.

1955
01:16:56,924 --> 01:17:00,260
AND NOT ONLY DO I AGREE, MOST

1956
01:17:00,260 --> 01:17:02,363
IMPORTANTLY CMS HAS BEEN

1957
01:17:02,363 --> 01:17:03,897
PERSUADED BY THIS.

1958
01:17:03,897 --> 01:17:06,066
AND CMS IS NOW SAYING THAT

1959
01:17:06,066 --> 01:17:11,305
HOSPITAL SYSTEMS CAN BILL FOR

1960
01:17:11,305 --> 01:17:12,906
COMMUNITY HEALTH WORKER

1961
01:17:12,906 --> 01:17:13,474
ENCOUNTERS.

1962
01:17:13,474 --> 01:17:15,342
I MENTIONED BEFORE THIS MEETING

1963
01:17:15,342 --> 01:17:20,114
WHAT IS HARD IS FOR SYSTEMS TO

1964
01:17:20,114 --> 01:17:23,617
GEAR UP TO BILL.

1965
01:17:23,617 --> 01:17:25,185
ONCE WE CAN GEAR UP TO BILL AND

1966
01:17:25,185 --> 01:17:27,755
WE CAN WORK WITH COMMUNITY

1967
01:17:27,755 --> 01:17:30,724
COLLEGES, CBO GROUPS TO TRAIN

1968
01:17:30,724 --> 01:17:32,259
COMMUNITY HEALTH WORKERS, I

1969
01:17:32,259 --> 01:17:34,661
THINK THIS WILL BE A VERY

1970
01:17:34,661 --> 01:17:37,097
IMPORTANT EXPANSION OF THE WORK

1971
01:17:37,097 --> 01:17:37,464
FORCE.

1972
01:17:37,464 --> 01:17:39,900
SO THE BILLING IS NOW SET UP.

1973
01:17:39,900 --> 01:17:41,468
AND NOW IT'S TIME FOR PEOPLE TO

1974
01:17:41,468 --> 01:17:45,205
TAKE ADVANTAGE OF IT.

1975
01:17:45,205 --> 01:17:46,774
>> THANK YOU.

1976
01:17:46,774 --> 01:17:50,110
QUESTION ABOUT ARE THERE DATA

1977
01:17:50,110 --> 01:17:50,944
BASES THAT ARE AVAILABLE AT THE

1978
01:17:50,944 --> 01:17:52,513
NATIONAL LEVEL SUCH AS CLAIMS

1979
01:17:52,513 --> 01:17:55,249
THAT ARE USE TO FEEL EXAMINE THE

1980
01:17:55,249 --> 01:17:59,086
BILLING OF MEDICAL INTERPRETERS?

1981
01:17:59,086 --> 01:18:00,254
>> FANTASTIC QUESTION.

1982
01:18:00,254 --> 01:18:01,321
NO, THERE ARE NOT.

1983
01:18:01,321 --> 01:18:04,525
WHAT HAPPENS IS THAT YOU CAN GET

1984
01:18:04,525 --> 01:18:05,426
FROM A PARTICULAR HEALTHS

1985
01:18:05,426 --> 01:18:05,659
SYSTEM.

1986
01:18:05,659 --> 01:18:09,029
WE PAY FOR THIS MANY MINUTES PER

1987
01:18:09,029 --> 01:18:10,497
MONTH FOR INTERPRETER SERVICES.

1988
01:18:10,497 --> 01:18:12,433
YOU CAN GET A BREAKDOWN OF THE

1989
01:18:12,433 --> 01:18:13,734
LANGUAGES AND SO ON.

1990
01:18:13,734 --> 01:18:15,936
WHAT YOU CANNOT GET IS DID SO

1991
01:18:15,936 --> 01:18:18,672
AND SO RECEIVE AN INTERPRETER ON

1992
01:18:18,672 --> 01:18:21,275
THIS DATE IN THIS INTERACTION.

1993
01:18:21,275 --> 01:18:26,213
AND THAT IS AN AREA WHERE PEOPLE

1994
01:18:26,213 --> 01:18:27,381
WHO MANUFACTURE ELECTRONIC

1995
01:18:27,381 --> 01:18:29,516
RECORDS AND OTHER SOURCES REALLY

1996
01:18:29,516 --> 01:18:30,851
NEED TO STEP UP.

1997
01:18:30,851 --> 01:18:34,021
WE HAVE TO BE ABLE TO SEAMLESSLY

1998
01:18:34,021 --> 01:18:36,523
CLICK ONE BUTTON AND IT IDENTIFY

1999
01:18:36,523 --> 01:18:40,928
INTERPRETER WAS USED AN WHO THE

2000
01:18:40,928 --> 01:18:41,695
INTERPRETER WAS AND HOW LONG

2001
01:18:41,695 --> 01:18:46,533
THAT INTERPRETATION LASTED.

2002
01:18:46,533 --> 01:18:49,136
THIS CANNOT BE THAT -- THIS

2003
01:18:49,136 --> 01:18:50,471
CAN'T BE THAT HARD.

2004
01:18:50,471 --> 01:18:55,509
AND YET THIS IS AN AREA WHERE

2005
01:18:55,509 --> 01:18:58,579
AGAIN MEDICAL RECORDS HAVE THE

2006
01:18:58,579 --> 01:19:03,550
POTENTIAL BUT HAVE NOT REALIZED.

2007
01:19:03,550 --> 01:19:11,592
>> ANOTHER QUESTION HOW IS
VRI

2008
01:19:11,592 --> 01:19:12,459
TRANSLATEDDERSES WORKING WITH

2009
01:19:12,459 --> 01:19:16,396
TRANSLATOR SERVICES?

2010
01:19:16,396 --> 01:19:19,366
>> I'M NOT ENTIRELY SURE
WHAT

2011
01:19:19,366 --> 01:19:21,702
VRI IS.

2012
01:19:21,702 --> 01:19:27,975
BUT WHAT IS IMPORTANT IS IT

2013
01:19:27,975 --> 01:19:31,211
ISN'T EASY -- LET ME TAKE A STEP

2014
01:19:31,211 --> 01:19:32,079
BACK.

2015
01:19:32,079 --> 01:19:34,948
TELEHEALTH AS YOU ALL KNOW HAS

2016
01:19:34,948 --> 01:19:36,150
TREMENDOUS POTENTIAL TO BE ABLE

2017
01:19:36,150 --> 01:19:40,988
TO IMPROVE CARE FOR OUR

2018
01:19:40,988 --> 01:19:41,255
PATIENTS.

2019
01:19:41,255 --> 01:19:43,056
IT MAKES LIFE MUCH EASIER FOR

2020
01:19:43,056 --> 01:19:44,992
THE PATIENT NOT TO HAVE TO COME

2021
01:19:44,992 --> 01:19:45,425
IN.

2022
01:19:45,425 --> 01:19:48,195
IF I'M DOING SOMETHING LIKE

2023
01:19:48,195 --> 01:19:49,963
TITRATING INSULIN LEVELS OR

2024
01:19:49,963 --> 01:19:51,598
BLOOD PRESSURE MEDICATIONS AND I

2025
01:19:51,598 --> 01:19:53,667
CAN ASK THE PATIENT WHAT THEIR

2026
01:19:53,667 --> 01:19:55,636
NUMBERS ARE, I DON'T NEED TO SEE

2027
01:19:55,636 --> 01:19:56,837
THEM IN THE OFFICE, I NEED TO

2028
01:19:56,837 --> 01:20:00,874
HAVE A CONVERSATION WITH THEM.

2029
01:20:00,874 --> 01:20:03,243
WHAT HAPPENS IF I'M TRYING TO DO

2030
01:20:03,243 --> 01:20:05,579
THAT IN A INTERPRETIVE

2031
01:20:05,579 --> 01:20:06,013
CONVERSATION?

2032
01:20:06,013 --> 01:20:09,149
WELL, IT'S REALLY HARD.

2033
01:20:09,149 --> 01:20:10,784
NOW I'VE LOST -- IF I'M DOING IT

2034
01:20:10,784 --> 01:20:14,621
BY TELEPHONE, I'VE LOST THE

2035
01:20:14,621 --> 01:20:16,356
VISUAL QUEUE THE PATIENT AS WELL

2036
01:20:16,356 --> 01:20:17,457
AS WITH THE INTERPRETER.

2037
01:20:17,457 --> 01:20:19,359
EVEN IF I HAD THE INTERPRETER ON

2038
01:20:19,359 --> 01:20:21,428
THE PHONE ROUTINELY AND THE

2039
01:20:21,428 --> 01:20:22,095
INTERPRETER KNOW HOES TO YOU

2040
01:20:22,095 --> 01:20:23,864
WORK THE PHONE, I'VE LOST THE

2041
01:20:23,864 --> 01:20:24,865
VISUAL CUE AND THAT IS HARD.

2042
01:20:24,865 --> 01:20:26,900
BECAUSE I'M NOT REALLY SEEING

2043
01:20:26,900 --> 01:20:29,436
WHERE THE PATIENT WANTS TO TALK

2044
01:20:29,436 --> 01:20:30,671
MORE OR THEY ARE SHOWING THEY

2045
01:20:30,671 --> 01:20:32,439
DON'T UNDERSTAND AND SO ON.

2046
01:20:32,439 --> 01:20:36,743
THE FIX TO THAT IS VIDEOTAPE.

2047
01:20:36,743 --> 01:20:38,445
WHERE YOU HAVE THE PATIENT ON

2048
01:20:38,445 --> 01:20:41,315
THE VIDEO, INTERPRETER AND

2049
01:20:41,315 --> 01:20:42,149
PHYSICIAN ON THE VIDEO.

2050
01:20:42,149 --> 01:20:43,483
SOME SYSTEM VERSUS MANAGED TO

2051
01:20:43,483 --> 01:20:44,451
PUT THAT IN PLACE.

2052
01:20:44,451 --> 01:20:46,820
WHAT IS HARD IS SO MANY OF OUR

2053
01:20:46,820 --> 01:20:48,689
PATIENTS DON'T HAVE ACCESS TO

2054
01:20:48,689 --> 01:20:49,890
VIDEO SERVICES.

2055
01:20:49,890 --> 01:20:53,126
OR IF THEY DO, ARE NOT ALLOWED

2056
01:20:53,126 --> 01:20:54,528
TO USE THEM.

2057
01:20:54,528 --> 01:20:56,930
FOR EXAMPLE YOU PROBABLY ALL

2058
01:20:56,930 --> 01:21:01,235
KNOW THAT LATINOS, IMMIGRANT

2059
01:21:01,235 --> 01:21:04,271
LATINOS HAVE ONE OF THE HIGHEST

2060
01:21:04,271 --> 01:21:05,505
PENETRATIONS OF SMARTPHONES IN

2061
01:21:05,505 --> 01:21:06,506
THE COUNTRY.

2062
01:21:06,506 --> 01:21:09,243
BECAUSE THEY WANT TO CALL HOME.

2063
01:21:09,243 --> 01:21:13,013
EVERYONE, EVEN MY PATIENTS WITH

2064
01:21:13,013 --> 01:21:15,449
THE THIRD GRADE EDUCATION KNOW

2065
01:21:15,449 --> 01:21:17,251
THOUSAND USE WHAT'S APP OR FACE

2066
01:21:17,251 --> 01:21:17,484
TIME.

2067
01:21:17,484 --> 01:21:20,887
THAT CAN ALLOW ME TO USE VIDEO.

2068
01:21:20,887 --> 01:21:23,056
I'M NOT ALLOWED TO USE THAT

2069
01:21:23,056 --> 01:21:27,494
BECAUSE IT'S NOT PROTECTED

2070
01:21:27,494 --> 01:21:27,728
ENOUGH.

2071
01:21:27,728 --> 01:21:30,230
FROM COMPLIANCE POINT OF VIEW.

2072
01:21:30,230 --> 01:21:32,199
IT'S PUT ME IN A VERY STRANGE

2073
01:21:32,199 --> 01:21:35,636
POSITION OF SAYING TO MY BOSSES,

2074
01:21:35,636 --> 01:21:36,903
IT IS MORE IMPORTANT TO THE

2075
01:21:36,903 --> 01:21:39,573
PATIENT AND TO ME THAT WE HAVE A

2076
01:21:39,573 --> 01:21:41,241
CONVERSATION WHERE WE CAN SEE

2077
01:21:41,241 --> 01:21:44,411
EACH OTHER THAN THE SMALL CHANCE

2078
01:21:44,411 --> 01:21:46,346
SOMEBODY WILL FIND OUT MR. CHOW

2079
01:21:46,346 --> 01:21:47,247
HAS DIABETES.

2080
01:21:47,247 --> 01:21:48,649
HE DOESN'T CARE AND I DON'T

2081
01:21:48,649 --> 01:21:48,882
CARE.

2082
01:21:48,882 --> 01:21:51,018
BUT UNFORTUNATELY THE MEDICAL

2083
01:21:51,018 --> 01:21:54,288
LEGAL SYSTEM DOESN'T WORK THAT

2084
01:21:54,288 --> 01:21:54,621
WAY.

2085
01:21:54,621 --> 01:21:56,223
AND I'M INTERESTED IN HEALTH

2086
01:21:56,223 --> 01:21:57,658
CARE DISPARITIES BROADLY.

2087
01:21:57,658 --> 01:21:59,092
ONE OF THE THINGS I HOPE YOU ARE

2088
01:21:59,092 --> 01:22:00,360
GETTING FROM THIS TALK IS HOW

2089
01:22:00,360 --> 01:22:03,830
SOMETHING THAT SEEMS SO EASY,

2090
01:22:03,830 --> 01:22:05,599
LET'S IMPROVE LANGUAGE ACCESS

2091
01:22:05,599 --> 01:22:09,903
SERVICES TOUCHES SO MANY ASPECTS

2092
01:22:09,903 --> 01:22:12,739
OF BILLING, MEDICAL LEGAL WITHIN

2093
01:22:12,739 --> 01:22:16,743
OUR COMPLEX SYSTEM.

2094
01:22:16,743 --> 01:22:18,812
>> I'LL ASK THIS ONE MORE

2095
01:22:18,812 --> 01:22:20,814
QUESTION RELATED TO THIS.

2096
01:22:20,814 --> 01:22:23,917
WHAT ROLE COULD AI, ARTIFICIAL

2097
01:22:23,917 --> 01:22:25,752
INTELLIGENCE PLAY IN

2098
01:22:25,752 --> 01:22:30,857
FACILITATING INTERPRETATIONS?

2099
01:22:30,857 --> 01:22:34,661
COULD THAT INCREASE

2100
01:22:34,661 --> 01:22:34,995
AVAILABILITY?

2101
01:22:34,995 --> 01:22:35,829
>> THANK YOU.

2102
01:22:35,829 --> 01:22:35,996
YES.

2103
01:22:35,996 --> 01:22:38,131
WE ARE STUDYING THAT NOW.

2104
01:22:38,131 --> 01:22:41,134
FOR EXAMPLE, WE WANT TO BE ABLE

2105
01:22:41,134 --> 01:22:43,537
TO PROVIDE HOSPITAL DISCHARGE --

2106
01:22:43,537 --> 01:22:46,807
I SHOWED STUDY ON ER DISCHARGE

2107
01:22:46,807 --> 01:22:47,240
INSTRUCTIONS.

2108
01:22:47,240 --> 01:22:49,943
WE WANT TO BE ABLE TO PROVIDE

2109
01:22:49,943 --> 01:22:51,244
HOSPITAL DISCHARGE INSTRUCTIONS

2110
01:22:51,244 --> 01:22:53,480
IN A PATIENT'S LANGUAGE F. WE

2111
01:22:53,480 --> 01:22:55,315
PAY AN INTERPRETER THAT TAKES A

2112
01:22:55,315 --> 01:22:56,416
CERTAIN AMOUNT OF TIME.

2113
01:22:56,416 --> 01:22:59,386
THEY HAVE TO BE CERTIFIED IN

2114
01:22:59,386 --> 01:23:00,454
TRANSLATION AND INTERPRETATION.

2115
01:23:00,454 --> 01:23:02,255
IT KEEPS THEM FROM DOING OTHER

2116
01:23:02,255 --> 01:23:02,556
THINGS.

2117
01:23:02,556 --> 01:23:06,093
SO THE QUESTION IS CAN AI DO

2118
01:23:06,093 --> 01:23:09,096
THAT OR CAN AI DO THAT AND THEN

2119
01:23:09,096 --> 01:23:12,366
HAVE THAT OVERREAD BY AN

2120
01:23:12,366 --> 01:23:12,666
INTERPRETER?

2121
01:23:12,666 --> 01:23:16,269
IN THE SAME WAY THAT THE EKG

2122
01:23:16,269 --> 01:23:19,106
MACHINE WILL READ THE EKG AND

2123
01:23:19,106 --> 01:23:20,040
THIS CAN BE HELPFUL.

2124
01:23:20,040 --> 01:23:23,110
BUT WE STILL RELY ON A POSITION

2125
01:23:23,110 --> 01:23:26,146
TO OVERREAD THE EKG MACHINE.

2126
01:23:26,146 --> 01:23:27,881
SO RIGHT NOW WE'RE GOING TO SET

2127
01:23:27,881 --> 01:23:31,051
UP A STUDY UNFUNDED IN WHICH WE

2128
01:23:31,051 --> 01:23:36,223
ARE LOOKING AT WHETHER OR NOT A

2129
01:23:36,223 --> 01:23:38,525
SYSTEM OF HAVING AI DO IT FIRST

2130
01:23:38,525 --> 01:23:41,161
AND THEN OVERREAD, HOW MUCH MORE

2131
01:23:41,161 --> 01:23:43,130
EFFICIENT IS THAT THAN JUST

2132
01:23:43,130 --> 01:23:45,999
HAVING THE TRANSLATOR TRANSLATE?

2133
01:23:45,999 --> 01:23:48,068
BECAUSE I THINK THAT IT IS IN

2134
01:23:48,068 --> 01:23:51,138
THOSE MINUTES OF INTERPRETER

2135
01:23:51,138 --> 01:23:53,273
TIME THAT WE WILL SEE TO WHAT

2136
01:23:53,273 --> 01:23:57,110
EXTENT IS THIS WORKING?

2137
01:23:57,110 --> 01:23:59,679
HOW EFFICIENT IS IT?

2138
01:23:59,679 --> 01:24:01,281
>> THANK YOU SO MUCH LISA

2139
01:24:01,281 --> 01:24:01,548
SAPINSLEY.

2140
01:24:01,548 --> 01:24:10,857
 -- ALICIA MOST OFTHE DATA YOU S

2141
01:24:10,857 --> 01:24:16,663
RELATED TO SPANISH.

2142
01:24:16,663 --> 01:24:19,299
AND YOU EASILY JUSTIFY WITH

2143
01:24:19,299 --> 01:24:20,934
61 PERCENT OF PEOPLE WHO DON'T

2144
01:24:20,934 --> 01:24:25,138
SPEAK ENGLISH AT HOME SPEAK

2145
01:24:25,138 --> 01:24:25,372
SPANISH.

2146
01:24:25,372 --> 01:24:27,274
OF THE GROUP THAT DON'T.

2147
01:24:27,274 --> 01:24:29,843
WHAT IS THE NATURE OF THE OR THE

2148
01:24:29,843 --> 01:24:32,946
STATUS OF EMPIRICAL WORK IN

2149
01:24:32,946 --> 01:24:34,748
NON-SPANISH LEP?

2150
01:24:34,748 --> 01:24:36,216
>> VERY SMALL.

2151
01:24:36,216 --> 01:24:37,484
VERY SMALL.

2152
01:24:37,484 --> 01:24:39,286
BECAUSE AS YOU KNOW DOING THIS

2153
01:24:39,286 --> 01:24:41,021
WORK IS EXPENSIVE.

2154
01:24:41,021 --> 01:24:44,891
YOU NEED BILINGUAL RESEARCH

2155
01:24:44,891 --> 01:24:45,192
ASSISTANTS.

2156
01:24:45,192 --> 01:24:48,595
YOU ALSO NEED TO PAY

2157
01:24:48,595 --> 01:24:49,162
PROFESSIONAL INTERPRETERS,

2158
01:24:49,162 --> 01:24:50,564
PROFESSIONAL TRANSLATORS TO

2159
01:24:50,564 --> 01:24:51,231
EVALUATE SOMETHING.

2160
01:24:51,231 --> 01:24:53,533
OFTEN THE RESEARCH GROUP ITSELF

2161
01:24:53,533 --> 01:24:55,135
HAS TO BE ABLE TO READ

2162
01:24:55,135 --> 01:24:56,436
TRANSCRIPTS OR LISTEN TO AUDIO

2163
01:24:56,436 --> 01:24:58,472
TAPES AND IN THAT CASE IN ORDER

2164
01:24:58,472 --> 01:25:01,975
TO DO SOMETHING, YOU NEED A

2165
01:25:01,975 --> 01:25:04,377
MULTILINGUAL BIO MEDICAL

2166
01:25:04,377 --> 01:25:07,314
SCIENTIFIC WORK FORCE.

2167
01:25:07,314 --> 01:25:09,483
AND WHO IS INTERESTED IN THESE

2168
01:25:09,483 --> 01:25:10,650
QUESTIONS.

2169
01:25:10,650 --> 01:25:12,219
UNFORTUNATELY THE LITERATURE ON

2170
01:25:12,219 --> 01:25:14,721
OTHER LANGUAGES HAS LAGGED

2171
01:25:14,721 --> 01:25:15,755
BEHIND SPANISH.

2172
01:25:15,755 --> 01:25:18,258
I'M VERY LUCKY TO WORK WITH SOME

2173
01:25:18,258 --> 01:25:20,227
ASIAN COLLEAGUES WHO ARE ABLE TO

2174
01:25:20,227 --> 01:25:21,995
AND WE'RE ABLE TO WORK TOGETHER.

2175
01:25:21,995 --> 01:25:25,599
AND THAT'S WHY WE'RE DOING WORK

2176
01:25:25,599 --> 01:25:27,234
THAT INCLUDES MANDARIN AND

2177
01:25:27,234 --> 01:25:29,336
CANTONESE AS WELL AS SPANISH.

2178
01:25:29,336 --> 01:25:31,037
THE TRUTH OF THE MATTEDDER IS

2179
01:25:31,037 --> 01:25:36,943
THERE NEEDS TO BE ROBUST FUNDING

2180
01:25:36,943 --> 01:25:37,544
STRAINS JUST LIKE NIH INVESTED

2181
01:25:37,544 --> 01:25:40,013
IN OTHER AREAS THAT ALLOW PEOPLE

2182
01:25:40,013 --> 01:25:42,115
TO CREATE THE GROUPS THAT ARE

2183
01:25:42,115 --> 01:25:45,685
NECESSARY MUCH IN THE SAME WAY

2184
01:25:45,685 --> 01:25:48,321
THAT OTHER SCIENTIFIC QUESTIONS

2185
01:25:48,321 --> 01:25:52,392
REQUIRE MULTIDISCIPLINARY

2186
01:25:52,392 --> 01:25:56,763
MULTISKILLED RESEARCH TEAMS.

2187
01:25:56,763 --> 01:25:59,199
>> THANK YOU.

2188
01:25:59,199 --> 01:25:59,799
AND THE LAST COMMENT I'LL MAKE

2189
01:25:59,799 --> 01:26:02,536
AND LET YOU EXPAND ON IT.

2190
01:26:02,536 --> 01:26:06,139
AT LEAST FOR THE WORK FORCE,

2191
01:26:06,139 --> 01:26:11,878
THERE IS AN OFFICE OF THE NIH

2192
01:26:11,878 --> 01:26:13,847
DIRECTOR CHIEF OFFICE OF THE

2193
01:26:13,847 --> 01:26:15,482
SCIENTIFIC FOR WORK FORCE

2194
01:26:15,482 --> 01:26:18,184
DIVERSITY THAT WAS STARTED AND

2195
01:26:18,184 --> 01:26:22,088
THEN HANNA VALENTINE WAS THE

2196
01:26:22,088 --> 01:26:26,760
FIRST PERSON AND NOW IT'S MARIE

2197
01:26:26,760 --> 01:26:26,993
BERNARD.

2198
01:26:26,993 --> 01:26:31,565
I KIND OF SEE IN THE CONTEXT OF

2199
01:26:31,565 --> 01:26:32,165
THE SUPREME COURT DECISION ON

2200
01:26:32,165 --> 01:26:34,167
COLLEGE ADMISSIONS AND THE USE

2201
01:26:34,167 --> 01:26:37,304
OF RACE AND ETHNICITY AND SEX OR

2202
01:26:37,304 --> 01:26:39,406
GENDER ARE CONSIDERED IN THE

2203
01:26:39,406 --> 01:26:41,174
SAME CATEGORY AS NOT BEING ABLE

2204
01:26:41,174 --> 01:26:43,209
TO USE THOSE IN TERMS OF

2205
01:26:43,209 --> 01:26:45,345
CONSIDERATION AS A FACTOR IN

2206
01:26:45,345 --> 01:26:47,180
COLLEGE ADMISSION AND HOWTA WILL

2207
01:26:47,180 --> 01:26:49,983
APPLY TO OTHER FIELDS, WHAT

2208
01:26:49,983 --> 01:26:52,919
ABOUT LANGUAGE FLUENCY?

2209
01:26:52,919 --> 01:26:55,388
DOESN'T IT MAKE SENSE THAT SINCE

2210
01:26:55,388 --> 01:26:57,457
WE DON'T GET ENOUGH PEOPLE

2211
01:26:57,457 --> 01:26:58,458
SPEAKING SPANISH FOR EXAMPLE

2212
01:26:58,458 --> 01:27:02,429
THAT THAT BE A FACTOR CONSIDERED

2213
01:27:02,429 --> 01:27:06,967
IN MEDICAL SCHOOL OR RESIDENCY

2214
01:27:06,967 --> 01:27:09,202
SELECTION?

2215
01:27:09,202 --> 01:27:09,569
>> ABSOLUTELY.

2216
01:27:09,569 --> 01:27:12,772
IT IS A SKILL.

2217
01:27:12,772 --> 01:27:15,075
AND SAYING WE VALUE SOMEONE A W

2218
01:27:15,075 --> 01:27:18,678
A HIGHER MKAT MORE THAN SOMEONE

2219
01:27:18,678 --> 01:27:21,147
WITH A LOWER MKAT BECAUSE WE

2220
01:27:21,147 --> 01:27:25,018
THINK THAT IS REPRESENTATIVE OF

2221
01:27:25,018 --> 01:27:28,488
A FUND OF KNOWLEDGE THAT IS A

2222
01:27:28,488 --> 01:27:29,089
GOOD COMPONENT OF BEING A GOOD

2223
01:27:29,089 --> 01:27:29,789
DOCTOR.

2224
01:27:29,789 --> 01:27:31,658
WE THINK THAT COMMUNITIES THAT

2225
01:27:31,658 --> 01:27:33,793
MEDICAL SCHOOL ADMISSIONS SHOULD

2226
01:27:33,793 --> 01:27:35,528
PRIVILEGE PEOPLE WHO HAVE JUST

2227
01:27:35,528 --> 01:27:39,032
LIKE THE MKAT DOCUMENTED

2228
01:27:39,032 --> 01:27:40,834
EXPERTISE IN A PARTICULAR

2229
01:27:40,834 --> 01:27:42,669
LANGUAGE OF INTEREST FOR THAT

2230
01:27:42,669 --> 01:27:43,903
MEDICAL SCHOOL.

2231
01:27:43,903 --> 01:27:46,172
WHETHER IT'S ONE OR WHETHER IT'S

2232
01:27:46,172 --> 01:27:47,474
SPANISH, THEY SHOULD BE ABLE TO

2233
01:27:47,474 --> 01:27:52,812
SAY WOW, THIS IS A SPEAKER, WE

2234
01:27:52,812 --> 01:27:54,581
SHOULD TAKE A SECOND LOOK AT

2235
01:27:54,581 --> 01:27:55,749
THIS APPLICANT.

2236
01:27:55,749 --> 01:27:57,217
I DON'T THINK IT'S ENOUGH FOR

2237
01:27:57,217 --> 01:27:58,852
PEOPLE TO SELF-CERTIFY.

2238
01:27:58,852 --> 01:27:59,919
I SPEAK SPANISH.

2239
01:27:59,919 --> 01:28:00,620
MAYBE YOU DO.

2240
01:28:00,620 --> 01:28:02,555
MAYBE YOU DON'T.

2241
01:28:02,555 --> 01:28:04,858
I DO THINK THERE NEEDS TO BE A

2242
01:28:04,858 --> 01:28:06,660
PROCESS WHERE YOU ARE ABLE TO

2243
01:28:06,660 --> 01:28:07,494
SHOW YOUR KNOWLEDGE.

2244
01:28:07,494 --> 01:28:10,630
BUT I DO THINK THAT PUTTING THAT

2245
01:28:10,630 --> 01:28:13,466
INTO PLACE BIPASSES SOME OF THE

2246
01:28:13,466 --> 01:28:15,702
SUPREME COURT'S CONCERNS ABOUT

2247
01:28:15,702 --> 01:28:19,205
SOCIAL FACTORS THAT THEY DO NOT

2248
01:28:19,205 --> 01:28:21,508
BELIEVE SHOULD INCREASE

2249
01:28:21,508 --> 01:28:24,310
ADMISSIONS BY PUTTING IT

2250
01:28:24,310 --> 01:28:27,013
SQUARELY WHERE THAT BELONGS AS A

2251
01:28:27,013 --> 01:28:27,247
SKILL.

2252
01:28:27,247 --> 01:28:29,315
SOME PEOPLE HAVE IT, SOME PEOPLE

2253
01:28:29,315 --> 01:28:29,649
DON'T.

2254
01:28:29,649 --> 01:28:31,351
WE SHOULD PRIVILEGE THAT.

2255
01:28:31,351 --> 01:28:34,287
THAT SAID, I DON'T WANT ANYONE

2256
01:28:34,287 --> 01:28:37,390
THINKING THAT I DON'T BELIEVE

2257
01:28:37,390 --> 01:28:42,195
THAT LANGUAGE -- THAT CULTURAL

2258
01:28:42,195 --> 01:28:43,863
CONCORDANCE ISN'T HUGELY

2259
01:28:43,863 --> 01:28:44,130
IMPORTANT.

2260
01:28:44,130 --> 01:28:45,799
WE HAVE AMPLE EVIDENCE OF THE

2261
01:28:45,799 --> 01:28:47,901
DIFFERENCE IN RELATIONSHIP

2262
01:28:47,901 --> 01:28:50,403
BETWEEN BLACK PHYSICIANS AND

2263
01:28:50,403 --> 01:28:51,037
THEIR PATIENTS ON HOW IMPORTANT

2264
01:28:51,037 --> 01:28:54,274
THAT IS IN TERMS OF PATIENT

2265
01:28:54,274 --> 01:28:56,376
TRUST AND SELECTED PATIENT

2266
01:28:56,376 --> 01:28:56,710
OUTCOMES.

2267
01:28:56,710 --> 01:29:02,482
AND SO THEN AGAIN, THIS IS NOT

2268
01:29:02,482 --> 01:29:04,517
ABOUT -- THIS IS TRULY ABOUT

2269
01:29:04,517 --> 01:29:06,886
WHAT SOMEONE CAN BRING TO THE

2270
01:29:06,886 --> 01:29:09,589
TABLE THAT WILL IMPROVE PATIENT

2271
01:29:09,589 --> 01:29:10,590
CARE.

2272
01:29:10,590 --> 01:29:11,524
UNFORTUNATELY IN CALIFORNIA

2273
01:29:11,524 --> 01:29:14,127
WE'VE HAD OVER 20 YEARS OF

2274
01:29:14,127 --> 01:29:16,596
DEALING WITH CROP 290 WHICH

2275
01:29:16,596 --> 01:29:18,665
PROHIBITED CONSIDERATIONS OF

2276
01:29:18,665 --> 01:29:22,068
RACE IN FEDERALLY FUNDED

2277
01:29:22,068 --> 01:29:24,237
ADMISSIONS IN ALL PUBLIC

2278
01:29:24,237 --> 01:29:24,571
UNIVERSITIES.

2279
01:29:24,571 --> 01:29:28,274
SO ALL OF THE UCS I, WE KNOW HOW

2280
01:29:28,274 --> 01:29:30,577
BAD THIS BE.

2281
01:29:30,577 --> 01:29:33,813
WE KNOW UC BERKELEY AND UCLA

2282
01:29:33,813 --> 01:29:36,616
HAVE NEVER RECOVERED FROM THE

2283
01:29:36,616 --> 01:29:38,885
DROP IN STUDENTS AND THAT IS

2284
01:29:38,885 --> 01:29:39,219
HORRENDOUS.

2285
01:29:39,219 --> 01:29:41,855
THE MEDICAL SCHOOLS HAVE FIGURED

2286
01:29:41,855 --> 01:29:44,691
OUT HOW TO BRING IN PEOPLE BASED

2287
01:29:44,691 --> 01:29:47,193
ON THEIR SKILLS, BACKGROUNDS AND

2288
01:29:47,193 --> 01:29:49,162
INTEREST WHICH ARE IMPORTANT THE

2289
01:29:49,162 --> 01:29:52,031
MEET CALIFORNIA'S REQUIREMENTS.

2290
01:29:52,031 --> 01:29:53,900
SO WE ARE HOPE HALF OTHER

2291
01:29:53,900 --> 01:29:55,235
MEDICAL SCHOOLS WILL BE ABLE TO

2292
01:29:55,235 --> 01:29:57,637
DO THE SAME.

2293
01:29:57,637 --> 01:29:59,906
BUT WE WILL ALL BE FRUSTRATED BY

2294
01:29:59,906 --> 01:30:02,575
THE IMPACT ON THE PIPELINE

2295
01:30:02,575 --> 01:30:07,113
PARTICULARLY ON THE ELITE

2296
01:30:07,113 --> 01:30:09,149
COLLEGES AND UNIVERSITIES.

2297
01:30:09,149 --> 01:30:11,785
>> WITH THAT WE'RE
SLIGHTLY OVER

2298
01:30:11,785 --> 01:30:13,720
3:30 SO WE SHOULD TOP.

2299
01:30:13,720 --> 01:30:18,224
I WANT TO THANK YOU ALICIA FOR A

2300
01:30:18,224 --> 01:30:19,025
WERE WONDERFUL TALK.

2301
01:30:19,025 --> 01:30:23,830
I LEARNED A LOT AND YOU WERE

2302
01:30:23,830 --> 01:30:25,398
ARTICULATE AND CLEAR.

2303
01:30:25,398 --> 01:30:27,167
IT LOOKS LIKE THE AUDIENCE

2304
01:30:27,167 --> 01:30:29,402
REALLY ENJOYED IT.

2305
01:30:29,402 --> 01:30:32,272
WE HAD MORE QUESTIONS THAT THAN

2306
01:30:32,272 --> 01:30:33,206
WE COULD HANDLE.

2307
01:30:33,206 --> 01:30:35,508
AND THAT IS NOT COMMON FOR THESE

2308
01:30:35,508 --> 01:30:35,909
SEMINARS.

2309
01:30:35,909 --> 01:30:38,011
LET'S LEAVE IT AT THAT.

2310
01:30:38,011 --> 01:30:39,379
THANK YOU FOR TAKING THE TIME TO

2311
01:30:39,379 --> 01:30:41,314
SPEND A COUPLE OF HOURS WITH US

2312
01:30:41,314 --> 01:30:42,849
THIS AFTERNOON.

2313
01:30:42,849 --> 01:30:46,986
AND WE'LL BE IN TOUCH.

2314
01:30:46,986 --> 01:30:50,423
THANK YOU FOR THE INVITATION.

2315
01:30:50,423 --> 01:30:53,092
THANK YOU.

2316
01:30:53,092 --> 01:31:03,069