Sydney Goldstein ’22

Communication, communicación, Kommunikation. English, Spanish, German. Same meaning, different language. Much like math, health and medical vocabulary carries the same universal meaning regardless of what language it is conveyed in or the country in which the service is provided. When it comes to provider to patient interaction, seamless communication in healthcare is of utmost importance and without it, the quality of healthcare delivered would be severely impaired. What is adequate communication? Relaying information through speech or other methodology to get a point across. In healthcare, providers must be able to listen to and fully understand their patients’ explanations of their health complaints, patients must understand their providers’ intentions regarding diagnosis and treatment, and so much more. However, in a world where there are approximately 6500 languages spoken, language can serve as an impediment, posing a threat to patient safety and also to patients’ satisfaction ratings regarding the service provided to them.

Language barriers occur frequently in situations between healthcare providers and patients when they do not speak a common language. Inability to understand the patient on the physician’s behalf can lead to misdiagnosis and treatment, which can inherently engender adverse effects on patients’ health and ultimately create a cost burden in the healthcare system. In the United States, where a language that is not English is spoken in upwards of one in five homes, patients with limited English-speaking capabilities are referred to as patients with limited English proficiency (LEP). To take things to the official legal platform on August 11, 2000, President Bill Clinton signed Executive Order 13166, in Title VI of the Civil Rights Act of 1964, which serves to improve access to services for people with LEP.

Language barriers in the US are often related to migration to the US, especially since immigrants frequently live in communities that are iterations of their original communities in regards to spoken language. Time and age of migration can also play a part in the barrier. Sometimes older immigrants, who may have travelled to the US decades ago, either never developed understandings of the English language or may also lose some of their neurologic function and lose strong abilities to converse in a second language, therefore calling for a language interpreter to break the barrier.

In another light, the effects of language barriers are not restricted to the English language in the US: one study, provided in an Oman Medical Journal article, conducted via face-to-face interviews with patients at a Saudi Arabian hospital in 2009 showed that of patients treated by nurses who did not speak the local language, 30% found it hard to understand medical instructions, 30% had problems with the reliability of information, and 50% believed that the language barrier contributed to errors. Another study conducted via telephone interviews with California inhabitants in 11 different languages and in-person interviews with patients in four of Canada’s French provinces showed that of patients who did not speak the local language, 49% had trouble understanding a medical situation, 15.8% had a bad reaction to medication due to a problem understanding their healthcare provider’s instructions, 66.7% faced an obstacle when accessing healthcare, and 20% did not seek healthcare services if they were not readily available, simply out of fear of not understanding the healthcare official. For more compiled data regarding effects of language barriers, see this table compiled in a study published in the Oman Medical Journal. Keeping in mind the difficulty as expressed in these statistics, it is the provider’s responsibility under the Hippocratic Oath to “not be ashamed to say ‘I know not,’ ... to call in my colleagues when the skills of another are needed for a patient's recovery.” With that being said, the professional is obligated to, if capable, call upon resources to obtain interpretation services to aid in communication.

Generally, anyone related to the patient in need of interpretation, and anyone under the age of 18, is prohibited from providing services except for in urgent situations. Using someone so closely related to the patient, such as a sibling or parent, allows room for conflict of interest or another form of conflict to get in the way of complete and proper translation, especially when uncomfortable or difficult information needs to be translated ie; relating to substances, sexual health, terminal illness. Using family and generally untrained interpreters leaves room for errors down the line, and may also pose risks in confidentiality protections.

Another non-technology-related way to improve linguistic competency in the healthcare setting is by hiring more diverse staff representative of the desired demographics. This can be performed by first administering a community needs assessment of the organization to garner a sense of the local, typical demographics. This is not always an option, however, which goes to show that the entire staff of a healthcare organization should be expected to go through cultural and linguistic competency training, most effectively carried out by a member of staff representing the targeted patient demographic.

Despite technological resources like the apps mentioned previously, studies show that lack of these services does result in poorer health outcomes for patients who do not speak the local language of the provider when compared with patients who are native speakers. Regarding access to services, economic and geographic disadvantages always play a part in the equation, especially in circumstances like asylum-seeking patients in more strenuous situations, separated from their native countries and hence separated from their native languages. All in all, there are certainly promising solutions to the medical interpretation problem, all of which make progress in the direction of easier communication.

Bibliography

Al Shamsi, Hilal, et al. “Implications of Language Barriers for Healthcare: A Systematic Review.” Oman Medical Journal, OMJ, 30 Apr. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7201401/.

de Moissac, Danielle, and Sarah Bowen. “Impact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada.” Journal of Patient Experience, SAGE Publications, Mar. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6572938/.

Juckett, Gregory, and Kendra Unger. “Appropriate Use of Medical Interpreters.” American Family Physician, 1 Oct. 2014, www.aafp.org/afp/2014/1001/p476.html.

Neira, Lissa. “The Importance of Addressing Language Barriers in the US Health System.” Duke Personalized Health Care, 22 Aug. 2018, dukepersonalizedhealth.org/2018/07/the-importance-of-addressing-language-barriers-in-the-us-health-system/.

Ratna, Haran. “The Importance of Effective Communication in Healthcare Practice.” Harvard Public Health Review: A Peer-Reviewed Journal, 13 Nov. 2019, harvardpublichealthreview.org/healthcommunication/.

Squires, Allison. “Evidence-Based Approaches to Breaking down Language Barriers : Nursing2020.” LWW, Sept. 2017, journals.lww.com/nursing/Fulltext/2017/09000/Evidence_based_approaches_to_breaking_down.10.aspx.

Wilson, Elisabeth, et al. “Effects of Limited English Proficiency and Physician Language on Health Care Comprehension.” Journal of General Internal Medicine, Blackwell Science Inc, Sept. 2005, www.ncbi.nlm.nih.gov/pmc/articles/PMC1490205/.