To reduce your risk, start by asking the patient if she'd like a translator. This person can be a family member, or another healthcare provider, but should be someone to whom the patient feels she can openly express her concerns. If your facility does not have a mechanism in place for hiring professional interpreters, talk to your supervisor about instituting one. At the very least, make up a list of healthcare providers in your facility who are fluent in a foreign language.

Assuming that someone is available to translate, you'll want to document the patient's consent to using an interpreter in her chart. Include the interpreter's name and relationship-if any--to the patient. Through the interpreter, make sure the patient understands her plan of care. Ask her if she has any questions and have her repeat back your instructions. If possible, give her written instructions in her native language that reinforce your oral directions.

If you care for a large number of patients who speak a particular language, contact a local college or adult school about a language course. In the meantime, check out the following resources and Web sites for more information on overcoming language barriers and cultural differences:

• JDV publishes Spanish, French, and Russian editions of its Pocket Medical Series. Each book costs $11.95 and includes more than 400 medical phrases and questions. Companion audiotapes, priced at $9.95, are also available. A set costs $19.95. To order, call (800) 788-0064.
• Culturgrams describe the customs and lifestyles of people in different areas of the world. These four-page briefings provide information on geography, history, population, religion, gestures, eating customs, family, dating and marriage, diet, and health. Culturgrams cost $6 each; a complete set of 167 costs $120. To order, call (800) 528-6279.
• Cross Cultural Health Care can provide articles, contacts, and-in the case of their Web site-links to Web sites on cultural diversity. Call (301) 588-6051 or visit their Web site at www.diversityrx.org/html/wercch.htm.
• The University of Washington's Harborview Medical Center has a Web site that deals with community issues, cultural topics, and medical beliefs of Amharic, Cambodian, Eritrean, Oromo, Somali, Tigrinean, and Vietnamese immigrants. It also features links to other Web sites, further reading, and patient education materials. The site address is: http://healthlinks.washington.edu/clinical/ethnomed.
• The Office of Minority Heath Resource Center, a division of the Department of Health and Human Services, has a database of information on social customs and healthcare practices of different cultures. You can call them at (800) 444-6472 or visit their Web site at www.omhrc.gov.
• The National Center for Cultural Competence in Washington, D.C., has a Web site that offers articles on providing culturally diverse healthcare and features links to other Web sites. Visit the site at www.dml.georgetown.edu/depts/pediatrics/gucdc/cultural.html, or call them at (800) 788-2066.

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