A Talk with Ines Olmos on Barriers in the HealthCare System

This is the transcript of a German Language podcast. With the specialist Ines Olmos I talk on barrieres in the health System.

Domingos: So welcome to a new podcast on digital accessibility. Today I have another exciting guest with me: I'm talking to Ines Olmos about the topic of accessibility in the healthcare system. First of all, thank you Ines for taking the time for this podcast.

Ines: Yes, thank you very much for the invitation and also for your time.

Ine's background

Domingos: With pleasure. As always, we start with you briefly introducing yourself to those listening.

Ines: I'm Ines Olmos, I'm a physiotherapist by training, I also worked practically for many years, then I studied to become a health scientist. Now, in my main job, I work on the topics of prevention and health promotion. This means that as a physiotherapist I worked with individuals and now I have the population or specific groups of people in mind.

And yes, I am self-employed part-time in the area of health and accessible health communication. And yes, all of my heartfelt topics come together there. In addition to prevention, health promotion also the topic of inclusive health. Communication and the topic of health literacy, which is also very closely related to it. And health literacy? I don't know if that means something to you or if I should say some more words about it.

The importance of health literacy

Domingos: Yes, pleease go head.

Ines: Yes, health literacy is a person's ability to actively receive health-related information, but also services, for example, or to deal with health-related challenges. And through strong health literacy you are then able to take care of your health, your own health and your own well-being. But you can then also take care of the well-being of others and have a lot to do with health communication and also depend on each other because that also supports participation and self-determination over your own health.

Domingos: Yes, definitely a super exciting topic. How do you approach the topic of health literacy and accessibility? If you come from the topic of physiotherapy. You don't see any direct connection now.

Ines: Actually, yes. The topic of health and accessibility actually has a connection to my biography and also to my entire professional career. it's just that a lot of health information is often too difficult. In everyday life, many people have great challenges in understanding them and even if I don't understand them, I can't apply health information and I have felt this problem in my professional career and in my biography. I was born and grew up in Bolivia and then came to Germany alone when I was 20. To Berlin. And that was the first time I felt this barrier in the health system myself, namely I didn't even know how the health system works. I didn't even know that I had the right to health insurance, but I also didn't know where I could get health insurance and what it's like to go to the doctor, and that also has to do with health skills, for example.

And because you said, especially physiotherapy. Maybe it doesn't have such a strong connection, but it is very strong, because as a physiotherapist, for example, I was often the contact person for patients with questions that people brought with them from the doctor they had had contact with. Then you get some recipes that you didn't know about. What do I do with it now or have I brought any findings with me that the doctor looked at briefly and then? Yes, two or three words were said about it in technical language and they couldn't do anything with it or medication leaflets that they then couldn't understand and didn't know what to do with it. And yes, as a physiotherapist I was able to get to know many barriers in the health sector through contact with different people, namely cultural barriers that exist in medical care or language barriers in contact. But also an important issue, infrastructural barriers, for example an older gentleman who wants to come to the practice with a walker, but the physiotherapy practice is on the 3rd floor without an elevator. But also physical or mental impairments.

Physical barriers

Domingos: Yes, super exciting. Then let’s start with the different facets of accessibility. You have just touched on the topic of accessibility to the premises. And there is definitely a gender aspect, let’s say. It is particularly difficult for women with disabilities, for example, to find suitable doctors for the different issues that concern them. Something like pregnancy, but also gynecologists in general, is also your experience.

Ines: Yes, well. Accessibility in doctor's offices exists in these areas, as you just said, in the structural or medical devices that exist, and a visit to the gynecologist is an important one that is mentioned again and again. Barrier aspect because the treatment chair is simply difficult to get on if, for example, I sit in a wheelchair or have certain spasticities in the lower extremities, but then there are also quite simply chairs that are not height-adjustable, that is also the case often a barrier that is not really taken into account. Or other medical devices that are not really accessible either. For all groups of people at the ear, nose and throat doctor, for example, or at the ophthalmologist. Or at the dentist. There are lots of things there.

Doctor-patient commmunication

But of course there are also problems away from these structural barriers. For example, forms that I have to fill out at the doctor's office. When I arrive somewhere as a new patient, for example, I am given a piece of paper. If the practice is a little more technologically connected, I am given a tablet and have to do one Fill out the form. And this form is in difficult language, I'll say now. There is no version in an easy-to-understand language. In my opinion, this is a really big barrier, because if I can't fill it out, it simply takes away my freedom to decide for myself, what kind of information do I give or what information do I get? Or? Yes, of course there are forms that are probably not created for people with visual impairments and things like that. You may have already had experience with this.

Domingos: I have to say, I haven't been to the hospital for a long time, so I don't know what it's like there. But I've actually been lucky so far. So my family doctor, who I got when I moved to Bonn, didn't even give the form into my hand, but we filled it out together, he just asked me and then we filled it out together and I mean , that was also the case with most other doctors.

Ines: Yes, the data protection regulations and so on always change or perhaps it is regulated directly in patient doctor communication. That exists too, but that would also be another barrier, for example, the spoken language. Unfortunately, there are still doctors and medical staff who speak far too much in technical language and then it is simply not understandable. Or that they don't give enough space to ask questions because there is simply no time left to have a dialogue, or you don't get any information, information sheets, for example, that are multilingual or in easy language or simpler Language. These are also important barriers. In addition to the structural barriers.

Domingos: Yes, I can remember, including from my past. We often went to the doctor with our parents so that we could explain to our parents, the first generation who immigrated to Germany, what the doctors actually say, and I can do that from a lot of others too other families with such a migrant background. This is also the first generation that doesn't understand German very well. So it works well in everyday life, but especially when it comes to paperwork or conversations. It's just very complicated, but it's also extremely important that you get sensible information if you have diabetes or something like that.

Ines: Yes, that's right, I often experienced in physiotherapy that the grandma came with the grandson, who was then perhaps only 10 or 12 years old and had to translate. And then it's just terms that you might not be able to interpret or know exactly at that age. Yes, that's right.

But that also exists, for example. I have worked for many years in health promotion and prevention for people with cognitive impairments and multiple disabilities. And I often experienced that there. Yes, one assumes that. OK, the person doesn't understand me now anyway, I'm talking to the person accompanying now and not addressing the patient directly. And then try to make it so understandable that everyone can understand it.

Domingos: Yes, definitely an exciting topic. A major trend in healthcare is the topic of digitalization. This year the whole topic of E recipes was really big and it should be digitized even more. I don't know to what extent you've had any contact with it or with the challenges that people face who may not be so digitally savvy.

Ines: Yes, this is a very big, but also a very, very important topic, which I was also able to observe. Through the work I mentioned earlier with people with mental disabilities during the pandemic, because everything was digital, and it was a big challenge because there was little digital health literacy. But access to technology was also more difficult. Unfortunately, many people these days still don't have a tablet or laptop. Almost everyone already has a smartphone, I would say. You are welcome to contradict me. I then often found out that the data volume was not sufficient. Or you were always dependent on WiFi and didn't always have internet access and I think that's another big challenge. First of all, to provide access to technology in addition to the. Yes, digital health skills now in my area.

Yes, and then of course there are many other challenges because I also work with health communication. For example, is there a challenge or if I take another step back, I would also say that the Internet is the most important source of information these days if I want to find out about illness or health. And I would just say that almost everyone knows how to look for something in any search engine. Then there are also those who also use HIS such as ChatGPT or something like that, where they then get more information in a bundle. And that gives the impression that you are well informed. If necessary, you will also receive additional information from the doctor. Has given. And then there is the challenge, namely misinformation. Or? There is also too much information, you have to be able to filter it somehow. And very important in the health sector is what information is really reliable?

What is qualitative information and scientifically proven information that I can really rely on? I see that as a very, very big challenge. Yes, there is still a lot of work to be done.

Digitalization in the healthcare sector

Then you also just mentioned the digital applications, such as the eReceipt or the electronic patient file. Which is being introduced or health apps. I think many people have already used a health app these days and I have often seen that they are not designed to be accessible.

That's more your work area now and I don't know if you're already using the E recipe. You had contact points and can already give an assessment of how accessible it actually is.

Domingos: Honestly, no. Well, I haven't actually been to the doctor this year, I'm lazy when it comes to things like that. I think I have it. Last year I looked at this app on the topic of electronic patient records because I work for a company that is very active in this area of the healthcare industry. But I was kind of annoyed because a lot of things had to be done that were, in my opinion, unnecessary. Registration, that was OK, but then you had to go to the insurance office and get verified and I was really annoyed and then I didn't even look at the eReceipt app because I saw OK, you can Redeem receipts with the health card. Then I saved myself this app, even though I am very tech-savvy. I have that then Let it go for now and I haven't seen any immediate advantages of this EPA, i.e. the health record, that I absolutely have to use it now.

Ines: Well, but what you are describing is actually the state. There's already a barrier in this file. So you basically start and leave it straight away. So yeah, it's not really accessible then. Not yet.

Complicated language

Domingos: You've already touched on the topic of communication a bit. So I would say, in addition to the physiological accessibility of the practice rooms and the digital accessibility, the topic of communication in general is also important between doctors and patients. What are the major challenges for the medical staff? Where do you see the big challenges?

Ines: Well, you can say that any contact with a patient or a user of the healthcare system can represent a barrier. There are a lot of barriers. In communication, the trend is now slowly coming for medical staff to be trained more and more in communicating with patients, those with disabilities, for example. Or with patients with low health literacy to encourage them to follow the treatment, follow the instructions or, for example, take the medication the way it needs to be taken. And there are certain conversation techniques that you can use, for example. But you have to learn that first.

Then I already mentioned that health information is difficult, that information about health and illness is often very complex and you don't really learn how to break it down in training or studies in such a way that it can be understood by everyone then adapt it to specific situations. This is exactly where there is still a lot of catching up to do.

Positive examples

Domingos: That's probably difficult because it's a broad topic. But are there good examples of accessible health communication in Germany?

Ines: Yes, there are good examples. For example, there is an organization, a non-profit company, that does free translations of medical reports into easy-to-understand language, that is, "what do I have?" You can write to people via the website, send them the results and then volunteer medicine students or even qualified doctors will work there and then pass it on to the patients in a way that they can understand. I think this is a really great initiative. Then there are various training courses, including on the topic of communicating in an easy-to-understand manner, for example with me or with various specialist societies. There is also a very nice website that I was able to help design. This is the first plain language health information website. It's called "Understanding Health Easily" and there. Is health information bundled in plain language? Yes, shown. All information or all Bro. Sheets uploaded or linked there must be free and in plain language. And yes, this is a tool that you can also use, even if, for example, I treat certain illnesses in my everyday life or have certain issues, so that you can perhaps point things out and then support the patients. Then there is, for example, language mediation. I don't know if you know that.

Language teaching is very special for people who. Who use health services within the framework of the Asylum Seekers Benefits Act and that is a person who then translates and then accompanies the people and has an interpreter function, so to speak.

Then there is also beautiful literature. There is a very nice book series Med Guide. This is a medical language guide on various key topics such as pregnancy or obstetrics, mental disorders or general medicine. Where you can look it up and that actually contains reliable and good translations. Patient doctor interactions and then there are, for example, pictogram booklets that can be used for communication without words. Yes, to give a few examples as aids or tools.

Further training for health personnel

Domingos: there is a lot. But even if more is needed. What specifically can people in the healthcare industry do to educate themselves in this regard? This doesn't happen during studies or training, but are there further training courses from you or other people who these interested people can attend, for example?

Ines: Yes, there are different training offers. For example, from specialist societies or associations. For dentists, there are offers from the Dental Association. Then there is the Society for Medicine for People with Intellectual Disabilities. I can't quite get the name right now, it's DGMGPGB, they also offer training on how to speak in an easily understandable way.

If you are interested, you can also look at these rules for simple language on the Internet. They are also freely available. And you can look at them and the rules listed there for writing texts can also be used in spoken language. Not all, but many, such as short sentences, use simple words. Explain technical terms. And so forth.

There is something I would recommend to everyone. Meeting people, for example people with disabilities. I volunteer in a physical therapy health program run by Special Olympics Germany. I am the national director of the physical therapy program there. During sports or other events we offer examinations on various topics, especially physical fitness. For people with mental disabilities and give recommendations and tips on how to move more in everyday life. Or if you already do sports yourself, how can I improve my training plan and I and my colleagues are supported by volunteer therapists or sports scientists or doctors who then come and go through some kind of training there. Beforehand, you will be trained again in how to deal with people with mental disabilities on the specific needs and needs of the target group. But also how they can best communicate.

And the highlight is of course always the practical part. in the investigations with the participants, because it is so enriching to simply break down the fear of contact that many people have. I have met female doctors who have been in the service for 20-30 years and were very nervous before such an event and were very unsure about what to expect. And. Yes, create encounters, learn from each other, talk to each other. If necessary, you will then receive immediate feedback. Yes, it is very, very enriching. If you want to continue your training there and if you want to raise your awareness and communicate in an easily understandable way, I can recommend it.

There are now many newspapers or news channels, but also museums, that offer audio guides in easy language. And that the next time I go to the museum, for example, I should take an audio guide in easy language and listen to it, try it out myself to get a feel for easy-to-understand language. I would recommend that again.

Domingos: Yes, thank you very much for these insights. A super exciting topic. definitely thank you very much. I think you are also a good person to contact if somebody has further questions on the topic.

Ines: Of course, very much. Yes, thank you very much for the invitation. Thank you also for your time.