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Objective This study aimed to identify the types, frequency, and clinical significance of altered interpreta-tion in clinical settings.Methods Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese doctors, and hospital-provided interpreters were digitally recorded and transcribed. Segments of consecutively interpreted utterances were coded as “altered,” in which the interpreter changed the meaning of the source utterance, or “unaltered (accurate),” and the types and frequency of occurrence were analyzed. Altered interpretations were categorized as clinically negative or positive and classified into four categories: omission, addition, substitution, or voluntary intervention. Incidents resulting from alterations were investigated. Reliability was assessed by examining the correlation between random independently coded samples.Results In total, 111 encounters were analyzed. The mean segments per encounter was 67.9 (range 14-186), and the mean frequency (standard deviation) of altered interpretations per 100 segments was 46.7 (14.3) for accurate interpretations; 46.1 (17.9) for negative or not significant alterations, including 27.2 (10.3) for omissions, 6.0 (5.0) for additions, 10.4 (6.9) for substitutions, and 2.5 (2.7) for voluntary interventions; 0.0 (0.2) for alterations potentially leading to an incident; and 26.2 (11.9) for positive alterations, including 1.8 (2.6) for positive omissions, 7.7 (4.7) for positive additions, 7.8 (6.3) for positive substitutions, and 8.8 (5.2) for positive voluntary interventions. The frequency of negative alterations was weakly negatively correlated with number of segments per minute (r＝−0.339). Conclusion Trained healthcare interpreters with fewer clinically significant altered interpretations were effective. Professional medical providers should recognize the importance of positive alterations by healthcare interpreters and collaborate with them to provide safe medical care for foreign patients. To facilitate the provision of appropriate medical care to a growing foreign population with diverse cultural and linguistic needs, undergraduate medical education should teach aspiring medical professionals how to collaborate with healthcare interpreters and foreign patients.
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AbstractObjectives To explore factors related to difficulty in caring for foreign patients among Japanese nurses.Methods A self-administered online survey was conducted with nurses working in a university hospital and a general hospital in Tokyo using Google Forms. The survey involved participants’ demographics, including language ability and international experiences, and 16 questions on difficulty in caring for foreign patients.Results A total of 138 nurses completed the survey (response rate of 11.3%). The average nursing experience was 14.1 (±10.6) years, and 50% of the participants had a bachelor’s degree. The higher-difficulty items were predominantly related to communication, followed by insurance or payment. The most difficult item was “communication in a language other than English,” but no factor was associated with it. The path analysis showed that “being able to speak a foreign language” was directly and significantly associated with a lower total difficulty score (β＝−0.313, p＝0.011). Higher educational degree was associated with higher “self-evaluated English level” (β＝0.282, p<0.001), which was associated with “being able to speak a foreign language” (β＝0.396, p<0.001). Higher educational degree was also associated with “international experiences (study)” (β＝0.161, p＝0.044), which was associated with both “self-evaluated English level” (β＝0.256, p<0.001) and “being able to speak a foreign language” (β＝0.286, p<0.001). Lower educational degree was associated with more nursing experience (β＝−0.454, p<0.001), which was associated with a higher “number of foreign patients cared for” (β＝0.291, p<0.001) but not with lower difficulty. Although “international experiences (sightseeing)” was highly correlated with “international experiences (study)” (β＝0.338, p<0.001), sightseeing was not significantly related to higher “self-evaluated English level” or lower difficulty. Conclusion Learning foreign languages, including English, and international study experiences could reduce difficulty in caring for foreign patients. An intervention study that evaluates the effect of training that includes a language aspect on caring for foreign patients may be necessary.
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Objectives The objective of this study was to investigate the needs and motivation of nurses regarding training on how to take care of foreign patients at hospitals and to explore related demographic factors.Methods A questionnaire was distributed to all nurses working at two hospitals in Tokyo, one university and one general, using Google form. The needs and contents of training they would like to participate were summarized using descriptive statistics. Fisher’s exact test, t test, Mann-Whitney U test and Spearman’s correlation coefficients were used to analyze related factors. Results Responses of 138 nurses were analyzed (98 university and 40 general) with a response rate of 11.3%. More nurses in the university hospital held a bachelor’s degree and higher subjective English ability than the general hospital. In both hospitals, 59.7% answered that they “strongly feel” or “feel” stress/anxiety in dealing with foreign patients and 77.5% answered that training is necessary. “Language training” was felt most necessary, followed by training regarding “different cultures and religions.” In regard to language training, “daily conversation” was most necessary, followed by “technical terms”; English being most necessary, followed by Chinese. Approximately one-fourth of participants (24.6%) answered in the affirmative for attending such training by adjusting their private schedules and 59.4% answered they only wanted to attend if it fits into their schedule. Nurses who answered, “unable to speak English”, had a higher desire to improve their ability to take care of foreign patients; also, those who had higher stress/anxiety felt it was necessary to attend the training. Participants who had been studying a foreign language showed higher motivation.Conclusion Daily conversation in English was felt most necessary regarding training to care for foreign patients. Training during work hours rather than on private time was preferred.
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International medical service is becoming much more popular at present with the increased exchanges between countries around the world.This paper mainly analyzes the characteristics and practical measures taken by the international department of some large comprehensive class A tertiary hospitals in regard to customer orientation,service features,facility and environment building,talent team building and foreign communications,management and credentials,and insurance cooperation.It is found out that thecustomers are ambassadors,counselors,foreign workers and their family members,foreigners for business visits or foreign tourists;appointment service,one-stop service and other special service are provided;separate clinical area or room of international elements are installed;they continually enhance foreign exchanges and improve language skills and foreign culture cognitions of team members;they have particular management modes and operate with international standards;they cooperate with international insurance companies.The mode of international medical service is thus concluded on the analysis.
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The "Act on Overseas Medical Expansion and Foreign Patient Attraction Support"(legislation no. 13599), due to be enacted by the National Assembly during the general meeting on June 23, 2016, will give institutionalized support and fully recognize the efforts for medical tourism-that is, the overseas expansion of medicine and ingress of foreign patients. However, before jumping into medical tourism, the failures of previous ventures in this field must be analyzed. The absence of specific goals and strategies, insufficient planning and analysis of feasibility, the lack of international experience, and glocalization and marketing failures of previous projects are all areas in which improvement is advised. Further, overseas medical expansion is only possible when various considerations are examined, such as the influence on the domestic medical market, as well as plans for securing the management capacity to ensure economic feasibility and risk management of medical institutions.
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Humans , Marketing , Medical Tourism , Risk ManagementABSTRACT
OBJECTIVES: This study investigated changes in the clinical characteristics of foreign patients receiving psychiatric treatment in a public mental hospital in Seoul over the last nine years. METHODS: We compared the sociodemographic and clinical characteristics of a multi-cultural mental health (MCMH) clinic group of 49 foreign psychiatric patients, who had attended the newly opened special clinic for foreigners during the period August 2009-2010, with those of a general group of 71 foreign psychiatric patients, who had been treated in conventional ways during the period 2002-July 2009. RESULTS: The MCMH clinic group was characterized by voluntary attendances with the assistance of family, friends or supporting organizations. The patients were more likely to have resided longer in Korea, to have Korean citizenship, to be young married immigrant women and to have children. They were also more able to communicate by themselves or with the support of bilingual interpreters and were more likely to receive outpatient-based treatment and to experience longer periods of treatment. In contrast, the general group was characterized by involuntary hospital attendances supported by the police or the embassies of their home countries, and patients received inpatient services. They were also discharged sooner to be sent back to their home countries. Depressive disorder, anxiety disorder, and adjustment disorder were more common in the MCMH clinic group, while schizophrenia, bipolar disorder and a past history of psychiatric disorders were more common in general group. In the MCMH clinic group, those patients with Korean citizenship or permanent residency seemed to maintain consistent and stable treatment with a good prognosis. CONCLUSION: The findings from the specialized multi-cultural mental health clinic suggest that specialized setting for foreigners is more efficient in helping them, particularly for married immigrant women. This means that specialized systematic evaluation and treatment approach needs to be developed to provide culturally relevant mental health services for foreigners living in Korea.
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Child , Female , Humans , Adjustment Disorders , Anxiety Disorders , Bipolar Disorder , Depressive Disorder , Emigrants and Immigrants , Friends , Hospitals, Psychiatric , Inpatients , Internship and Residency , Korea , Mental Health , Mental Health Services , Police , SchizophreniaABSTRACT
BACKGROUND: Recently, foreigners among outpatients in dermatologic clinics are increasing as foreigners staying in Korea are increasing. OBJECTIVE: The purpose of this study was to investigate the epidemiologic and histopathologic characteristics of skin diseases in foreign patients. METHODS: Total 277 foreign patients had undergone skin biopsies among patients visiting through international health services, Samsung medical center during 7-year period between January, 1996 and December, 2002. Their clinical data and histopathologic findings were reviewed. RESULTS: The number of skin biopsies taken from foreign patients was 429(4.6%) among total 8779 skin biopsies during 7 years. It showed a tendency to increase with time. The mean age of patients was 42.3 years and the ratio of men to women was about 2: 1. Distribution of nationality showed most of the patients came from North America(47.7%) and Europe (22.0%). Patients from USA were most common(41.5%). The distributions of dermatoses were common melanocytic nevi(24.2%), seborrheic keratoses (11.4%), actinic keratoses(8.4%), dysplastic nevi(6.8%), and epidermal or pilar cysts(5.1%). Total 266 cases(62%) were the dermatoses which could be clinically manifested as pigmented lesions. The numbers of cutaneous premalignant lesions and malignant tumors were 20(4.7%) and 68(15.9%), respectively. CONCLUSION: This study showed epidemiologic and histopathologic characteristics of the skin diseases of foreign patients staying in Korea. In comparison with Korean patients, it seems that foreign patients concern themselves much more about skin cancers and want their pigmented skin lesions to be examined. Dermatologists should consider performing skin biopsies in foreign patients who presented pigmented skin lesions.
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Female , Humans , Male , Actins , Biopsy , Emigrants and Immigrants , Ethnicity , Europe , Health Services , Keratosis, Seborrheic , Korea , Outpatients , Skin Diseases , Skin Neoplasms , SkinABSTRACT
BACKGROUND: Recently, foreigners among outpatients in dermatologic clinics are increasing as foreigners staying in Korea are increasing. OBJECTIVE: The purpose of this study was to investigate the epidemiologic and histopathologic characteristics of skin diseases in foreign patients. METHODS: Total 277 foreign patients had undergone skin biopsies among patients visiting through international health services, Samsung medical center during 7-year period between January, 1996 and December, 2002. Their clinical data and histopathologic findings were reviewed. RESULTS: The number of skin biopsies taken from foreign patients was 429(4.6%) among total 8779 skin biopsies during 7 years. It showed a tendency to increase with time. The mean age of patients was 42.3 years and the ratio of men to women was about 2: 1. Distribution of nationality showed most of the patients came from North America(47.7%) and Europe (22.0%). Patients from USA were most common(41.5%). The distributions of dermatoses were common melanocytic nevi(24.2%), seborrheic keratoses (11.4%), actinic keratoses(8.4%), dysplastic nevi(6.8%), and epidermal or pilar cysts(5.1%). Total 266 cases(62%) were the dermatoses which could be clinically manifested as pigmented lesions. The numbers of cutaneous premalignant lesions and malignant tumors were 20(4.7%) and 68(15.9%), respectively. CONCLUSION: This study showed epidemiologic and histopathologic characteristics of the skin diseases of foreign patients staying in Korea. In comparison with Korean patients, it seems that foreign patients concern themselves much more about skin cancers and want their pigmented skin lesions to be examined. Dermatologists should consider performing skin biopsies in foreign patients who presented pigmented skin lesions.
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Female , Humans , Male , Actins , Biopsy , Emigrants and Immigrants , Ethnicity , Europe , Health Services , Keratosis, Seborrheic , Korea , Outpatients , Skin Diseases , Skin Neoplasms , SkinABSTRACT
The objective of this study is to identify any differences in disease status between foreign patients staying in Korea and Korean patients. The study results are : First, more foreign stayers than Korean in their 20's and 30's seek medical services but those after age of 60 show the opposite pattern. This difference seems to feflect cultural difference in the concept of medical services and health seeking behavior. Second, foreign pateints were much more frequently(almost threee times) diagnosed as having an acute disease, and the fact that the most common diseases were "diseases of the respiratory system" can suggest the seriousness of air pollution problem in Korea. And, the fact that foreign stayers, especially those from developed countries, tend to take more periodic general physical examina-tion indicated that their health maintenance efforts place emphasis on prevention. Foreign patients seek more medical services during the spring and summer time when compared to Korean patients, and Korean patients visited the clinic more frequently during the autum time. Also, the review of the number of outpatients seeking medical services and the average duration of outpatient follow-up mainten-ance after discharge suggest that foreigners suffer less severe diseases than Koreans do. Finally, in contrast to the usual practice of Koreans of coming to the center without prior calling for reservation, most foreign patients tend to make reservations before coming(usually a day before) in general. This is also reflective of cultural difference related to the way of utilizing medical services.