Brand the Interpreter

A Shift in Terminology with Dr. Casey Lion, Dr. Corrie McDaniel, and Dr. Desiree Yeboah

March 17, 2023 Season 6 Episode 88
A Shift in Terminology with Dr. Casey Lion, Dr. Corrie McDaniel, and Dr. Desiree Yeboah
Brand the Interpreter
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Brand the Interpreter
A Shift in Terminology with Dr. Casey Lion, Dr. Corrie McDaniel, and Dr. Desiree Yeboah
Mar 17, 2023 Season 6 Episode 88

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For nearly 50 years the term Limited English Proficient (LEP) has been continuously used to refer to our multilingual communities since it was first coined in the Lau vs. Nichols Supreme Court case of 1974.  As we shift towards a better understanding and appreciation of multilingualism, perhaps it's time we start having conversations about a shift in terminology that more positively reflects our communities that speak a language other than English.

In today's enriching conversation I have the opportunity to discuss this particular topic with a team of Drs. from Seattle Children's Hospital, authors of the commentary - Language Matters: Why We Should Reconsider the Term "Limited English Proficiency"

Dr. Desiree Yeboah is a 2nd year Pediatric Hospitalist Medicine Fellow at Seattle Children’s Hospital, committed to advancing and sustaining equitable healthcare for underserved patients through quality improvement and medical education research.

Dr. Corrie McDaniel is an Assistant Professor and Pediatric Hospitalist with the University of Washington School of Medicine and Seattle Children’s Hospital, currently a funded Investigator with the Agency for Healthcare Research and Quality with specific interest in addressing disparities for children in rural hospitals.

Dr. Casey Lion is an Associate Professor of Pediatrics in the divisions of General Pediatrics and Hospital Medicine at the University of Washington School of Medicine, and an investigator at the Seattle Children’s Research Institute.

Some topics discussed include:

  • The marginalization of our multilingual communities
  • Focusing on limitation changes our approaches
  • Changing system approaches
  • The role time plays in discussions about language services
  • Empowering with knowledge
  • Reconsidering the terminology currently adopted, and more!

Only on the podcast that shares your stories about our profession. Brand the Interpreter!

Thanks for tuning in, till next time! 👋

Connect with Mireya Pérez, Host
www.brandtheinterpreter.com
Facebook
LinkedIn
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Show Notes Transcript

Send us a Message!

For nearly 50 years the term Limited English Proficient (LEP) has been continuously used to refer to our multilingual communities since it was first coined in the Lau vs. Nichols Supreme Court case of 1974.  As we shift towards a better understanding and appreciation of multilingualism, perhaps it's time we start having conversations about a shift in terminology that more positively reflects our communities that speak a language other than English.

In today's enriching conversation I have the opportunity to discuss this particular topic with a team of Drs. from Seattle Children's Hospital, authors of the commentary - Language Matters: Why We Should Reconsider the Term "Limited English Proficiency"

Dr. Desiree Yeboah is a 2nd year Pediatric Hospitalist Medicine Fellow at Seattle Children’s Hospital, committed to advancing and sustaining equitable healthcare for underserved patients through quality improvement and medical education research.

Dr. Corrie McDaniel is an Assistant Professor and Pediatric Hospitalist with the University of Washington School of Medicine and Seattle Children’s Hospital, currently a funded Investigator with the Agency for Healthcare Research and Quality with specific interest in addressing disparities for children in rural hospitals.

Dr. Casey Lion is an Associate Professor of Pediatrics in the divisions of General Pediatrics and Hospital Medicine at the University of Washington School of Medicine, and an investigator at the Seattle Children’s Research Institute.

Some topics discussed include:

  • The marginalization of our multilingual communities
  • Focusing on limitation changes our approaches
  • Changing system approaches
  • The role time plays in discussions about language services
  • Empowering with knowledge
  • Reconsidering the terminology currently adopted, and more!

Only on the podcast that shares your stories about our profession. Brand the Interpreter!

Thanks for tuning in, till next time! 👋

Connect with Mireya Pérez, Host
www.brandtheinterpreter.com
Facebook
LinkedIn
Instagram

**Trailer** (00:00:00) - Welcome to the Brand the Interpreter Podcast. I am your host Mireya Perez, and this platform is dedicated to sharing the stories of language professionals that is the interpreters and translators from around the world. This show aims to highlight not just the profession, but mainly the people behind the amazing work. These are your stories about our profession, and this is the Brand, the Interpreter podcast.

**Host** (00:00:39) - Welcome back, language professionals from around the world to another episode of the Brand the Interpreter Podcast. This is Mireya, your host, and today I am extremely honored to bring to this platform a team of doctors who inspire today's conversation. A bit of a heads up, this episode is jam-packed with information, so be ready to break it down into chapters if needed, but don't miss it. Before I introduce our guest and today's topic, I'd like for you to pause your mind for just a bit and think about the words or images that come to mind when you hear the word limited. Matter of fact, say the things that come to mind out loud when I say the word limited. What do you think of? Keep this in mind as we enter today's discussion. Dr. Casey Lyon is an associate professor of pediatrics in the divisions of general pediatrics and hospital medicine at the University of Washington School of Medicine, and an investigator at the Seattle Children's Research Institute.

**Speaker 0** (00:01:38) - She completed her undergraduate degree in English at Princeton University, then undertook her medical training at U C S F with a Master's in public health from uc, Berkeley. She moved to Seattle for her pediatric residency training at the University of Washington and Seattle Children's Hospital, then stayed on for research fellowship, followed by a faculty position. Clinically, she sees patients and supervises residents and medical students in the primary care clinic and the newborn service at the UW Medical Center. She is an NIH funded health services researcher whose work focuses on healthcare equity, language justice, patient provider communication, and health system navigation. In her work, she partners with parents and providers to design interventions to improve healthcare experiences and outcomes for children's and families at risk for disparities, especially those who use a language other than English for medical care. She has methodological experience related to the rigorous evaluation of QI interventions with a particular focus on QI and healthcare equity.

**Speaker 0** (00:02:44) - She co-directs the health services and quality of care research fellowship and serves as program lead for patient navigation within the UW Cancer Consortium's Office of Community Outreach and Engagement. Dr. Desiree Ywa was born and raised in, in New York, New Jersey. She attended Binghamton University where she majored in neuroscience and graduated with a bachelor's of science degree. She earned her MD from New York Medical College and then went on to complete her pediatric residency training at Hospital Children's Hospital in Rhode Island. She is now a second year pediatric hospitalist medicine fellow at Seattle Children's Hospital. She is committed to advancing and sustaining equitable healthcare for underserved patients through quality improvement and medical education research. Through the intersection of health equity and quality improvement, she intends to improve language access for hospitalized patients and families whose primary language of care is not English. She is also passionate about developing anti-racist curriculum and medical training and promoting inclusion initiatives for underrepresented in medicine trainees.

**Speaker 0** (00:03:49) - Dr. Corey McDaniel is an assistant professor and pediatric hospitalist with the University of Washington School of Medicine and Seattle Children's Hospital. She completed her medical school training at Midwestern University, followed by a pediatrics residency and chief year with Advocate Children's Hospital in Chicago. She is currently a funded investigator with the Agency for Healthcare Research and Quality with specific interest in addressing disparities for children in rural hospitals. So without further ado, it is with great pleasure that I welcome to the show Dr. Casey Lyon, Dr. Desiree Ywa, and Dr. Corey McDaniel. Authors of the article Language Matters, why we should reconsider the Term Limited English proficiency,

**Speaker 0** (00:04:40) - Dr. Lion, Dr. McDaniel, and Dr. Yevo. It is such a pleasure to have you all here today to be able to have today's conversation that I feel our particular community is going to very much embrace. Welcome to the show. Thanks so much. Thank you for having us. Absolutely. Thank you. Thank you for being here. And I think that today's conversation is some something that we've, we've meaning the audience and in this particular podcast had touched upon here and there on a couple of occasions, very briefly, I've never actually gone into depth, uh, as to why other than there is a very short episode, solo episode that I had at one point with regards to this particular conversation. But the title of that episode was Words Have Power or The Power of Words. Right? And so in that sense, I was trying to convey the message of, uh, positivity in the words that we share, that we share, uh, mainly that we speak to ourselves.

**Speaker 0** (00:05:43) - But in that, I do remember mentioning or sharing that there was someone in one of the threads on LinkedIn. Of course, that's where I go for, you know, conversations such as these that, uh, they were recommending the change or the shifting out of the acronym l e p, right? And, and then they went into why they felt that limited English proficient, uh, had more of a negative connotation for the families that we serviced. And I thought, wow, that's powerful. I never, I never really thought about it from that angle. And so that is in fact what we're gonna get to talking about today by the, uh, co-authors actually of an article that I came across. And, you know, lucky you guys, I get to link the article in the episode notes because I was just sharing, uh, with the doctors that for the life of me cannot remember mm-hmm.

**Speaker 0** (00:06:40) - <affirmative> where I came across this amazing article, but I am so happy that it came across or that it fell on my lap. And the article is entitled Language Matters, why We Should Reconsider the Term Limited English Proficiency. And with that, I'd like to once again welcome you doctors to the show and begin by asking our very first question. I'll begin, uh, with Dr. McDaniel, if you're okay with that. Dr. Mcd McDaniel, just because you happen to be on top of the screen, <laugh> sitting right next to me, sitting virtually right next to me. If you could share a little bit of your background and, and then how eventually your work ended up with this particular community that for now, uh, LA later on we'll learn about what we could potentially be calling, calling our community or naming our community. But for now, how you ended up working with the L e P community and your experience with this particular community.

**Speaker 2** (00:07:36) - Yeah. Thank you so much for having us. Um, so I'm Dr. Corey McDaniel. I'm a pediatric hospitalist at Seattle Children's Hospital. Um, I'm part of the University of Washington here in Seattle. And at our institution we have a very broad referral basis of children who come to seek care at our hospital. Um, not just from the surrounding Seattle area, but the state of Washington and beyond. Um, we are the like number one referral children's hospital for a whole five state region, um, up here in the Pacific Northwest. And so we have a really wide diversity of patients and because of that, we take care of kids who speak many languages, um, many languages other than English, many languages and English. And so, um, working with children and parents and families, um, in a medical setting where we're communicating in a very stressful time, hospitalization is of a child is one of the most like anxiety producing times for families. And so learning how to communicate and how to support and how to explain in a high stress, high anxiety time with families becomes quintessential to actually providing good medical care for our kids. And so that's, uh, the milieu in which I became more involved in this work, uh, cuz it's part of everyday practice and taking great care of kids.

**Speaker 0** (00:09:19) - Absolutely. Now, before we continue, just to expand on the question, and this will go, uh, for everyone else as well, Dr. McDaniel, are you bilingual? Are you able to communicate directly in a specific language? And if not, what was your experience with attempting to communicate with this particular community?

**Speaker 2** (00:09:37) - Yeah, that's a great question. I am not bilingual. Um, so all of my interactions are with an interpreter. So either a phone interpreter, an iPad interpreter, or a video interpreter, um, Google Translate when we really have to, when we're trying to find more rare languages that we don't always have video interpretation for.

**Speaker 0** (00:10:02) - Thank you very much. I appreciate that. Yes, and I think that is important because of course, this particular audience is definitely the language professional in the, in the many different specialties, uh, around the world. And so there is absolutely a connection. I mean, I don't think anybody would've thought that there wasn't a connection, but we work the, these are the professionals, the doctors that we work hand in hand with on a daily basis. And, um, the fact that this conversation, uh, was brought up in an article by the doctors that are seeing these patients and working with the language professional, uh, I mean, I'm, I'm even more excited to, to continue today's conversation. So thank you Dr. McDaniel. Uh, Dr. Lyon.

**Speaker 3** (00:10:43) - Great. Yeah, thanks so much for having us. Um, my name is Casey Lyon. I am a general pediatrician here at Seattle Children's in the University of Washington, and a researcher based at the Seattle Children's Research Institute. Um, and I would say my sort of engagement with language equity work really started during my residency. I'd always been interested in inequities and sort of social justice and how we can really think about systems and leverage systems in order to make the world more equitable and more just. And it was really during my residency that I started to notice what a different experience families who used languages other than English had in the hospital. Um, and this was at a hospital that had, especially at the time, really good language access, really great interpreter services compared to most other places. And still our families were having a wildly different experience, um, just in not know, not getting updated, not understanding what was going on.

**Speaker 3** (00:11:55) - I frequently, um, I am certified proficient in Spanish, and at the time we didn't have a certification process, but I was frequently being asked to interpret for the medical team. And I am not an interpreter, right? Even with my certification, I can communicate my own ideas, I cannot interpret, right? It's a whole different skillset, as you all know mm-hmm. <affirmative>, um, that requires a lot of training in practice. Um, and so it, it really quickly stood out to me as one of the places where there are real disparities in care where we actually have a known intervention that we don't use as much as we can and should, right? Mm-hmm. <affirmative>. And so I, I think it, it very quickly stood out to me as a place where like, you know, healthcare disparities are complex and multi-factorial and multi-layered, and they start outside of the hospital and they continue in the hospital.

**Speaker 3** (00:12:51) - But this was one where it was like, wow, there's a thing we can and should be doing, which is partnering really reg partnering for every communication with our professional interpreter colleagues. And we don't, right? We don't do it to the extent that we can and we should. And so I think that was really where it sort of like lit, lit my, you know, social justice and health equity fire in terms of like, I wanna, I wanna figure out what we can do about this. And so that's actually also sort of really where my research career launched in thinking about like, okay, how do we understand what's going on here? And then how do we partner with our interpreter service colleagues and patients and families and other cl and clinicians to figure out like, what do we do about this? Um, and so yeah, so that's sort of where a lot of my research has been over the past decade and a half at this point. And it's something that, you know, continues to get me fired up every single day.

**Speaker 0** (00:13:52) - That's fantastic. Now I have to ask, just because you mentioned, um, residency, if you wouldn't mind defining for us what residency is, and then of course, um, with behind that, at, at what stage, if at all, was the cultural awareness piece brought into, you know, your, your beginning, beginning your practice, basically?

**Speaker 3** (00:14:16) - Yeah, sorry. Thank you. As I was saying it, I was like, I should define that, and then I <laugh> and then I forgot. Um, yeah, so residency training is essentially, um, we to, to become, so we're all board certified pediatricians and to get to this place, we did our four years of medical school, at which point we're a doctor, but we're not sort of, we haven't had any supervised practice out in the world. And so to pursue any sort of specialty like family medicine or pediatrics or surgery or anything like that, there's, um, supervised training. You're a doctor, but you are in a sort of structured training environment where you're being supervised by more seasoned people in that profession. And so residency for pediatrics is a three year, um, long hours, pretty intense work environment, um, where we're seeing lots and lots of different patients across all the sort of different, um, clinical care settings that one might encounter in pediatrics in this case. Um, so I think the reference, this is, this is a very dated reference at this point, but, you know, Grey's Anatomy or Scrubs, those give you sort of an idea of what, it's not actually nearly as fun as either of those, but, um, it gives you, gives you a sense

**Speaker 0** (00:15:35) - <laugh>, aw, I was gonna say Grey's Anatomy or, uh, what is it? The other one was my favorite was, um, doctor, was he, uh, House? 

**Speaker 3** (00:15:44) - It? Oh, House, yeah.

**Speaker 4** (00:15:46) - <laugh>. That's a good one. Yeah. No,

**Speaker 3** (00:15:47) - Not nearly as fun as either of those.

**Speaker 0** (00:15:51) - Now, was cultural awareness part of any, any of, of the training aspect, even after being at the university and now, now doing this supervised training? Was cultural awareness part of the discussion at any point?

**Speaker 3** (00:16:05) - Yeah, it, it was, and I would say, you know, I did my residency training between 2007 and 2010, and for sure we got orientation to interpreter services. There were discussions about sort of, you know, I don't think we were saying cultural humility per se at that point. We were talking about cultural competence at that point and sort of thinking about how do we understand where patients and families are coming from and then really try to sort of partner effectively with them. But I would say that the culture now and, and we're all still involved in supervising and teaching residents and medical students, and I would say it's very different now. There's, it's way more front and center. It used to be sort of, you know, like one lecture or one orientation session or a thing you that sort of got touched on, but wasn't really integrated into the training in the way that I would say it very much is now.

**Speaker 0** (00:17:03) - I love that. Thank you. That's important. And, you know, we'll come back to that later, but thank you so much Dr. Lyon. And last, but certainly not least, we've got Dr. Yevo here today. Dr. Yabo, if you can also please, uh, talk to us or share with us a little bit about your experience, how you got started, and of course, the direct experience with, uh, l e P communities.

**Speaker 4** (00:17:23) - Thank you so much for having us. Um, and apologies in advance if I have to shut off my, uh, camera at any point. Um, so I am currently, my name is Dr. I'm currently a second year pediatric hospitalist medicine fellow at Seattle Children's Hospital, um, affiliated with the University of Washington. Um, and how, I guess basically how I got interested in language, um, equity, um, out of the, um, the group here, I am the youngest in my career medical career, but I will say from, um, from the beginning, beginning of my medical journey starting in medical school, um, it was always something that was very important to me. I also, similar to Dr Line, have have always had a very like social justice oriented mindset. And that, um, started since, you know, basically college. Um, and so I've always been trying to find ways to improve the current, um, care we give to our patients, and ways that we can improve, um, disparities in care.

**Speaker 4** (00:18:28) - Um, and I come, so my, I am Ghanaian American, and so I grew up in a household where there are multiple languages other than the English being spoken. So I love the diversity of language. Um, it gets me excited. I wish I like, um, knew a lot more languages than I know how to speak and, and fluent in. And so it, I I feel like it's something to be celebrated in our patients. It's part of, um, what makes them who they are. Um, and as a physician and their, uh, who's providing care for them, I, I feel like it's my duty to, um, bring that into my care with them and appreciate that, um, aspect of, of my patient and their family. So I, I feel like it, it stems from a, a, a, a love of language and culture and then also this like, mix of social justice, um, that I, that I just ingrained in me at this point. <laugh>.

**Speaker 0** (00:19:24) - No, absolutely. And I think it, it's going to, will demonstrate in today's conversation how that is reflected and, and poured over into, um, the work. And now basically the message that you are sharing out with members of this community and those connected, which at this point could be anyone and everyone, right? Um, connected to this particular community. Um, and I, and I'm, I am gonna hold off on changing the name until we get to that point. So I will be referring to it as our l e p community, however, with the full intention of knowing that by the end of today's conversation, um, we will be changing our language. At least I will <laugh> and I'm hoping to convince others to do so as well. I'm gonna get started with actually getting into, um, the beef of today's conversation, which has to do with this particular article, um, that just had me super excited and, and made me cross my fingers that if I invited, uh, the authors of this article, they would consider my invitation.

**Speaker 0** (00:20:27) - So in December of, uh, 2022, your article language matters why we should reconsider the Term Limited English proficiency was published in the Journal of Hospital Pediatrics. And like I said, it, uh, it definitely caught my eye. I, I feel that, that that particular term, uh, limited English proficient and the change behind it, or a drive behind it kind of reminded me of a different area in education actually, in which they're already having these conversation for our English learners. Um, and we'll get to that in just a bit, but, uh, I'd like to read an excerpt from the article that I felt, you know, it, it, it really hit, um, in terms of what made that connection for me. And you stated that the label limited English proficiency, and, and I quote what what this piece here, the label limited English proficiency, l e p, has been widely used in clinical care and research for decades.

**Speaker 0** (00:21:29) - It is time to examine the negative connotations embedded within this terminology and propose new terminology that reflects a respectful and responsive approach to providing high quality care regardless of patient's language needs. And it struck me because the words that that highlighted there for me were terminology that reflects a respectful and responsive approach, right? And at the beginning of today's episode, I posed the question of what comes up to you when you think of the word limited, and just, you know, what, get, get us starting into thinking in that way. So I'd like to begin then, today's, uh, questions, uh, about this particular AR article, doctors with a little bit of background perhaps on the term l e p, if, um, and this is for whomever would like to, uh, give a response to this first question. When was the term l e p first coined?

**Speaker 4** (00:22:32) - Um, I can take that. Um, so initially was first coined, um, by a, through a Supreme Court case in 1975, um, called, uh, LA versus Nichols. And basically, um, the Supreme Court, um, basically, uh, with that case decided that there was a lack of supplemental language education for students in public school, and that it was a violation of the Civil Rights Act. Um, throughout, uh, decades following the term has, um, evolved and, and been used in, um, our government, our government system, particularly with President Bill Clinton's executive order in 2000. The, the term was used, um, to require federal agencies to examine the services that was provided by the government, um, to those who had, at that their, the term they used had li limited English profic proficiency. And just so to, to define what that term is, according to the executive order, um, put in place. Um, it, it defines an individual who does not speak English as their primary language. And within that definition, they also state that it's someone who has an individual who has, has limited ability to read, write, understand, or, uh, speak English. Um, so that's how the term came about.

**Speaker 0** (00:23:53) - So there was no actual necessarily, as far as we know, at least, uh, research with regards to the community. Someone coined it, someone used it, and then, and then it just trickled from there. It snowballed. People continue to use it. It reminds me of the story of the fish. Have you guys heard that story in which, uh, the daughter asks the mom why she cuts off the head and tail of the fish? And the mom responded, um, well, that's the way my, my mom taught me. So the daughter goes and asks the grandma, why did, why do you cut the tail and head of the fish? And she says, well, that's the way my mom taught me. So they go and visit great grandma, and great grandmama thinks for a while after they ask her, and, and she responds, well, the pan that I had didn't fit the entire fish, and so I had to cut off the tail in there,

**Speaker 4** (00:24:40) - <laugh>.

**Speaker 0** (00:24:41) - So it's kind of like the same thing. There's really no necessarily, you know, a research or study or anything done in order to quote unquote label this particular, this multilingual community. It was just limited English proficiency. Mm-hmm. <affirmative>, uh, I'd like now then to ask in what ways, just so that we can get an understanding of those that maybe potentially have not made that connection yet. In what ways does the label limited English proficient evoke negative connotations?

**Speaker 4** (00:25:10) - Um, I can start it off too, and then have the rest chime in. Um, I think that it, the main thing that I think that is, is very challenging about this terminology is that you asked about the use of the word, like limited, right? When I, um, think of that word, I think of, um, deficit, like something lacking, right? Um, and in a lot of these patients, uh, are multilingual patients and their families, um, they, a lot of them, like we say, they might not speak English, that a lot of them will speak different languages or some, some of them are multi multilingual. To me, that's not a deficit, right? To me, that is actually, like, that's amazing. That's amazing that you speak, you know, a different language than me. It's, it's amazing that you can speak multiple languages. Um, and my job as a physician is like, how can I best support you?

**Speaker 4** (00:26:03) - How can I best communicate with you in your language, um, to provide the best care? So when I, when I hear the word limited used with anything with our patients, like in, in that, to me, it, it, it's just like a, it further stigmatizes that population and further reinforces that like that English is the primary or like ideal language that you must speak in order to get the best care in our society, which I, I am, am against. I don't think that that is true or fair, um, to our population. So I think it just further just marginalizes our multilingual, um,

**Speaker 3** (00:26:42) - Patients and their families. Yeah, I think I, I absolutely agree with everything Desiree just said. And I think that, um, you know, when we focus in that way on limitations, it changes the way we think about what we as the clinicians are sort of doing, right? It makes it seem like they need something extra and different from me rather than it being part of that normal frame where, rather than it actually being about like, well, I don't speak Vietnamese, so just like I'm not a cardiologist and if I need cardiology expertise, I'm going to, you know, talk with my cardiologist colleagues who have specialized knowledge and training in that field, right? And similarly, if I have a family that speaks Vietnamese, then I need to actually pull in a colleague with specialized training for that. But that's not how we think about it. When we frame the, when we frame the family as being limited, that makes seem like, well, they're lacking something and then, well, there's something I could do extra to try to address that, but I'll do it if I have time, or I'll do it if, you know, but it's gonna put me out.

**Speaker 3** (00:27:56) - Right? And so I think there's a really important way, and we don't think about like none of it's conscious, but I think they're really important ways that when we're framing it as like a real deficit in the family, it changes our whole relationship to how we respond to it.

**Speaker 0** (00:28:10) - Well, I think that's important too. What you just mentioned Dr. Lyon, is the fact that it's now at this point, it's a such a subconscious, um, approach or thought about this particular community just because of the power that word now has. It's already created a narrative in everyone's mind. And I almost feel like you gave the perfect example when you hear you, you're about to, you know, see a limited English proficient patient. You're coming in perhaps with the approach of, I already have something that I'm not going to be able to give this patient. Right? Like, there's already like this sense of lacking even perhaps even in the individual that's supposed to show up to see what can I do to support or to help, you're already coming in as well. I don't have already have something that they're going to need, which in this case would be the language. Dr. McDaniel. Yeah,

**Speaker 2** (00:29:02) - I, I was just going to add to that, that that is felt and experienced by our patients and their families too. Like they feel then that they are the ones that are deficient, that they aren't bringing something to the table, and that because of that, that they aren't going to get good enough care. And that is really negative, you know, that perpetuates challenges in providing excellent care because they're perceiving our deficiency as their deficiency because we've created a system that makes them perceive that. And part of why changing the system level of how we approach this is so important because it's not just me changing the words I use or Dr. Yabo changing the words she uses, but it's actually changing how we as a system approach patients who speak languages other than English, so that the deficiency isn't internalized by them when they're receiving care in our institutions.

**Speaker 0** (00:30:04) - Go ahead,

**Speaker 4** (00:30:04) - Please. Yeah, I was gonna say that's really good. And I wanna expand on that even more, like the fact that patients do really feel like this, like almost like a burden countless times. Like in, I've only been practicing now for like, what, four and a half years, um, that patients who speak another language other than English, it's, you know, when you're, when you go out of what, I mean, it's not even going outta my way, it's my job. But when it's, to them, it seems like going out of the way to like, bring the, bring an in-person interpreter or like have this, you know, whether it's like a little brief two minute conversation to update them in the afternoon about their child. It's almost like, oh, no, no, no, no, it's fine. And I don't need an interpreter. And I think it's like, it's that the, the system in itself, like it's almost makes them, them feel bur burdensome by having this other language that, that like, oh, the doctor has to go out of their way to like do this extra thing. You know? And so I just wanted to echo what, um, Dr. McDaniel said that the, the real impact that the patients feel, because I think we've all experienced, um, experienced it.

**Speaker 3** (00:31:09) - The, the thing that I would add onto that is that actually part of the process of changing the language that's used throughout Seattle Children's from l e p two language other than English, um, involve talking to community members. And, and they told us these things, right? They told us, yes, it feels stigmatizing, it feels bad, it feels like I'm a burden. And we were then able to run by, I I'm probably jumping the gun here, but, um, we, you know, we were, we were able to run by a number of different alternate terminologies and get community input. Um, and, and I think that's just such a crucial piece of understanding, like what we say about patients and families, they hear and they feel, and it ch and we hear and we feel, and it changes everything about how we interact with them.

**Speaker 0** (00:32:01) - Yeah, most definitely. I've, I've not had in interactions in, in that same role as, uh, any of of you ladies, but I feel I'm feeling the words right now. I'm, I mean, I was even in a little like emotional in thinking, you know, what Dr. McDaniel just said, which is their perceiving our deficiencies as their deficiencies. That was powerful to me because it's, we haven't even yet interacted with the patient, um, or the client or the family. And this is already, we've already created, you know, how we're going to walk in and interact with, with the families. So I wanna further expand on, um, how the, the term limited English proficient influences a clinician's perspective attitude or, you know, behavior towards an L e P patient.

**Speaker 4** (00:32:58) - I think it, we had kind of already, um, started talking about it, but, and how it affects our behaviors as clinicians. Um, but I think having the, using the terminology limited English proficiency, uh, puts that language in this like deficit framework, um, as we were mentioning, um, in that, like, it, it puts the attention solely on the patient's limitation, right? Um, rather than like, there be like, rather than it be a collective need, right? Because it's, it's, I, I, as a clinician, if, if my patient speaks, um, for instance, French, right? And that is the only language they speak similarly, like instead of, I I, you can label me as a limited French proficiency, right? Like, I don't speak French fluently. Um, and I just think that when we frame, like when we put the, um, limit, when we use a terminology limited English proficiency, it, like, it frames the language in like the patient is lacking something instead of the fact that the truth of the matter is both people need to be on the same page and speak, you know, communicate, um, using an interpreter.

**Speaker 4** (00:34:14) - And we are both like, um, we both need this communication tool to better understand, um, each other. Um, so I think that, I'm trying to think of a particular example per se, but I just thinking overall, like when we, when we are taking care of our, um, multilingual patients, you know, we work in a busy system, like we are constantly busy, um, especially those of us who work inpatient. Um, and so time is, is is often a barrier to being able to deliver the, the best equitable care in, in, in, in all areas. And especially with language access. And I, I think that sometimes, um, if we, if the system, if the structural system has, is placing the sole onus or responsibility on the patient is lacking something, there's often like, oh, I'm trying to find a better word than giving an excuse. But I think it kind of gives us an excuse as clinicians to just be like, well, I don't have the time for this. Like, let me just kind of find the easier way out. Um, sometimes. Um, so instead of, I think recognizing that it's more than even just the individual, really, it's like this whole system really has to make the necessary steps in order to really value language as an important clinical tool for both the clinician and the patient. So I think in, in summary, I think it puts the onus on the patient instead of the hospital system in really valuing language and equitable language access.

**Speaker 3** (00:35:49) - Yeah, and I think to, to build on that a little bit, that, um, you know, we all as humans have biases and we all, like our brains use stereotypes as shortcuts, right? And especially when we are busy mm-hmm. <affirmative> tired and like cognitively overloaded, our brains use these shortcuts more often. And when we lead with something like limited English proficiency, right? That is going to call up a certain set of biases and stereotypes about who and where, like where that family is coming from, what that patient or family is like. And often things like l e P are linked in studies and the way people talk about things with lower health literacy or limited education or limited financial resources, right? And so I think one of the real problems is it calls up this image before anyone has even stepped in the room of a family that may have a lot of needs.

**Speaker 3** (00:36:57) - And then that influences not only, right, the, our, our biases and stereotypes influence how we act, but also we influence what options that we offer to a family. We may automatically start making assumptions about their degree of education, which then makes us make assumptions about how involved they wanna be in decision making, right? And so we may not offer them things like participation in shared decision making because we may think like, oh, they probably aren't going to be able to do that, right? So I think there are all of these ways that these, these sort of stereotypes that we have that are informed by the way the language gets used and the way different terms get coupled frequently, that then really influence, you know, their studies about, um, what, what sort of options people are given, even in terms of study participation of clinicians excluding families from participation in a study based on largely assumptions about what would be good for that family rather than actually just offering it to them. So I think there are lots of way, right? So I think when I think about the specific examples, it's sort of that that chain of stereotypes and linked stereotypes that end up really changing everything that we do. And I think a lot of that happens before we even step into the room because all of these biases get activated immediately and subconsciously Yeah. Unless we're working really hard to overcome them,

**Speaker 0** (00:38:28) - To overcome them or understand it in a different, you know, in a different way if it's embedded in the system differently, perhaps. Right? Because now now you're following that, that systemic approach that's, that's created inclusivity, right? Rather than, than excluding or in, in your particular, uh, example, Dr. Lyon, I appreciate it very much the fact that we're already thinking in limited terms, right? Like, oh, we have to condense, you know, condense the options because we, we feel that it might fit this particular audience better, um, without really even yet understanding what the needs are. That was so important. I appreciate that. Thank you so much, Dr. McDaniel. I think you were going to add as well.

**Speaker 2** (00:39:09) - Yeah, I don't remember the specific example I was gonna share earlier, but I, building off what Casey was saying is, you know, we think about and talk about intersectionality in regards to race quite a bit, um, but it absolutely applies with language as well and all of the, you know, challenges that when we start to layer things on top, um, make it even harder for patients to interact with our system, uh, as in the medical healthcare system in general. And I think that we as providers do, like when you hear limited English proficiency, you are absolutely assuming things about a patient that you actually have no idea whether or not that is true. And I, you know, Casey brought up the example of education and I, that is, I think very strongly linked with that term as well, that you're assuming that your patient and or their family does not have high levels of education, which that is a complete assumption that you do not know before you have talked to the family. And even if you talk to the family, you still are making assumptions and the intentional, like decoupling of that like assumption is really important to providing care.

**Speaker 0** (00:40:29) - Thanks so much, Dr. McDaniel. I'd like to, in addition also talk about how this negative connotation may also guide the work of the organization on addressing the needs of these communities. So now shifting the focus from an individual point of view to an organizational point of view,

**Speaker 3** (00:40:49) - I think that the, um, right, the sort of the term l e p has a, has a definition that is based in the US in the US census question. And so, right, so it started as, as Desiree described, and then has been sort of codified in US census. And that's also where a lot of the sort of national statistics come from, and that's the terminology they use. And I think in some ways the fact that it's all like really grounded in this sort of legal framework, I think from an organizational perspective, and I don't know, right? I am not sort of a hospital leader, but, um, I, I suspect that the fact that it's all really grounded in this sort of like government driven organizational framework, maybe oriented around like, what do we need to do to not in, you know, not actually, um, end up with a civil rights violation suit, right?

**Speaker 3** (00:41:50) - So, so I think in some ways, rather than actually really framing it in, in the way of like, what are the particular unique, um, skills and, um, strengths and needs of a family, and then thinking about how flexibly as a healthcare organization, we, we figure out how to deploy our services to meet those, um, which is the way a lot of the sort of more medically oriented services are thought about, I think it actually keeps it more in sort of a legal, a legal framework, um, for a lot of places. Um, and I wouldn't say that's necessarily true at our institution, but I think broadly that is sort of the, the place that l e p lives for a lot of organizations nationally.

**Speaker 0** (00:42:35) - No, that makes, I mean, that makes perfect sense. How do we, if you, if you're already thinking about just the term itself, you know, and, and the negative connotation to that, you can see how it's reflected in just the thought process of how do we not get sued <laugh>, you know, it's already that it's already a negative, um, you know, way of thinking with regards to this particular community. And I think also, uh, Dr. Yabo mentioned it earlier that perhaps it's not even so much about, um, the, the, the service in itself or the language aspect in itself, perhaps, you know, I'm just throwing it out there, but a lot to do with the time aspect, right? It's going to take longer. This is going to take, you know, uh, take up more time because of X, Y, and Z. So it's a lack of understanding.

**Speaker 0** (00:43:25) - Most definitely. I feel, and I think in your particular situation for, um, the, your, the hospital, it's, they've embedded a culture now in which they are approaching the need from the beginning and, and bringing in the right people at the right time to the conversation. Is there more work to be done? Absolutely. I think, and it goes back to just the term itself, right? But, but I think that it, we begin to shift, and especially when they're open to these discussions such as the ones we're currently having, just the way in which the communities are viewed, and therefore, um, the way the systems or the policies that are created as a result of that, I think it's, it's super powerful and why it's important that we have these conversations. Thank you. I didn't mean to sound like it was the same question, you know, just, uh, phrase in a different way.

**Speaker 0** (00:44:14) - But I think that it's important that as language service providers, meaning not the companies, but the individuals are providing this service as interpreters and translators, we also understand how this, this, uh, is reflected in the systems in larger systems such as the hospital setting, right? In, in the children's hospital. We're working with the families there as well, with the children and the families there as well, and also healthcare providers, because we're also ha talking, uh, constantly about having these conversations amongst everyone. Language access is everyone's issue, not only the department of T N I or the interpreter and translators, right? So, um, I just wanted to make sure that we, we saw it from different angles and what that could look like and so much conversation and so many examples with, with such a simple term or so we thought perhaps right? <laugh>, so in the conversation, or excuse me, in the conversion of meaning, meaning from la one language to another context matters when we're thinking about we're we are going to interpret or translate, we're always thinking or must be thinking about context, right? In order to, uh, appropriately place, uh, the, the, the meaning behind the message. In your point of view, would the adaptation of a more inclusive term be enough to change clinician attitude and behavior towards patients? Or should it be paired with another topic such as, for example, cultural awareness or cultural competency and embed the change of a term? Because I feel like it's just the term by itself and changing the way. Is that going to change the mentality, or should we be embedding another conversation to that?

**Speaker 4** (00:46:04) - This is a really, really good question. Um, I think that it is a great first step. I mean, well, it's not the first step, it's a good additional step, right? Um, but as Dr. Lyon, uh, stated earlier on, um, this is a multilayered, multifactorial, uh, approach, uh, to delivering equitable care in general, and then specifically in the domain of equitable language care, um, to our patients. Um, I think that it is, there are mult, there's multiple facets and layers that go into it. Um, but I think anytime that you really want to inc like really bring systematic change to anything, I think starting with or, or focusing on terminology is a great, um, great tool, right? Because if you can start to, um, you know, consider in the ways that the, the terminology that you've been using might be, um, exclusionary or offensive or harmful in any way to patients, um, I think that it one gets, you know, it gets everyone talking and, and it, it also in turn like helps to start to change mindsets and start to, to, um, uh, bring new ideas on how, how we can overall provide better care, um, to, um, to these patients.

**Speaker 4** (00:47:34) - And so, although I don't think that it is the sole thing that is going to change clinicians' behaviors, um, um, and attitudes, I definitely think it is, uh, a vital importance for us to consider the terminology that we're using with, um, patients who speak in another language other than English. Um, I do think topics, I mean, pairing it with topics such as cultural humility, um, I know, I mean, here at Seattle Children's there are, um, courses that, that all providers have access to specifically for, um, language access. Like how to use an, like, how to work with an interpreter, not use, sorry, how to work with an interpreter. Um, like, so there's that available too. And I think that it, so basically what I'm trying to say, it's like the educational tools are also as important as like us changing our terminology, right? Like, that is a good, that is a good step and it's a good, it needs to to happen, but also you need to, in order to change people, you need to empower them with like knowledge <laugh> and, and educate them so that they know like what to do. And so I think that that piece is important. So having, um, mandatory or, you know, or at least accessible education about how to work with interpret interpreters, the importance of language, um, uh, interpretation for our patients, I think it definitely should be paired with some educational tools for, um, clinicians and trainees across the board.

**Speaker 2** (00:49:08) - Dr.

**Speaker 0** (00:49:08) - Lyon, Dr. McDaniel, anything you'd like

**Speaker 2** (00:49:10) - To share? Yes, I would just add that anytime you're trying to influence system change on a larger level, you need kind of anit to start to engage around. And, you know, we talk a lot as a medical community about not using medical terms with families and having, you know, clinical conversations using everyday language. And so we're kind of used to thinking about things in one way and then having to change. And so in some ways it's an approachable way to start to realize that there is actually like systemic oppression essentially, and how we treat patients who don't speak English. Um, and shifting that mindset in our words can help to influence on a system level than how we begin to approach it. It will not fix the system things. You know, Casey talked about a whole bunch of things, not to totally go down a rabbit hole, but hospitals, healthcare is financially driven in this country. And framing, you know, working with interpreters and needing for services and all of that, uh, from a financial model rather than from the like basic medical care we provide to patients, model influences, then, you know, we just get so ingrained on a system level for how we approach this. And so I bring that up, not because we're gonna change that with changing our words, but because changing our words allows us a place to start a conversation.

**Speaker 0** (00:50:44) - Hmm, indeed. Now let's get into how do we change this then in addition to, or what should we change this to? And in addition to, I feel like we've understood the importance and the heaviness of such a simple term we think, and what this has done throughout the years, if we go all the way back to the Lao versus Nichols case, and, uh, for those of us that are in education are very familiar, uh, with that case, uh, it's, it's a, it's a constant case that is brought up when we're talking about what shaping or what shape language access laws in education and the services. And so we see that it, that's not the only thing it changed, you know, it helped to shape understanding these communities or the thought of that we're thinking that we understand these communities. We can see or begin to see now that it goes beyond just the, uh, language services and how we are going to appropriately provide them.

**Speaker 0** (00:51:44) - Uh, in your article, you do propose a new term and, and I feel like this term somehow I came across it again on LinkedIn, <laugh> more uncertain, which was, which is what inspired that that one episode, um, you're proposing the, the, the term to be. Of course, you know, I'm sure there's other stuff out there as well, but I really appreciate this just because even in the way in which it made me think of these communities and that term is language other than English, right? Or l o e. Let's expand a little bit on the benefits of adopting a new term such as this one.

**Speaker 4** (00:52:21) - Yeah. Um, first off, I'd like to say that there, there is currently like no consensus across the board, right? I think that, um, if you go to a different institution, they might use a different term other than, um, L OE or Lang, like as you stated language other than English. Um, I think the, the, the, the main thing that I want us as we are considering our, the viewers are gonna consider is that in all of this, as, as terminology changes, I think we, we should always like have the input of the population that it is, you know, directly infect, affecting, and like their input should also matter, um, you know, throughout the years as terminology may, may change again, right? Um, but l o e, um, is what we currently use here at Seattle Children's. Um, you think it, it definitely, you know, we talked about the L E P has this deficit oriented language in it.

**Speaker 4** (00:53:17) - Um, so having that removed from that, it doesn't have this, um, it kind of re removes that connotation, um, as seeing a patient or, or, and, and their family is an, uh, a limited ability or deficit, uh, ability. And so, uh, as we've mentioned, like that can help, you know, to change some of that behavior, um, that clinicians and hospital staff have, um, when caring for, um, patients who do speak in other language other than English, and really, um, hopefully I'm, I'm hoping it drives, you know, the, the mindset and change to involve interpreter use throughout all assets of their care. Um, and that the stresses the importance of language communication, like I stated earlier, that it's, it's, it's necessary for the patient and necessary for the clinician as well.

**Speaker 3** (00:54:12) - I think the, the thing I would add to that, um, which was said so well, is that we also talk about, so when we're, you know, in a little bit of a broader sense beyond just the l o e, we also, we talk about a patient's or a family's language for care. And I think what's part of what's really important about that is it highlights the fact that language comfort and ability and preference is really context specific. So that's another problem with l e p, it is like, it is sort of like a top line description of someone's English proficiency, but actually language proficiency and language comfort is different in every single setting of somebody's life, right? And so I think it's really, and this is actually a place where I think clinicians get into trouble when we think we can assess somebody's English ability by talking to me, right?

**Speaker 3** (00:55:13) - We go in and we start chatting, um, and we're like, oh, they speak English, right? We're just gonna do this in English. They totally understand me. And I think, um, that talking, really thinking about language other than English for medical care helps us understand that actually, like the language you use for your medical care may be different than the language you use very comfortably in other settings. Because medical terminology is different. That, and stress levels when you're in a medical setting are different. And so I think that's actually another really important piece of this shift in terminology.

**Speaker 0** (00:55:49) - That's an excellent point too, Dr. Lyon, uh, with regards to either them or the provider, right? Um, they speak English good enough, right? They, they speak it well enough. We heard that often in, uh, sometimes in the school settings with teachers. Well, um, they're not fluent, but they speak well enough, or I speak their language well enough. And then when you asked the patient or the family what was understood, nowhere near <laugh>, nowhere near what the message that was trying to be conveyed, I believe it was Dr. McDaniel that talked about this earlier too, with the way in which the, the different professionals or the different providers, excuse me, are even speaking with the patients or the families or the client, uh, in the high register jargon, which even if we keep it from English to English, half the time is not understood. We don't understand it even in the same language right here. So yeah. Let alone in trying to make that into another language or create that into another language. Dr. McDaniel, did you wanna add anything to this particular question?

**Speaker 2** (00:56:58) - I think it allows for flexibility among family members too, right? Because, you know, within pediatrics, a lot of times most of our communication is not only with the patient themselves, uh, you know, depending on the age of the patient and what's happening with them, but with their families and depending on who's at the bedside. And there are often differences between caregivers and family members, um, between their own preferences and what they can and cannot understand and prefer to communicate in. Um, and I think changing the, when you have, when you use the term l e p, it kind of just is like a label that goes in general, like, oh, this is an l e p room, or that's an l e p patient versus when you're thinking about like, preferred languages of care and languages other than English, then that allows like, well, maybe mom is comfortable and states she is comfortable having medical conversations in English, but dad actually, you know, prefers having conversations in Somali, right? And so it, it allows for a lot more flexibility, uh, in communication with the family as well.

**Speaker 0** (00:58:11) - Absolutely. I, I feel like e even just in today's conversation and when we're thinking, Dr. Lyon mentioned it just now, uh, in the approach of how we even identify or assess the language of, of the multilingual community or the languages of our multilingual communities in the school setting, for instance, it's checked off on, uh, what's called a home language survey. What is another language or what language is spoken at home? While that seems very innocent in its approach, the families have identified amongst themselves, they speak amongst themselves, not to include a different language on there, because if you do, the student will be placed. And what they feel is, you know, they, they're separating the child from regular mainstream, and it's going to be, you know, not, not a good thing for the students. So they've already made the connection and by word of mouth, you know, we'll go in and they'll say that there is no other language.

**Speaker 0** (00:59:13) - And because of this one question, this is an education, right? Because of this one question. Um, there's so much, much, so much, so many other things that occur. For instance, they will, they will check off that there is no other language, which means then you therefore, as a family do not need communication in your home language right there because you've checked off that there is no other language. The child now is, uh, not categorized as an English learner, or I should say it's, is not assessed because that, that is supposed to automatically place the child in, you know, some sort of, um, English assessment, right? To determine the level of proficiency. So there, it's like, it's like a double-edged sword there, right? It's like if you, if we do this for some reason, for some reason families have associated this with, it's a negative thing.

**Speaker 0** (01:00:05) - And so it takes education on behalf of, of our educators, of our administrators to make a difference. But it's just one question on this home language survey. So I also feel that this conversation about even the way in which we approach the systems that we create in support of our families makes a difference just by even changing one term language other than English. I, I feel it, even me when I say it, I'm, it's more of an expansion. There's, there's more than English, right? And so, oh, how do I, how am I able to communicate or make sure that I'm communicating the right message? Completely different feeling absolutely. Than the term limited English proficiency. And I think it's so, so powerful, and which is why I feel I made such a connection with your article. Um, like I said, I had, I had seen it briefly in, in something else, um, not as detailed as I read in the article.

**Speaker 0** (01:01:06) - And so for that, I'm very appreciative that as the authors, you took this opportunity to put this down and really sharing it, uh, out there for others such as myself, to begin applying this in our daily conversations. I'd like to open it up now just for, um, an open discussion on this specific topic. What is the article, uh, created or allowed now for in terms of conversations in addition to being invited to, uh, this little, uh, humble, small podcast of mine? What other conversations has this led to or open up to in order to, to really get into the conversation with potentially other colleagues, if any?

**Speaker 4** (01:01:48) - Um, so I, one of the things that I've been hearing, which I makes me feel really great, um, is that, um, some, some of the attendings that, um, I work with here have, uh, shared with me that they've shared on rounds with their residents, um, about this topic. And I was like, that's great. That's awesome. Um, so I think that, um, this is, this is why we, why we do commentary pieces, why we do research. It's to, you know, to keep conversations going to, to, um, you know, have new ways of, of thinking about things and, and challenging and challenging kind of, um, things that maybe need to be outdated, a little, uh, that are outdated and need to be changed. And so that, that's been something that I've, uh, recently heard about, um, since this, uh, this commentary piece was published in the hospital pediatrics, um, um, journal that this article is being used to as a teaching tool, um, to teach trainees, which is

**Speaker 0** (01:02:46) - Great. Definitely. Yes. Go ahead, Dr. McDaniel, please.

**Speaker 2** (01:02:50) - Uh, I was just gonna say that resulting from, uh, EZ Desiree's article is that the Journal of Hospital Pediatrics actually changed their policy around articles that discuss, uh, anything in regards to language that they will no longer publish the term l e p, but that they prefer that they will use terms such as preferred language or language other than English for their publications. And that directly resulted from this article. That's, so that's a pretty big deal for the whole journals

**Speaker 0** (01:03:25) - Very big deal. Such a, such a large hospital, um, to, to acknowledge not just the work, but I think acknowledge its effort, the effort right, of the intention rather of what this means. I feel that that's, that's huge for anyone. Um, and it is about, uh, this is why I'm always sharing on a podcast. It's, it is about sharing this and, and it is about sharing these messages with others that it serves us no purpose to learn something and then keep it to ourselves, because you never know how far you know, your message can reach. And so in this case, I know I am, uh, I mean, I, I, you know, I've expressed it over and over, but I'm just so grateful that I came across it and of course, so grateful that you said yes to having this conversation. Dr. Lyon, is there anything further you'd like to add with regards to this particular article or anything in general?

**Speaker 3** (01:04:22) - Yeah, I was just gonna add, sort of building on what Corey pointed out about Desiree's article, changing the whole policy of hospital pediatrics. Um, I've heard from a lot of national colleagues that they are really excited and grateful to have a new term. I think people have been really feeling the tension of not, not, not feeling like l e p was respectful, but not knowing what to use instead, and really sort of struggling in that space. And so I've actually heard from a lot of folks and seen changes in groups across the country, um, in the way that they're talking about these, these patients and families. And so it's been really, you know, I've been, I've been doing research for a while and it is uncommon to see a single article get this sort of uptake

**Speaker 4** (01:05:17) - This

**Speaker 0** (01:05:17) - Quickly. I think it just comes to show you too that what we believe sometimes, that the message we have to share, who's gonna wanna listen or who's gonna be interested or, and, and all it takes is this, this little pebble thrown in this large pool to create a ripple effect. And we can see it here, you know, in, in all sorts of different directions that this two page, uh, commentary is, is creating, right? It's, it's, I mean, from organizational change down to, you know, community interpreters to, you know, colleagues in the same field, all they needed was was that quote unquote permission to use something different because they, you know, that term wasn't resonating and now you've opened the doors to the opportunity to even just shift the terminology. That's huge. Doctors, that's huge. Mm-hmm. <affirmative>. And I am just very grateful again, that you were open to having this conversation here at the close of every episode on the podcast. I allow the opportunity for recommendations from the guests that are on the show, on the topic that we're discussing. And so I would like to ask you what recommendations you would be able to give associations maybe that lead these, these discussions, committees that talk about, um, these particular issues, the administrators, whether they be in health or any other organization that are thinking about bringing a seat, uh, to the table and having this conversation on language. What would you recommend with regards to this particular topic?

**Speaker 4** (01:06:56) - Uh, such a great question. I think, um, for me, this goes, this goes to, um, kind of echoing myself on the statement I said prior that, um, the families, the patients and the families who are most affected by, um, disparities in language access, they need to be at the table <laugh>. Um, they always need to be at the table. Um, I feel like that is, um, it's vital. It's vital because like I said, they are the ones that, um, are gonna be most affected, um, by this terminology. And, um, my, my hope is that committees, uh, whoever listens to this, doctors, clinicians, trainees, that we always keep in mind that it's important to have input from these popula the, uh, individuals who are, uh, who are, who require, um, a language other than English in their medical care, um, multilingual patients and their families. I think it's important and vital that, um, that their input is always taken in, is always considered, um, when making any changes in policy, whether it's hospital policy, whether it's federal policy, um, I think, think it's important to have, um, to have them at the table.

**Speaker 4** (01:08:18) - Um, and I think overall, I I, I, I hope that, um, you know, with this, with this publication in hospital pediatrics, that I, I hope that other journals too, right? Like you, I think ho Hospital Pediatrics is, uh, really de uh, you know, committed that, that they're going to change that, uh, the terminology. And my hope is that, you know, this is goes beyond, um, even within pediatrics. It goes to other, there's other publications, um, in our, in our field and even outside our field, right? We, you know, medical field has so many different, um, specialties and, um, my desire and and goal is that across the board, um, in all specialties that this is the con, these are the conversations that we're having, um, when it comes to language equity and how we can provide better care to our patient.

**Speaker 2** (01:09:09) - I guess to just share some big picture reflections that I think, you know, getting you referenced at the very beginning, your solo podcast previously about words are powerful and, you know, the title of our article was Language Matters. And I think that regardless of organization or setting, if you are having conversations around terms that are framing something in a negative way, you know, limited or restricted, or not necessarily just language, but in regards to anything to pause and consider, who are we putting that restriction upon? And if we're putting that restriction upon another person, then we should pause and think about what the implications of that are, and is that what we actually want to do or do we need to reconsider and shift to the frame? And I think that goes for language, but I think that there's also broader implications in other, in other applications as well.

**Speaker 0** (01:10:15) - Thank you so much. Once again, I sincerely appreciate the opportunity to have this particular conversation. I think it's important, and I think that this message needs to reach all involved in any aspect of language access and language justice and language equity. But I think just a conversation in general that even it trickles down to, let's say, the teachers that are working with the students that can emphasize the importance and the beauty of our students' language that's other than English. So that even students as they're growing up and are working in the systems, um, within their communities or, you know, just anywhere for that matter, that they are also honing in and really appreciating, rather than trying to suppress that language, uh, that they're also appreciating and, you know, embracing the language that is from their families. Uh, my dad once told me, I don't have money to leave behind when, when I die.

**Speaker 0** (01:11:18) - What, what I have for you is my language. And I'm hoping that you pass that on to your generations or the generations that follow. So I very much appreciate, um, Dr. Yaba, Dr. Lion, Dr. McDaniel, this conversation and this opportunity, and I hope that you continue talking about this for years to come. Thank you so much. Thank you for having me, so much for having us and for you the audience. I am hoping that this shifts your terminology and that we no longer are utilizing in our own vocabulary, the term limited English proficient or l e p, and we adopt something more positive, such as what the doctors have proposed language other than English. Thank you so much for joining us. Hey, thanks for sticking around to the very end. If you'd like to connect with me, head on over to the website brand the interpreter.com, and click on the Connect with me tab. You can also stay connected on social media, Instagram, Facebook, YouTube, as brand, the interpreter, or Media Perez on LinkedIn. Till next time.