Emergency Care Across Languages: A Conversation with Dr. Jeffrey Chen

Eyal Heldenberg (00:12)
Hi everyone, welcome to Care Culture Talks. My name is Eyal, I'm the CEO of No Barrier, an AI medical interpreter for providers. I'm delighted to have Dr. Jeffrey Chen with me, which I call a dear friend of mine. Welcome Jeffrey to our show and please introduce yourself in a nutshell and we can do a deep dive.

Jeffrey Chen (00:36)
Yeah, thanks for having me, Eyal. It's been a pleasure getting to know you over the last year. Just to give everyone an intro on myself. So my name is Jeff Chen. I'm currently based in the Bay Area in Mountain View, California. I've been here for the better part of the last 10 years where I went to medical school at UCSF. I had a brief stint in Boston for residency, but I've been out here practicing as an attending since.

Currently, I am working at Mills Peninsula Hospital in Burlingame, California. We're right across the street from San Francisco International Airport, and we get tons of patients, obviously, who speak all kinds of languages as a result. And I've been helping advise No Barrier for the last year, and have recently taken on the role as head of medical affairs. And it's been really a pleasure to work together on this amazing product.

Eyal Heldenberg (01:28)
Yeah, yeah, I'm going to share kind of a personal story. In 2023, I think we started to kind of run with this idea, thinking about it and approaching, you know, different providers, different healthcare professionals on LinkedIn. And I remember my first kind of message to Jeffrey and, you know, we went on a Zoom and I kind of started to, you know, introduce the concept and there was some click there and we just knew that we want to work with you. We need to work with you.

And I can share that, it was a hell of a ride. learn every day walking together. So yeah, so that was my, my angle. Perfect. So I think, you know, it's kind of, we want to touch on different topics, really about, you know, the four walls where you have the patient and the provider and just touch to on a different kind of cultural aspects there, sometimes language, sometimes beliefs.

and any kind of things that related to communication, to trust. know, Geoffrey, you come from the ER aspect, you're kind of emergency medicine, and maybe you can share with us kind of, you know, the bits and bytes of what does it mean to be in the ER with kind of facing different cultural aspects or patients with different backgrounds.

Jeffrey Chen (02:56)
Absolutely. So, I still remember that LinkedIn message and our first times connecting. I was so excited by this mission of No Barrier because it's such a big problem, right? We, both in the ER as well as outpatient clinics and anywhere really within the healthcare system, the United States is an increasingly diverse place and San Francisco is particularly a melting pot. I remember as a medical student at UCSF,

and doing a lot of rotations at San Francisco General Hospital, now known as the Zuckerberg Chan General Hospital of San Francisco and Trauma Center. We really had such an incredibly diverse patient population where about a quarter of patients were primarily Spanish speaking, maybe a quarter of patients were primarily Chinese speaking, a quarter of patients were English, primarily English speaking, and then maybe a quarter of patients were all other languages.

Russian, Arabic, et cetera. And it was really during this time, during my formative years, that I realized there's such a big gap in terms of the care that's provided to patients who speak English really well, as well as those with LEP, what we call limited English proficiency. And so I remember, I was particularly drawn to emergency care because you got to see everybody and everyone. You got to treat all kinds of conditions.

from heart arrhythmias to respiratory failure, to broken bones, to trauma, deliver babies. and so I, I loved the, come one, come all aspect of emergency medicine. How at San Francisco general hospital, you could be in one room taking care of the CEO of a multi-billion dollar tech company. And in the next room have a homeless immigrant who doesn't even speak English, who's coming to seek care and.

And to be able to care for that broad of a spectrum is really incredible. Now, the way I got to see No Barrier is such an important product is because as a medical student, it was always my job as the least most valuable person on the team to be able to sit on a phone, you know, for five minutes, wait through phone menus. Welcome to X interpreter service. Please dial one for Spanish. Please dial two for Chinese.

Please dial three. excuse me, I didn't hear what you said. Can you please try again? Welcome to X interpreters. It was just such a mind boggling, frustrating use of time. And that's why it always fell upon the medical students to get the interpreter on the line and then page the team once the interpreter was finally available to be able to communicate with our patients. And I thought, you know, there has to be a better way.

Eyal Heldenberg (05:47)
Yeah, yeah, amazing. Going back kind of the diversity, specifically in San Francisco or maybe even California, do you see any kind of specific properties or something around the different cultures that you see every day?

Jeffrey Chen (06:08)
Yeah, I mean, you when people come to San Francisco, they're they're coming to a world renowned city where they might have some relatives, they might have some friends. And so you may know San Francisco is actually oftentimes somewhat divided into kind of ethnic neighborhoods. It's obviously increasingly more more blended. But for example, Chinatown, it's one of the oldest Chinatowns in kind of the new world.

San Francisco Chinatown has been around since the 1800s, 1840s during the gold rush. to this day, there's a hospital there called Chinese Hospital that I practiced at for a couple of years that provides care primarily to the Cantonese, Tosunese speaking population in the area. And, you know, in the SF Mission neighborhood where San Francisco General is located, there happens to be a pretty heavily Hispanic population.

that speak Spanish only. And so, you know, as people move across oceans, across continents to come here, they tend to find people who speak their own language, you know, their own cultural customs. And as a result, you know, different hospitals will be caring for different populations.

Eyal Heldenberg (07:28)
Yeah, yeah, yeah, got you. Amazing. All right, so let's go back to the room where you have your provider and patient, let's say like in other non-English language. guide us through different experiences when you need to have medical translator with you, remote, maybe in person. Is it bilingual provider, maybe a friend of yours?

family member, like what are the different kind of set up that you probably see you saw in the last years?

Jeffrey Chen (08:03)
Yeah, so there's a number of different options. You bring up family members and that's, I think, one of the more common options, especially in specific populations. I think it's pretty well known that a lot of folks within the Hispanic community, their family members might have had a bad experience at some point in a hospital. So oftentimes, Spanish-speaking patients

will come in with a family member who will serve as an interpreter, right? And they'll, you know, this other family member, whether it's a child or grandchild or cousin or whoever, will be taking a day off of work, right? To be able to come in and accompany their family member into the ER, into the clinic, because they have a little bit of distrust in the health system to provide proper care. Right? I can imagine, I can remember, you know, there was one attending that I worked with at San Francisco General who would

look at a patient and you know their physical exam right rather than waiting for the interpreter to get online and everything they would just point at their head and be like the Lord point at their chest and be like the Lord point at their belly the Lord the Lord the Lord is there the Lord here is there the Lord there and you know exactly yeah it's it's it's not optimal care and so I think a lot of Spanish-speaking patients and then you know obviously this applies to all cultures as well they'll they'll end up bringing in a family member to ensure that they have

Eyal Heldenberg (09:12)
It's the get by, right? The get by solution.

Jeffrey Chen (09:29)
kind of linguistically and culturally competent care. So, you know, I'd say that's, especially in California, in this area where there happens to be a lot of Spanish speaking patients, that's probably, you know, 20 to 40 % of encounters depending on exactly where you are. In addition to that, you know, there are phone interpreters and iPad interpreters at big academic medical centers, right? Like at UCSF and in Boston where I trained.

at Mass Stardom and Birdom, were fantastic in-person interpreters as well. And it was actually, you know, I made friends with a lot of them. They were really, really patient in teaching me Spanish. I decided to learn Spanish in my last year of medical school because I was so fed up with this whole process and I thought, you know, it's a good life skill to have anyway. And so, those are options as well. They have their pluses, they have their minuses.

And then increasingly, of course, AI is all the rage and anywhere you open the news and increasingly there's AI interpreters such as No Barrier, which I'm really excited to be working with. Beyond that, there's kind of unofficial non-sanctioned AI interpreters such as Google Translate, which are obviously amazing products, but also not necessarily designed and regulated for use within

healthcare settings where privacy laws are so strict.

Eyal Heldenberg (11:00)
Yeah, yeah, yeah. You know, we talked to many providers and you know, in the last 40 years, I would say medical translator is the go-to solution. And we've heard that, I would say the goal standout here is to have an on-site interpreter, right? So like, I'm sure that you are aware that there are pros and cons to that. what, can you kind of guide like,

why on-site interpreter would be kind of a really, really good solution or maybe sometimes there are some drawbacks here.

Jeffrey Chen (11:36)
Yeah, so mean, obviously in-person interpreters are, you know, they're the gold standard, right? Humans, even with how amazing AI is, even with how amazing, you know, video technology and audio technology can be, nothing replaces having a human-human interaction. And...

In addition, an in-person interpreter is able to read the room, of feel the tension, read body language, really be able to understand things a lot better that might be lost over the airwaves. Now, of course, they're not always available. And even in the current ERs I work with, which are pretty big, they're not frequently used because they're expensive. And beyond that, you know,

What I have seen in the past is sometimes, you know, certain language's community is actually quite small. And so a patient coming in with a very private medical issue, maybe related to their own previous drug use or sexual health history, they would be very shy to speak with someone that could possibly know someone within their community. And so those are some of the drawbacks.

You to be able to have someone available Saturday at 3 a.m. in the ER when someone comes in after a big car crash, right? Like, that's not always feasible.

Eyal Heldenberg (13:02)
Yeah, yeah, yeah. And when we compare it to remote, let's say phone interpreters, I would say some of the cons are the pros here, why there is anonymous, like anonymous phone call in a way, right? Or do you see any advantage or disadvantage on audio phone calls?

Jeffrey Chen (13:21)
Yeah, I mean, so audio only and even with a video over an iPad, for example, There's pluses and minuses, think. It's for the most part accurate, but there will be a lot of stuff lost in translation, right? Sometimes, I remember before I learned to speak Spanish, I would hear a patient speak for two minutes.

My hurts and my arm and I also lack air.

Eyal Heldenberg (14:08)
haha

Jeffrey Chen (14:15)
Beyond that, there's still the time aspect. Even though very few places use those touch tone menus like we used to, right? And oftentimes there's an iPad that you can just press Spanish or Chinese on. There's still a delay, right? You need to wheel around this iPad around the emergency department. And let's say you've got a Chinese speaking patient in room five and then all the way in room 23, you've got a Spanish speaking patient.

literally we're paging overhead, hey, can someone please bring the iPad interpreter card from room five to room 23 and that cuts out, cuts off room five's time with the interpreter and then the patient room 23, you know, the providers and the nurses, they're a little frustrated having to walk back and forth between just to move this piece of equipment. And so, so certainly that can be an issue. And then obviously there's still the issue of access, right? Saturday at 3 a.m. even online, like,

sometimes can be hard to find certain languages.

Eyal Heldenberg (15:20)
Yeah, yeah, yeah. So basically we assume that on-site interpreters, phone and iPad interpreters are kind of a certified medical translators where sometimes family members most likely are not. So this is another kind of advantage of a professional translation. But I totally agree on the other kind of waiting time. Sometimes we know that there is audio quality.

and disconnections of calls, so you need to do it all over again. Perfect. I wonder if you have like a miscommunication story that you either saw or were part of or something like that.

Jeffrey Chen (16:09)
Too many, Eyal. I mean, there's so many that it's hard for me to select. One pretty funny one that I can think of though is it actually comes from myself. So even after having learned Spanish, would frequently be in a patient's room as the nurse is going in and putting in an IV, right? And so, even though I'd say my Spanish is pretty decent, there were still some...

certain words that get lost here and there. And so when a nurse is putting in IV, I used to think like, oh, you know, like I would tell the patient, oh, you're going to feel a little pinch, right? And then so I would tell the patients, oh, you know, like, I was saying this for like two years. And for those who speak Spanish, you must be cracking up right now because you know that pinch or pinch and certainly in

certain areas of Latin America and in Spain could be a very derogatory word. And so I was just blindly going in and telling these patients, like, you're going to feel a little expletive, right? Like really bad word. And then so, you know, most patients, they're already like very surprised that, you know, me and my Chinese face can speak Spanish. And so oftentimes patients wouldn't say a word until one brave patient told me like, no, no, no, no, you shouldn't say pincha. Pincha means

bad bad word. You should be saying piquete instead or piquetito. And so here it was for two years saying like blindly a very bad word anytime a patient got an IV and finally I've learned to say it correctly right like te vas a sentir un piquetito. You're gonna feel a little pinch in your skin, a little sting, a little bug bite as we put in this IV.

That's, you know, I feel a little bit bad, right? Because I want to provide the most linguistically competent care that I can. And I hope, you know, at the very least it made patients laugh a little as they're getting their IV. So hopefully that took away a bit of their pain, but you know, always, always a learning experience, right? Also two different words that are used for constipation. Very, very frequently mixed up. think by a lot of folks who learn Spanish as a second language, this can certainly...

Eyal Heldenberg (18:11)
You

Jeffrey Chen (18:30)
I think make a lot of Spanish speaking patients laugh as well.

Eyal Heldenberg (18:33)
Nice, nice. Yeah, this is a good one. We heard kind of different kind of stories about miscommunication, for example, in diagnosis. We heard something, I think less funny of there was an interpreter that, you know, they were telling a patient you have cancer in...

type two or stage two something that was interpreted like you have two cancers. so yeah. So but I think one of the family members kind of caught that. we heard kind of many different stories about kind of some of sometimes it's kind of on the on the funny side. Sometimes it's it's getting lost in translation and could get to some misunderstandings. And and you know, I think, yeah, I think also the thing that you

Jeffrey Chen (19:07)
my goodness, yeah.

Yeah, absolutely.

Eyal Heldenberg (19:28)
on yourself to learn Spanish, really emphasize your commitment to a new standard of care for Spanish communities in that sense. I wonder if you have other tips or recommendations to other providers which may face this

Daily Challenge.

Jeffrey Chen (20:00)
Yeah, absolutely. you know, I, um, I, I, I'm very passionate about this issue as you can tell. And so, um, that's why during my fourth year of medical school, most, uh, physicians trained in the U S know that, uh, fourth year of medical school is generally a little lighter, right? You get brutalized during your entire third year or whatever year you have clinical rotations doing 80 hour weeks, uh, you know, 24 hour shifts every other day, super painful, but fourth year, um, generally has a lot more elective time. And so I took a lot of this time to

You know, really dive deep into textbooks, start using Duolingo, watch a lot of YouTube and Netflix series in Spanish with different Chrome extensions to be able to pause and really study hard the language. Not everyone has that time. And so, you know, I wouldn't expect everyone to just, you know, be able to pick up, you know, three other different languages. I'm also very lucky, lucky that, you know, my ethnic background is Chinese. And so

As a result, I'm able to speak Chinese, which is the second most common non-English language in the EDs that I work in. And so, you know, it's for me, it's been a product of luck and hard work to be able to communicate with these patients. I don't speak Russian. I don't speak Arabic. I don't speak Turkish, right? I don't speak Tagalog. And so for these reasons, I still need an interpreter for these patients.

Of course, it's oftentimes going to be easier to bust out my phone and use no barrier rather than, you know, run from room 23 back to room five to go grab that iPad. Right. When I've got five other patients waiting to be seen, know, 30 in the waiting room, this, this nurse is trying to show me this EKG that that family is trying to reach me and flag me down. This patient is trying to get, you know, this just it's nonstop and literally every second.

counts and makes a difference in the ER. And so for the other doctors and nurses who are listening to this, I presume that you're also very interested in being able to communicate with our patients with limited English proficiency. And so I would encourage you to do the right thing for the patient, right? Like even if someone brings in a family member trying to interpret for them, at least offer.

Um, a professional interpreter service, right? We're legally mandated to, and whether or not that's, um, through an iPad or through something like no barrier, you know, try not to, um, do the, do the easy thing and just say the Lord, the Lord, the Lord, the Lord. Right. Um, and so, um, that's number one, I think number two, like as, as we move forward and AI kind of takes over everything, um, you know, don't be afraid to adopt new technologies such as AI interpreters.

so obviously make sure that things are cleared with your hospital's, departments and that you're compliant with everything. but, you know, obviously a big benefit of no barriers, it's, it's, it's totally HIPAA compliant. and so, yeah, before thinking, try to do the right thing for the patient. and then beyond that, and Eyal, you and I have talked about this before, right?

beyond just language, right? There's so many cultural kind of details, right? That I think also make a big difference in patient's care. Some of you might've seen the movie, The Farewell, starring Awkwafina, who's a young woman whose grandma gets diagnosed with stage four cancer. And it's definitely a thing in Chinese culture and in a few other cultures where really bad medical news, oftentimes the family will try to guard the patient from knowing.

And so in this movie, right, they somehow are able to, you know, celebrate an entire, Chinese New Year party. Or I think they, they, they fake a wedding. They literally fake Awkwafina's wedding so that everyone has an excuse to go see grandma one last time without ever letting her know that she has stage four cancer. And she, you know, at various points, they're trying to trick her into getting treatment for what they, what they say is something else. I I've literally seen that in my own family in Taiwan, where a lot of the

Doctors are calling me, as the doctor in the family, to make a life or death medical decision without telling the patient what is going on with her or him. whether or not that's right or wrong, I think it's important that everybody learns the cultural intricacies and the little idiosyncrasies as well that can come up.

Eyal Heldenberg (24:27)
Wow.

Jeffrey Chen (24:47)
And hopefully, the product down the line will be creating little cultural guides that will help folks be able to understand the patient populations that they're working with more.

Eyal Heldenberg (24:59)
Yeah, Amazing. You cover a couple of things that I wanna, I wanna go again. One is that specifically the emergency department comparing to outpatient clinic, the rhythm and the mindset is very kind of quick response, overload tasks. like it's kind of every minute counts, like literally like, so this is one thing.

and basically the interpretation or let's say you need the Spanish medical translator right now, like how do you get it faster? So I totally get the sense. And the other topic that you raised on the cultural aspect where it's kind of how to navigate to get the patient autonomy, right? To get them to know what's going on regardless to the background culture, maybe family member in the room that kind of can...

Jeffrey Chen (25:47)
Mm-hmm.

Eyal Heldenberg (25:56)
and influence the flow of the call. We've heard also about some bias that could come from medical interpretation also. What's the background of each player in the room, I would say? This is kind of a nice thing to consider at least.

You kind of mentioned the AI, so maybe kind of a last question for the podcast or kind of maybe a vision or a future, what gives you hope for the future in our field, in our context?

Jeffrey Chen (26:38)
Yeah, I mean, I think increasingly, right, within medical school education, there's such a focus on providing care to an increasingly diverse population throughout the US. And so I think, you know, new doctors, new nurses, people are very hyper aware of these issues and they're and they're going to do the right thing. Because, you know, not just because we all say that a Hippocratic oath, but because in our heart of hearts, we all want to do what's best for a patient.

And so with new technologies like No Barrier being able to really expedite that, I'm really optimistic that, you know, folks are going to be able to go to a healthcare setting, a clinic, hospital, an emergency department, and be able to trust that their doctors and nurses are really able to understand them, to really be able to communicate with them and to explain to them what's going on and help.

make decisions together on kind of next best steps in a patient's care. And so I'm really optimistic about the future, I really am.

Eyal Heldenberg (27:44)
and through that. All right, so Dr. Geoffrey Chen, again, always a pleasure to talk now live on the podcast. So thank you and hope you had a great listening and take care.

Jeffrey Chen (28:00)
All right, take care,

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