Language Barriers in Medicine

A shared language, particularly in treatment settings, is of crucial importance to effective communication between medical professionals and their patients. In order for clinicians to obtain an accurate and complete history, patients must convey nuanced information describing relevant history, the medical problem itself, and the context in which it arose through mutual, intelligible means of communication [1]. In recent decades, the U.S. has seen a revival of linguistic diversity en masse (with the largest portion of non-English speakers being Spanish speakers) .

Conceivably, this demographic shift has resulted in language barriers that have affected non-English speaking patients’ quality of healthcare, access to care, and health status/outcomes [3]. According to a 2016 Brookings Institution report, nearly one in ten Americans aged 16 to 64 is considered limited- or non-English proficient [4]. Despite the fact that U.S. is considered by many to be a multicultural country, the healthcare system is primarily geared towards English-speakers [3]. Research demonstrates that when a patient does not speak the same language as their medical provider, various detrimental effects to their healthcare may occur [1, 3]. For instance, lack of comprehension in a discussion of relevant medical education and treatment information can lead to poor patient satisfaction, low treatment-plan compliance, and an underutilization of services [3]. Diminished access to preventive care and/or primary care has also been found to be common in populations with low English-fluency skills [5]. What’s more, there may be serious legal and financial repercussions if medical providers fail to provide adequate medical services to patients with limited English proficiency.Perhaps the most significant barriers in overcoming language disparities in clinical settings is the dearth of skilled, certified medical interpreters [1, 3, 5]. Research on the use of translators in emergency room settings revealed that no interpreter was used in nearly half of cases involving a non-English speaking patient [6]. Consequently, non-English speaking patients must often rely on bilingual family members and/or healthcare staff who do not have formal training in medical translation services, which may represent potential ethical breaches [1, 3]. Furthermore, crucial, nuanced details can become lost in mistranslation; and misinterpretation has been shown to precipitate medical and logistical catastrophes. In one case, hospital personnel translating for a nurse practitioner instructed the mother of a seven-year-old to administer oral amoxicillin in her daughter’s ears [5]. In another, a resident who relied on partial Spanish skills mistranslated a mother’s description of her two-year-old’s tricycle accident (the literal translation being that she “hit herself” while falling off) and perceived the fracture to have been caused by abuse; the attending contacted social services—without an interpreter—had the mother sign away custody of her two children [5]. Evidently, the consequences of language barriers may be severe and not limited to medical outcomes.

Furthermore, language barriers—even when assuaged by the use of interpreters—may represent complex challenges in effective patient-provider communication dynamics [5]. For instance, the delivery of subtle non-verbal cues indicative of relevant information may become lost in translation [1]. Additionally, a lack of sensitivity towards cross-cultural differences on all sides may hinder the quality and efficacy of healthcare services [1, 3]. Those who study this issue closely have proposed the notion that all payers be required to reimburse providers for medically skilled interpreter services [5]. Without question, the mandated provision of satisfactory language services would significantly aid in producing improved patient resource use, satisfaction, communication, outcomes, and patient safety .

Partida, Yolanda. “Language Barriers and the Patient Encounter.” Journal of Ethics | American Medical Association. American Medical Association, August 1, 2007.

Rumbaut, Rubén G, and Douglas S Massey. “Immigration and Language Diversity in the United States.” Daedalus. U.S. National Library of Medicine, 2013.

Timmins, Caraway L. “The Impact of Language Barriers on the Health Care of Latinos in the United States: a Review of the Literature and Guidelines for Practice.” Journal of Midwifery & Womens Health 47, no. 2 (2002): 80–96.

Wilson, Jill H. “Investing in English Skills: The Limited English Proficient Workforce in U.S. Metropolitan Areas.” Brookings. Brookings, August 24, 2016.

Flores, Glenn. “Language Barriers to Health Care in the United States.” New England Journal of Medicine 355, no. 3 (2006): 229–31.

Baker, D W, R M Parker, M V Williams, W C Coates, and K Pitkin. “Use and Effectiveness of Interpreters in an Emergency Department.” JAMA. U.S. National Library of Medicine, March 13, 1996.

Meuter, Renata F. I., Cindy Gallois, Norman S. Segalowitz, Andrew G. Ryder, and Julia Hocking. “Overcoming Language Barriers in Healthcare: A Protocol for Investigating Safe and Effective Communication When Patients or Clinicians Use a Second Language.” BMC Health Services Research. BioMed Central, September 10, 2015.