July 19, 2006
Wednesday

Fifteen or 20 years ago, acupuncturists, massage therapists or meditation therapists were about as welcome as patent medicine salesmen around most American hospitals.

But with at least 40 percent of adults in this country using alternative medicine in some fashion, the bastions of traditional, Westernized health care are opening their arms to some of the more widespread complementary and alternative services.

A new report released this week by Health Forum, a data-gathering subsidiary of the American Hospital Association, found that more than a quarter (27 percent) of hospitals responding to a survey mailed last winter report that they offer alternative medicine services to their patients.

The report is based on nearly 1,400 responses to a survey designed to take a close look at the types of programs and services being offered.

These can range from alternatives to painkillers for post-operative pain or lower back pain to stress management programs to augment the care of heart and cancer patients.

"More and more, patients are requesting care beyond what most consider to be traditional health services," write study authors Sita Ananth of Health Forum and William Martin of DePaul University in Chicago. "And hospitals are responding to the needs of the communities they serve by offering these therapies."

While patient demand is the major reason that hospitals have established alternative or integrative medicine centers, or brought specialists in the field into existing departments, hospitals also cited enhanced scientific evidence for the effectiveness of some procedures as a factor.

Also, many said the services reflect a hospital's desire to "treat the whole person _ body, mind and spirit."

On the other hand, many health practitioners say it's better to offer alternative care under the same roof, because otherwise, many patients won't tell a traditional doctor what other treatments they've been using.

Of course, there's also an economic element to the alternative services. They can help hospitals attract new patients and distinguish themselves in their markets. The surveys also note that most of the services are paid for out-of-pocket by patients.

Unfortunately, cost also plays a role in the failure to connect another cultural gap in many hospitals _ patients who don't speak the same language as the doctors and nurses.

Although many major medical facilities have trained medical translators on staff or on retainer to help with translations, too often the task is left to children, family members or friends who lack the expertise or sufficient grasp of the language themselves to pass along accurate information.

Many hospitals around the country also have lists of volunteer interpreters they can call upon from immigrant communities, but their grasp of medical issues may not always be complete, either.

Dr. Glenn Flores, one of the nation's top experts on language barriers to health care, notes in a perspective article in The New England Journal of Medicine this week that 50 million U.S. residents don't speak English at home and 22 million more have limited English proficiency.

According to one recent study, there was no interpreter used in 46 percent of emergency department cases involving patients with limited English proficiency. In many instances, there simply may not be a trained interpreter around. But another obstacle is that the patients who need interpreters either aren't insured or, if they are, very few health insurers cover translation costs.

Flores cites several examples of tragic consequences of miscommunication between patients and doctors:

_ The misinterpretation of a single word led to a patient being wrongfully treated for drug abuse when he was actually complaining of nausea. The delay in treatment led to rupture of a brain aneurysm that left the man a quadriplegic and cost the hospital a $71 million malpractice settlement.

_ A well-meaning volunteer interpreter told the mother of a seven-year-old girl to insert an oral antibiotic into the girl's ear to treat a middle-ear infection, requiring extra treatment to remove it.

_ A resident who misinterpreted a mother's explanation that her daughter had "hit herself" when she fell off a tricycle took the statement as an admission of abuse that resulted in the woman temporarily losing custody of her two children.

"Communication is essential to high-quality care and positive health outcomes in any physician-patient interaction," Flores said.

"When a language barrier exists without a qualified medical interpreter the situation can be potentially explosive. This is particularly true of young children who are unlikely to have full command of two languages and medical terminology and who generally avoid discussing sensitive issues."

He concludes: "The time has come for the federal government to require all payers to reimburse providers for interpreter services in health care."

On the Net:

http://www.aha.org

www.nejm.org

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