Providers Guide

When taking a medical history from a patient with a limited ability to speak English, which of the following is least useful?

a. While it may seem easier to ask questions that require a simple "yes" or "no" answer, this technique seriously limits the ability of the patient to communicate information that may be essential for an accurate history and diagnosis. Further, the patient may answer "yes" or "no" without really understanding the question. The most effective way to put the patient at ease and to ensure that the patient provides essential information about his or her symptoms is to combine two types of questions: 1) open-ended questions, such as "What can you tell me about the pain in your knee?" and 2) more directed questions, such as "What makes the pain get better or worse?" Always get a qualified interpreter whenever possible.

Using the ETHNIC Mnemonic

Getting an accurate history is, to a large extent, dependent on having a clear understanding of the patient's symptoms and perception of illness. This may be more difficult when the patient has a limited ability to understand and speak English or does not feel comfortable telling the provider about some aspect of his or her medical condition or lifestyle.

ETHNIC is a tool that providers can use to help create an environment in which the patient is more likely to discuss the situation openly and honestly from his or her own cultural perspective. It is important to ask the questions in a friendly, relaxed way; to listen carefully to the responses; to probe more deeply when the responses are unclear; and to refrain from asking questions when the patient's body language, tone of voice, or facial expression indicates tiredness, discomfort, or resistance.