• Communicating with Patients

    Interpreter and translator resources and guidance on communicating with patients who are deaf or hearing impaired and those with limited-English proficiency, a resource for communicating with patients with developmental disabilities, and guidance on communicating with patients electronically.


    Electronic Communications with Patients

    Electronic mail and the Internet can be useful tools in the practice of medicine and can facilitate communication between patients and the physician, but guidelines should be developed. 

    The AMA Code of Medical Ethics provides guidance for physicians engaged in electronic communications with patients under Consent, Communication and Decision Making Opinion 2.3.1 Electronic Communication With Patients.  

    The Texas Medical Association (TMA) and Texas Medical Liability Trust (TMLT) recommend that guidelines be developed for appropriate use and management of email and text communications with patients.

    – Changing the conversation (TMA) Texas Medicine article, June 2018 issue
    – Guidelines for electronic communications (Email) with patients (TMLT)
    – Sample of patient consent for use of email communications (TMA)
    – TMA Health Information Technology page for assistance with E-Communication and more.
    HCMS Health Information Technology page - for info on best practices, Cybersecurity, risk assessments, and more.

    Patients Who Are Deaf or Hearing Impaired

    The federal government requires "appropriate auxiliary aids and services where necessary to ensure effective communication with individuals with disabilities."

    According to the Department of Justice (DOJ), "the type of auxiliary aid or service necessary to ensure effective communication will vary in accordance with the length and complexity of the communication involved." The regulations include "qualified interpreters....available to individuals with hearing impairments..."

    The TMA Office of the General Counsel has prepared a whitepaper Americans with Disabilities Act and the Hearing Impaired that provides guidance on the statutory and regulatory provisions, penalties, and more. 

    TMA also has some tips Communicating with patients who are deaf or hard of hearing and guidance in Texas Medicine, Nov 2013 issue: Good communication - state, federal laws must be followed.

    In certain instances, Medicaid will pay for sign-language interpreting services. For commercial health plans, check with the patient's plan to determine if it provides reimbursement. Refer to our Billing and Payers Info page for web links.


    Interpreter Resources and Guidance

    For a list of Interpreters for the Hearing Impaired in the Houston area.

    Is an interpreter the only kind of auxiliary aid a physician's office may use?

    The gov't provides the following example of an appropriate accommodation: "H (the hearing impaired patient) goes to the doctor for a bi-weekly check-up, during which the nurse records H's blood pressure and weight. Exchanging notes and using gestures are likely to provide an effective means of communication at this type of check-up."

    However, when the ailment is of sufficient complexity that an interpreter is necessary to ensure effective communication, then the physician must provide a qualified interpreter.

    Note that certified interpreters need not be provided and are not required by the ADA - it requires only qualified interpreters. This is potentially a cost saving distinction.

    Can the physician's office use a family member?

    The lack of impartiality may cause the patient to avoid revealing important, but personal, facts. Also, the federal gov't has imposed requirements upon medical care providers to refrain from utilizing "a family member, companion, case manager, advocate, or friend" of a deaf individual as an interpreter. Impartiality is one of the elements necessary for an interpreter to be considered qualified.

    Who pays for the interpreter?

    The physician responsible for the care must pay for the cost of the interpreter and may not impose a surcharge on an individual with a disability directly or indirectly to offset the cost of the interpreter, as it is considered to be an overhead expense. Under certain circumstances, Texas Medicaid will reimburse the physician for some of the costs.

    Who gets to choose the appropriate accommodation?

    The physician, not the hearing impaired person, chooses the appropriate accommodation, and if an interpreter is needed, the physician chooses the interpreter. A physician "need not accept and pay for the services of a sign-language interpreter who is unilaterally retained by the family of a deaf patient, when the doctor has had no opportunity to make his or her own arrangements."



    Patients with Intellectual and Developmental Disabilities
    Source: The Vanderbilt Kennedy Center

    The Developmental Disabilities Health Care E-Toolkit Project provides guidance in and resources for communicating effectively with adults with intellectual and developmental disabilities



    Patients With Limited English Proficiency (LEP)

    Essentially, physicians who receive federal funds must take reasonable steps to ensure limited-English patients have a meaningful opportunity to participate in programs and services to which they otherwise would be entitled.

    The TMA Office of the General Counsel provides a summary of the HHS requirements and has also prepared a whitepaper Accommodation of Persons With Limited English Proficiency (LEP) that explains what entities are subject to the HHS LEP guidance, to what extent physicians must take reasonable steps to provide meaningful access, who is an LEP individual, the posting of notices and taglines, and more.

    TMA has also developed Section 1557 Notice templates, which can be customized for your practice.

    Search for a physician who speaks another language

    – Finding a Physician by Language via health plan.

    Working with Interpreters

    – Tips for working with health care interpreters 
    – Crossing the language barrier - it's more than just words

    Interpreter/Translator Resources

    For a list of Interpreters and Translators and the languages for which they provide services.

    Section 1557 Resources

    The MGMA provides guidance with Section 1557: What your practice needs to know.

    Health & Human Services (HHS) on Limited English Proficiency (LEP):
    – Fact Sheet on Guidance on Section 1557.
    – Frequently asked questions
    – Sample Notices and Taglines and other resources translated into many different languages.
    – Table showing the top 15 languages spoken by individuals with LEP in each state. 



    Other Topics on Patient-Physician Communication 
    Source: Texas Medical Association 

    TMA provides patient/customer service resources.

    Maintain an attitude of respect and helpfulness toward patients

    How to handle patient confrontations