Spanish Speaking patients in Psychiatry

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Darkskies

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Hi everyone,

So I double majored in Spanish in undergrad and have learned to manage to speak fluently. It has helped me tremendously on a number of my clinical rotations where I encountered many monolingual Spanish speakers. I know this will be a great aspect to providing healthcare in the US. However, will an ability to speak Spanish well be advantageous in Psychiatric practice too or does it not really apply in Psychiatry as much as it does in other medical specialties? Thanks.

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It applies tremendously. Unlike other fields, our knowledge of the language must be very fluent. If you want to know if a patient is in pain, you simply have to ask for words such as pain, 1-10, where, what type. For psychiatry the gamut of questions is complex and the cultural aspect makes use of language even more important.

You can get by in other fields speaking the patient's language poorly but not in psychiatry.
 
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I could get by as a PCP but not as a psychiatrist. If you are fluent it is going to be a big help.
The one benefit I have of being a partial speaker is that I know when the interpreters are not interpreting correctly. This happens all the time.
 
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Agree with all the above. I could function on family med rotations speaking Spanish but you have to be TRULY fluent to do it in psych.


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To return to the OP--it is still highly advantageous to be competent in a second language, even if not using as the primary language of your practice with a patient. It will make your time with interpreters much more efficient (as Indodo said above), and will mean you can save time and trouble of getting interpreters for many simpler issues.
 
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Repeat after me: “Empuje… No empuje”.
Now you are all ready to deliver a baby. This much Spanish works for OB. To do psychiatry, you really have to be very fluent good.
 
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In 1.5 years I have had 2 Spanish only speaking patients schedule an appointment at my pp. Family offered to translate. Both were no shows.
 
However, will an ability to speak Spanish well be advantageous in Psychiatric practice too
I'm sorry, but how could you have imagined any answers but the ones you're getting? Of course it's helpful!
 
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I studied Spanish in high school and college. At one point I considered myself fluent, after attending a 3-week immersion summer camp in high school, where I began to dream in Spanish. But it's really hard with languages that you don't learn as a child during the critical language-learning period. According to one of my linguistics professors, a person is not truly bilingual unless he/she learns the languages as a child and uses them both as primary languages. The people I know who have kept their Spanish the best are ones who traveled and lived in Spanish-speaking countries for some period of time. For me it was amazing what 3 weeks of immersion created versus years of studying in school. My Spanish has totally petered out from not using it since college (not that I actually spoke much in college—I was only there one year before leaving and the classes weren't taught entirely in Spanish and weren't language classes but cultural instead), and I'm not even sure if I could get back to where I was.

Right after I left college I got a job from home doing tech support for Apple and they asked if I knew any other languages and I listed Spanish. I can tell you that getting a 5 on the AP Spanish language exam in no way means you are qualified to do tech support with native Spanish speakers. What an embarrassing experience. It didn't help that I had been taught by non-native speakers and that the effects of immersion wear off very quickly. There are so many dialects, as well, that it can even be tricky for native speakers to speak with someone from a different region.
 
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You think it's a language thing, a cultural thing....?

Most definitely. For example, the Spanish lady I see had symptoms of Schizophrenia for 30 years before getting treated. Children had been taking care of her and keeping it on the down low.
 
Pretty crazy numbers considering I am in the southwest.
Are you accepting Medicaid? Monolingual Spanish speakers are overrepresented in the Medicaid population, underrepresented in cash practices and private insurance.


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Are you accepting Medicaid? Monolingual Spanish speakers are overrepresented in the Medicaid population, underrepresented in cash practices and private insurance.


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I accept Medicaid at the SMI clinic. Even so it seems underrepresented. I also did ER and inpatient psych in Texas and rarely saw Spanish only patients. Maybe some Texans and Californians can chime in.
 
I accept Medicaid at the SMI clinic. Even so it seems underrepresented. I also did ER and inpatient psych in Texas and rarely saw Spanish only patients. Maybe some Texans and Californians can chime in.
California here. Major metropolitan area.

In PES, we get plenty of monolingual Spanish speakers (amongst other languages). We get lots of folks who've been suffering from years and are finally brought in by frustrated families. Why don't we get more? Many monolingual Spanish speakers are born in Latin America, which is a protective factor. Some Spanish-speaking cultures also view serious mental illness a more of a spiritual problem than medical one. There is also access to care. Frankly, I think at PES we get fewer psychotic patients from police because the patients don't speak English and police don't realize how sick they are.

In the inpatient unit, they were well-represented. Our inpatient unit was fed heavily from our PES, so that makes sense.

In the outpatient clinics, they are under-represented, but only because there are a fair few Spanish-speaking solo practitioners and small practices that take Medicaid and folks tend to get referred there. We also have several public health clinics with Spanish-speaking clinicians and folks tend to get sent there, so they fade from sight if you're not part of that treatment community. I'm not sure if that's the case in your area.
 
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Most definitely. For example, the Spanish lady I see had symptoms of Schizophrenia for 30 years before getting treated. Children had been taking care of her and keeping it on the down low.

Hay Fonzie, here is a cultural correction. Unless your female patient is from Madrid, Granada, Malaga, or somewhere in Spain, she would refer to herself as Latina or Hispanic. Pardon my minor pet peeve.
 
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Hay Fonzie, here is a cultural correction. Unless your female patient is from Madrid, Granada, Malaga, or somewhere in Spain, she would refer to herself as Latina or Hispanic. Pardon my minor pet peeve.
My wife from Peru doesn't refer to herself as Hispanic.
 
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Hay Fonzie, here is a cultural correction. Unless your female patient is from Madrid, Granada, Malaga, or somewhere in Spain, she would refer to herself as Latina or Hispanic. Pardon my minor pet peeve.

Oops I know that too. I meant to say "Spanish only" as I have been referring to the fact that she only speaks Spanish.
 
Interesting factoids. There are slightly more Portuguese speakers than Spanish speakers in South America (though it's about 50/50). Latin America generally refers to both (Latin refers to the romance languages). Hispanic generally refers to a person or place that is Spanish-speaking. There are also very sizable indigenous-language populations, such as Quechua and Aymara.
 
In 1.5 years I have had 2 Spanish only speaking patients schedule an appointment at my pp. Family offered to translate. Both were no shows.

I appreciate all the positive comments but the above quote by Fonzie is what I feared. I had the sneaking suspicion that Spanish speaking patients(or any non-English speaking native) would be less likely to seek out or receive Psychiatric care as compared to other medical care. Are Fonzie's experiences unique to his situation and not really representative of the nation as a whole?
 
It requires outreach. The term underserved communities is well-named. Your language skills could be extremely helpful to a lot of people.
 
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There is an interesting dialectic among the inhabitance of the American continents outside of the US and Canada. Those that don’t identify themselves as Latin are on polar extremes. On the one hand, there are those that identify themselves strongly with the Native Americans and do not claim any part of Spanish lineage, and then there are those that don’t identify with having any Native American blood and therefore claim to be pure Spanish. “I’m not Argentinian, my family is from Spain”. “Really, what part of Spain are you from?” “Ahhh… Ahhh…I don’t know, I forgot to ask my grandmother”. This latter group infuriates “La Raza” types who see this claim as a failure of pride. Bringing this subject up is a very good way to start a fist fight at a quinceañera.
 
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One is not supposed to use family members as translators in the hospital. In the community? I'd recommend against but the reality is that a translator will cost an arm and a leg just for one patient. They will likely charge for the travel time since it's only one person.

And this has always put me in a conundrum. I don't want to use the family member as a translator but found no patient willing to pay for a translator when a family member could do the service or a translator willing to come to the office for only one patient without charging quite a bit.

I cannot fault someone for using family members as translators since it's hell trying to do it the appropriate way.
 
There is an interesting dialectic among the inhabitance of the American continents outside of the US and Canada. Those that don’t identify themselves as Latin are on polar extremes. On the one hand, there are those that identify themselves strongly with the Native Americans and do not claim any part of Spanish lineage, and then there are those that don’t identify with having any Native American blood and therefore claim to be pure Spanish. “I’m not Argentinian, my family is from Spain”. “Really, what part of Spain are you from?” “Ahhh… Ahhh…I don’t know, I forgot to ask my grandmother”. This latter group infuriates “La Raza” types who see this claim as a failure of pride. Bringing this subject up is a very good way to start a fist fight at a quinceañera.

I think this is rather off topic from what my original question was. To make things clear though, Latin America in general has had a wide variety of immigrant groups and mixing between them as well as the native inhabitants. European immigrants were not only Spanish/Portuguese but also from other Western European countries with particularly significant German and Italian immigration streams. There were also large immigrant populations from the Levant(Syria/Lebanon/Iraq) as well as China and Japan(particularly in Brazil and Argentina) in addition to Africans via the transatlantic slave trade. Studies have shown that self-identified 'whites' in Brazil had significant Amerindian and African ancestry while those that self-identified as 'blacks' had upwards of 50% or more European ancestry. Recent studies in Argentina have shown similar results albeit lacking a significant African component, indicating a high degree of admixture between European and Amerindian groups except for isolated tribes or in the case of more recent immigrants. Racial identification in Latin America is rather fluid and considering the complex genealogy of the populace, it's not surprising.
 
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I'm probably going to unintentionally upset someone with this info but it's true.

At Rutgers U, while I was there at least, there was an office of minority affairs. They gave free extra help in the form of tutoring to minority students. If, however, you were of an ethnicity other than Hispanic or African-American they turned you away saying you were not part of an actual academic ethnic minority. So one of my friends who was a Cuban American went there for help and they turned him away telling him they really only wanted to help Mexicans because among Hispanics, Cubans actually tend to do quite well in academics.

So he told them why is the policy to help anyone of any minority? Because, they told, him to say they only helped Mexicans (as was really the case) was racist. I had another friend who was a Hispanic Argentinian American and he was told the same exact thing. He came to the office just a few days later and told them he was Mexican and they opened up several programs for him.

I was going to type this up in an article at the Rutgers U. newspaper (The Daily Targum) but was told that to print this information, even if true, would be racist.

Hmm, I'm just telling about an incident that really happened and it's racist? I'm just the reporter.

Cubans, Puerto Ricans, Mexicans, etc. have very different cultural norms. I've seen Ataque de Nerviosa (a documented culture-bound syndrome) quite often in Puerto Ricans but I've never seen it in Mexicans or Cubans and I've treated hundreds of patients in all 3 demographics. Puerto Ricans even in the medical field told me they've had similar experiences and this has been called "Triple-Aye" Syndrome in NJ where there is a large Puerto Rican population. I asked why Ataque de Nerviosa is not then written that it's really Puerto Ricans and not the other Hisptanic cultures and I was told because to do that would be racist.

Again I don't get it. I see it happening that way, Puerto Rican doctors and nurses did, other Hispanics did but to talk about it was racist?
 
I'm probably going to unintentionally upset someone with this info but it's true.

At Rutgers U, while I was there at least, there was an office of minority affairs. They gave free extra help in the form of tutoring to minority students. If, however, you were of an ethnicity other than Hispanic or African-American they turned you away saying you were not part of an actual academic ethnic minority. So one of my friends who was a Cuban American went there for help and they turned him away telling him they really only wanted to help Mexicans because among Hispanics, Cubans actually tend to do quite well in academics.

So he told them why is the policy to help anyone of any minority? Because, they told, him to say they only helped Mexicans (as was really the case) was racist. I had another friend who was a Hispanic Argentinian American and he was told the same exact thing. He came to the office just a few days later and told them he was Mexican and they opened up several programs for him.

I was going to type this up in an article at the Rutgers U. newspaper (The Daily Targum) but was told that to print this information, even if true, would be racist.

Hmm, I'm just telling about an incident that really happened and it's racist? I'm just the reporter.

Cubans, Puerto Ricans, Mexicans, etc. have very different cultural norms. I've seen Ataque de Nerviosa (a documented culture-bound syndrome) quite often in Puerto Ricans but I've never seen it in Mexicans or Cubans and I've treated hundreds of patients in all 3 demographics. Puerto Ricans even in the medical field told me they've had similar experiences and this has been called "Triple-Aye" Syndrome in NJ where there is a large Puerto Rican population. I asked why Ataque de Nerviosa is not then written that it's really Puerto Ricans and not the other Hisptanic cultures and I was told because to do that would be racist.

Again I don't get it. I see it happening that way, Puerto Rican doctors and nurses did, other Hispanics did but to talk about it was racist?

Didn't you get the memo? Everything is racist now. Even Racism is racist.
 
I am fluent in Spanish and use it all the time, both in outpatient and inpatient settings. I have found that I use it the most in psych emergency and in outpatient child (usually w/the parents, the kids typically speak English). It's been tremendously helpful. It's true that it's harder to use Spanish in psychiatry than in other specialties, like primary care. The psych shortage is bad, but the Spanish-speaking psych shortage is terrible (at least in my area)... so I'd encourage you to utilize your skills.
 
One is not supposed to use family members as translators in the hospital. In the community? I'd recommend against but the reality is that a translator will cost an arm and a leg just for one patient. They will likely charge for the travel time since it's only one person.

And this has always put me in a conundrum. I don't want to use the family member as a translator but found no patient willing to pay for a translator when a family member could do the service or a translator willing to come to the office for only one patient without charging quite a bit.

I cannot fault someone for using family members as translators since it's hell trying to do it the appropriate way.

We have an in house interpreting service but sometimes if they are busy we call out to languageline. No idea what the cost is per call but probably a lot cheaper than having someone drive out. Even with ASL, there are video conferencing options.
 
We have an in house interpreting service but sometimes if they are busy we call out to languageline. No idea what the cost is per call but probably a lot cheaper than having someone drive out. Even with ASL, there are video conferencing options.

I thought the same. all hospitals I've seen have it. I'm talking about private practice. No private practice I've seen has one. I guess one should at least contact one of these services and see if they are available for private practices.
 
but found no patient willing to pay for a translator
If I'm reading this correctly, I have to question: can you legally charge a patient for an interpreter?
 
Hmm, I don't know. If someone in the office spoke Spanish, and they translated, I wouldn't charge them but any translator agency does charge. And as for that employee, they are being taken away from other work.
 
Hmm, I don't know. If someone in the office spoke Spanish, and they translated, I wouldn't charge them but any translator agency does charge. And as for that employee, they are being taken away from other work.
From my reading, and seemingly Mr. Bulb's link above, I know that you have to provide sign language interpreters for free (for at least some of the visits) even if you get paid less than the interpreter costs (unless doing so would actually make you go broke). But deafness is covered by the ADA. I don't know if speaking a language besides English gets covered the same.
 
Great question! I interviewed this year, and this was a major priority for me.

Yale has La Clinica Hispana, a fully bilingual psychiatry clinic for monolingual Spanish speaking patients.

Cambridge Health Alliance has a very international patient population and houses the Multicultural Mental Health Research Center with Margarita Alegria. Lots of research on Latino mental health.

NYU has an entirely Spanish speaking unit at Bellevue, with fully bilingual service. I'd expect Columbia has something but I didn't interview there.

Harbor-UCLA and USC are reputed to have significant Spanish speaking patient populations as well. Harbor residents sometimes do group therapy in Spanish. You can also spend time at Harbor if you are an NPI resident, at the PES or on the Harbor track.

I didn't apply to many Texas or California programs, so this is a very partial list... But rest assured that there are programs (and patients!) looking for someone with your skill set.
 
even if you get paid less than the interpreter costs (unless doing so would actually make you go broke).

Per ADA guidelines, they don't apply if the length to accommodate the disabled is unreasonable, but what is defined as unreasonable in this specific area to my knowledge hasn't been determined. This is where real law applies. What I mean by real law is like a physician doing lit-searches, a lawyer or someone with a law background would have to do legal research to see the existing body of case law to see what courts have determined if they have at all. I think most would agree that to make less money is still reasonable but exactly how much until it become "unreasonable"?

This is another parity issue. IMHO those that do not speak the language of the provider (or sign language) deserve to have an interpreter without barrier if they desire.
 
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