By Suvarna Bhatt

You can’t escape being sensitive to the needs of different cultures, races, and languages in the healthcare field, especially in a country as culturally diverse as the United States. Radiological Technologists particularly face challenges in this area because they have direct and imperative contact with patients. A smooth encounter between patient and technologist can have as much impact as receiving an accurate diagnosis.

Cultural and linguistic competence is so important that the United States Department of Health and Human Services Office of Minority Health has set an official definition. Summarized, it’s a set of behaviors, attitudes and policies that enable effective work in cross-cultural situations. This would include the different beliefs of racial, ethnic, religious, or social groups.

R.T.s encounter many patients on a daily basis, from a variety of cultural and linguistic backgrounds. They have to accurately explain procedures and position patients correctly to get a quality image that’s used for diagnosis. Effective communication can even help avoid mishaps such as a patients’ unnecessary exposure to radiation. It seems simple, but not if a language or cultural barrier stands in the way.

Margaret Brown, an R.T. working at the prestigious Hoag Hospital in New Port Beach, Calif., says she encounters many different cultures day-to-day. She says it’s "extremely important" R.T.s are culturally and linguistically sensitive to patients. "What means one thing to one person," says Brown, "can mean another thing to someone else in their country."

Brown says employees at Hoag are trained to be culturally sensitive when dealing with patients. In fact, the hospital has a mandatory policy that requires all employees to take a "Cultural Diversity" class and pass a test on that very subject.

Peter Shams-Avari, Health Policy Manager at the American Society of Radiologic Technologists, says there is no "actual problem" from an R.T. perspective – "being culturally and linguistically competent is likely to prevent potential problems," he says.

For example, Avari cites that in some cultures it’s forbidden for a man to be alone with a woman who is not his wife. "There is a potential problem if a male R.T. just pushes forward, touching a patient for the purpose of positioning, without considering the issue." Avari says.

Avari says jewelry that has religious significance is another issue. If a radiologic technologist removes the jewelry without warning, the patient may not react well. In such cases the technologist needs to explain that all jewelry must be removed to get a diagnostic quality image, and then let the patient remove the item.

Often, deciphering cultural cues is more challenging then realizing that a patient needs a translator. Fortunately, many facilities have access to medical interpreters and language call-in services. Brown says language barriers are not a problem at Hoag Hospital. She says that’s because the hospital has set up a special program for bilingual employees who would like to act as translators for the second language they speak.

Interested employees take a medical translation test in the language that they would like to translate. If they pass the test, their name goes on an inter-hospital translator list. "If I have a patient come in that speaks French— I call the translator line," says Brown. "They locate the employee that has been approved for medical translation, and send them to our department to translate for the doctor, nurse or therapist."

Brown says that being aware of body language is also very important when dealing with patients who do not speak English. "If you greet someone with a smile, it can ease a patient’s mind and set the tone that you are a friendly, caring person," she says.

Brown also suggests R.T.s should learn to speak a few key words in different languages. She recalls a patient she had recently from Iran who spoke no English. "I learned how to say ‘hello’ and ‘goodbye’ to them in their language," says Brown, "it was fun for me and it made the patient feel good too."

The U.S. has established legal requirements on Culturally and Linguistically Appropriate Services (CLAS). While it’s difficult to regulate, Avari says facilities are working toward compliance with the CLAS standards, but implementation has been slow. In fact, there has been very little enforcement mandated until recently.

Often, how well CLAS are administered depends on how the R.T. has been trained. Stephanie Eatmon, Ed.D, R.T., who is educational program director of the radiation therapy program at California State University, Long Beach says R.T.s are taught about CLAS thoroughly in her program. "I think we do a good job in the classroom and in the clinic," Eatmon says. She says the best way for R.T.s to do well in their careers is to be more culturally competent by working with a diverse community of patients and talking to them about their cultures.

She says there is a "tremendous" amount of information available for anyone to learn about CLAS even if it isn't through continuing education. "Not everything has to be offered in a class or a directed reading," Eaton says. "I am confident that therapists are able to assess the information they need from multiple sources and learn whatever it is that they need to know."

Avari says there are many ways to learn more and improve one’s cultural and linguistic proficiency. He says technologists should take advantage of any opportunities to learn about different cultures and get to know the person responsible for implementing facility policies regarding cultural and linguistic competencies. "Get involved in developing procedures if the opportunity presents itself," he advises.

Avari recommends a handy publication on the topic entitled Cultural Sensitivity – A Pocket Guide for Health Care Professionals which is available through the Joint Commission Resources.

As far as bilingualism, while it is useful, cannot be mandatory because both the CLAS Standards and the law simply require accommodations for non-English speakers. Plus, there are simply too many languages to choose from. "Which language would you want R.T.s to learn - Japanese, Spanish, Polish, Russian?" questions Eaton.

As impractical as it is for R.T.s to be multilingual, translation services are an additional expense for health care facilities searching for ways to manage rising costs. Because of this, any technologist would benefit from learning additional languages to give them a competitive edge in the job market.

Besides picking up a second language, learning what resources are available including access to medical interpreters, language call-in services, and available literature to provide to patients will help you immensely as you strive for cultural and linguistic competence in the work place.

Also, be sure to participate in linguistic and cultural competency training both to provide quality patient care and to enhance your job skills and improve your employability.

In the end, "cultural and linguistic competency is an extension of the Radiologic Technologist Code of Ethics," says Avari. "It is a means of providing the best care possible to those from other cultures."