Counseling in another language

[pharmalt82]

So, I'm at one of my last advanced rotations, a retail site, at a major chain.

There is no Spanish-speaking person available, even in the front, and no access by phone either. I tried but failed. It is extremely busy. I speak a little bit of retail Spanish (high school). I know how to ask for an insurance card, DOB, phone number, etc. I can read and correct translations from Google Translate and conjugate verbs slowly but accurately. I'm slow at complex Spanish but accurate with enough time. Even Spanish-speakers have said I understand it well.

I get 4 Rxs from a Spanish-only couple with 2 boys: a toddler with a 5-7 year-old brother at the drop-off window.

Now, I have to explain Diastat (generic) in Spanish.

I'm pretty sure the parents didn't even understand what it was for. The other Rxs made it clear that the little kid had newly dxed epilepsy. First time on meds.
The best I could do was tell them to go to diastat.com. I wrote the website down. The older kid was extremely grateful even though he didn't speak English either 🙂eek🙂. He understood what a website was.

The parents were pissed at me because I wasn't ringing them up fast enough for their sick child. They made certain that I understood this part. They kept making universal hand signs that clearly meant "hurry up jackass, we don't have time to wait for you." Why did I take so long? One of the anti-epileptic Rxs was incorrect and I had to call the MD to change directions and quantity and this was at a major teaching hospital, so basically no one takes responsibility. The MD was glad when I called and thanked me. To quote the MD: "Oh ****, good catch, thank you, I think I looked at the wrong drug, can you read and confirm the other 3 meds also." It was clear though that the hospital had only written Rxs and not even bothered explaining anything to the parents. They probably had the same issue as me.

Still, the father called me an idiot in Spanish (this word I know).

Even after this and other signs of contempt, they bother to come to me and ask what each of the meds are for. Thank god the sigs are in Spanish but explanations of the meds are not always in Spanish, I'm pretty sure they don't know what the diastat is for. I'm sure I could have pulled it off quite well if I had the time though but my preceptor would have been pissed if I took out my phone and tried to use Google Translate and spent the time to explain.

Is this foreal? In a heavily Spanish-speaking neighborhood, the company doesn't make it to mandatory to hire Spanish-speaking techs or Rphs? I asked the preceptor about this and his answer was basically that they he had 2 Spanish-speaking techs and they didn't like working here and to top it off, Spanish-speaking Rphs give hell to the company if they get placed at the store.

Here's the best part: I was setting the diastat and letting the preceptor watch/mentor. The tech was basically asked why I was touching their meds. Not that the tech understood, but I did and the parents knew.

This has to be one of the worst days of my life. One, no one appreciates that you prevented an OD, but they will gladly sue you for it. Second, I essentially got yelled at by the parents for not speaking fluent and fast Spanish and not having anyone there who does. The only one who could truly see the helplessness of this situation was the older brother (7yo at most) of the kid. He was clearly embarrassed by the bad attitude of his parents. I'm glad the kid at least knew that he had to use the internet to find a few things out.

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[zelman]

Parents dealing with pediatric hospital discharge have had a really rough day. They're taking that out on you. Don't take it personally.

If this is really a large chain, they probably do have a translation service available. It's legally required in some states. Do some investigation (or just post on here, and someone is likely to know).

 

[pharmalt82]

Parents dealing with pediatric hospital discharge have had a really rough day. They're taking that out on you. Don't take it personally.

If this is really a large chain, they probably do have a translation service available. It's legally required in some states. Do some investigation (or just post on here, and someone is likely to know).

I've seen enough hospitals to know that they probably had a rough day.
The translation service was more or less down.
I'm not going hard on myself for the problems of others. I honestly don't ultimately care even when I'm an RPh as long as the Rx doesn't leave incorrectly. However, what exactly is the liability level when dealing with translations. This is getting scary. Not only do I have to know the doses, interactions, indications, billing, etc. Now I also have to do this is in another language and be held liable for it while doing it at a McDonald's drive-thru pace?

 

[owlegrad]

If it is CVS or Walgreens then Spanish services are available. I wouldn't know about Rite-Aid.

 

[Stilltrying1288]

I haven't met any Spanish speaking Rphs and I'm in a Hispanic neighborhood.

 

[rxlea]

Learn Spanish. My people are taking over. Might as well be prepared. 😀😛

 

[Praziquantel86]

You're mandated by federal law to have access to some means of translation for explaining this. The major chains and, I'm assuming, the regional ones all have some form of telephone interpretation service available. The services I'm familiar with can't be "down" as they're all live interpreters. You were misled if you were told this is the case.

And in reference to the legal liability for cases like this - huge. You don't want to be violating the Civil Rights Act at any point in your career.

 

[zelman]

...However, what exactly is the liability level when dealing with translations. This is getting scary. Not only do I have to know the doses, interactions, indications, billing, etc. Now I also have to do this is in another language and be held liable for it while doing it at a McDonald's drive-thru pace?

At my chain, the word from corporate is that the computerized translations are guaranteed to be correct. This is to prevent pharmacists from avoiding auto-translated text because they can't verify it. There is a phone line that offers translators for counseling. In fact, per corporate policy, unless that phone service certified you in a non-english language, you are not allowed to counsel in anything other than english. There may or may not be a process for that certification, but I've never met anyone who was certified. If you follow these rules, the liability is not yours.

 

[pharmalt82]

At my chain, the word from corporate is that the computerized translations are guaranteed to be correct. This is to prevent pharmacists from avoiding auto-translated text because they can't verify it. There is a phone line that offers translators for counseling. In fact, per corporate policy, unless that phone service certified you in a non-english language, you are not allowed to counsel in anything other than english. There may or may not be a process for that certification, but I've never met anyone who was certified. If you follow these rules, the liability is not yours.

That's more or less what my preceptor said. I was surprised by how cool he was with the situation. To quote: "I don't give a ****. They're getting the drug and directions in Spanish, if they don't know what it's for, I don't care. That's what I bought extra insurance for." 😱

Learn Spanish. My people are taking over. Might as well be prepared. 😀😛

Any tips for learning Spanish?

 

[Praziquantel86]

That's more or less what my preceptor said. I was surprised by how cool he was with the situation. To quote: "I don't give a ****. They're getting the drug and directions in Spanish, if they don't know what it's for, I don't care. That's what I bought extra insurance for." 😱



Any tips for learning Spanish?

Honestly, that's worth reporting to your school's experiential director. That is not the attitude that students should be learning from.

 

[pharmalt82]

Honestly, that's worth reporting to your school's experiential director. That is not the attitude that students should be learning from.

That's nothing. I've seen worse.

One preceptor let his tech make the students go and ring up permethrin, ivermectin, etc. even when we're not allowed to ring things up. And no, we weren't offered gloves, like they do at work.

Another thought it was okay to turn a clinical pharmacy rotation into a make batch IVs and put up the stock boxes for the technician and then leave rotation.

Another thought that being forced to vacuum for an hour (technician's orders) was okay.

Almost every student has had a rotation that turned us into the slaves of the techs. I'm blaming the pharmacists that tell us to "do what the techs say."

As far as rotations and preceptors are concerned, this guy was one of the nicest people.

I used to get angry about this, then I saw Medical Residents and the grunt work that they were made to do all day with no emphasis on learning, I considered myself lucky after that. Here's what I saw an IM resident have to do qam: get coffee, print rounds reports, arrange seats for all the nurses and the attending, take "customer service" complaints, and here's the best one: go to the basement and get the meds for the nurses and then get the meds for the pharmacy students to setup the crash carts. Oh, and he also had to make sure that one of the coffee's was mint-flavored. He was made to do various other work to make up for the "staffing" issues.

Everywhere I go, it seems that students/residents are treated like free slaves to push around rather than people here to learn on the job.

My worst experience was with a tech who told me that she has the password to the grading system and that she is in charge of it thanks to the RPh and that if the unit-dose returns to the pharmacy weren't put away on the shelves by a certain time, I would have to make up the hours or fill the weekend carts all by myself or see my grade go down. "It's your choice" she said.

The worst story I heard: A girl in my class was made to take out the garbage, clean stock shelves, check for expireds, arrange the controls, and move around boxes in the back room. Absolutely no typing of rxs, no dealing with customers, no filing rxs, no phone calls, just labor for the techs.

A lot of rotation sites have preceptors tell the techs what they should make the students do.

 

[Praziquantel86]

That's nothing. I've seen worse.

One preceptor let his tech make the students go and ring up permethrin, ivermectin, etc. even when we're not allowed to ring things up. And no, we weren't offered gloves, like they do at work.

Another thought it was okay to turn a clinical pharmacy rotation into a make batch IVs and put up the stock boxes for the technician and then leave rotation.

Another thought that being forced to vacuum for an hour (technician's orders) was okay.

Almost every student has had a rotation that turned us into the slaves of the techs. I'm blaming the pharmacists that tell us to "do what the techs say."

As far as rotations and preceptors are concerned, this guy was one of the nicest people.

I used to get angry about this, then I saw Medical Residents and the grunt work that they were made to do all day with no emphasis on learning, I considered myself lucky after that. Here's what I saw an IM resident have to do qam: get coffee, print rounds reports, arrange seats for all the nurses and the attending, take "customer service" complaints, and here's the best one: go to the basement and get the meds for the nurses and then get the meds for the pharmacy students to setup the crash carts. Oh, and he also had to make sure that one of the coffee's was mint-flavored. He was made to do various other work to make up for the "staffing" issues.

Everywhere I go, it seems that students/residents are treated like free slaves to push around rather than people here to learn on the job.

My worst experience was with a tech who told me that she has the password to the grading system and that she is in charge of it thanks to the RPh and that if the unit-dose returns to the pharmacy weren't put away on the shelves by a certain time, I would have to make up the hours or fill the weekend carts all by myself or see my grade go down. "It's your choice" she said.

The worst story I heard: A girl in my class was made to take out the garbage, clean stock shelves, check for expireds, arrange the controls, and move around boxes in the back room. Absolutely no typing of rxs, no dealing with customers, no filing rxs, no phone calls, just labor for the techs.

A lot of rotation sites have preceptors tell the techs what they should make the students do.

I'm not talking about doing grunt work...this is bad patient care. There's never a situation where being told to provide inadequate, dangerous, and legally deficient patient care is appropriate.

 

[molyhelp]

If it is CVS or Walgreens then Spanish services are available. I wouldn't know about Rite-Aid.

I asked and got good news, Rite Aid pharmacy has translation service by phone for many years for many many different languages (free call for store, funded by chain's bugget, does not cost store's budget.)

 

[sakigt]

1) Download "Coffee Break Spanish" podcast. Im on ep #12, so far so good
2) http://www.amazon.com/Manual-Relatively-Painless-Medical-Spanish/dp/029275146X