By Nathan Shlobin, Northwestern University ’20
Eight percent of the United States population exhibits limited English proficiency. In the past thirteen years, the number of Americans with limited understanding of English has increased substantially, from almost 14 million to 25.1 million, primarily reflecting an increase in immigration.1
In medicine, where every detail is critical, this impaired communication can have detrimental consequences. Patients with limited English proficiency are less likely to have a primary care physician and utilize preventative health services.2 As a result, they may have poor health and avoid seeking medical care when they become ill, resulting in more serious complications from their illnesses and more frequent hospitalization. Once patients are finally admitted, their severely hindered patient-provider interactions pose greater risk of misdiagnosis and longer hospital stays.3 This combination of factors perpetuates a vicious cycle of events in which medical professionals are unable to effectively treat many patients who desperately need treatment.
A patient who speaks poor English is at a greater risk of experiencing a medical error than a patient who speaks English fluently. To take one example, a 9-year-old Vietnamese girl whose parents could not speak English passed away from an adverse reaction to the gastroesophageal reflux disease medication Reglan. She and her 16-year-old brother, who both spoke English poorly, served as interpreters during the office visit.4 Unfortunately, this sort of situation is all too common.
However, it is not only a patient’s limited English proficiency, but also the language level of the provider that can cause medical errors. The rates of English proficiency for immigrants who work in healthcare in the United States ranges from 91 percent for doctors to 55 percent for nursing, psychiatric, and home health aides.5 While most immigrant healthcare professionals are proficient in English, many still are not. This may lead to communication difficulties with patients and consequently ineffective treatment.
Language barriers on both sides of the patient-provider interactions complicate care, most notably when the patient and the provider do not share the same primary language. For example, an endocrinologist whose primary language was Mandarin and spoke English as a secondary language failed to communicate effectively with a Thai woman whose primary language was Thai and secondary language was English. The woman then proceeded to develop a cancerous obstruction of her lymph nodes.4 Even though they both spoke some English, the language gap between them was too large to transcend and resulted in the fatal delayed diagnosis.
In response to language barriers, many hospitals have begun to provide a variety of interpreter services. These options include, but are not limited to, in-person interpretation, hospital-wide video conferencing, and interpretation via phone calls. More variants exist and are implemented throughout the country.
The availability of trained interpreter services assists healthcare professionals in providing care. A Massachusetts health maintenance organization began to employ five full-time in-person and over-the-phone Spanish and Portuguese interpreters and discovered that the delivery of health care increased for both preventative care and primary care.6 Similarly, a study conducted by Glenn Flores, the distinguished chair of health policy research at the Medica Research Institute, determined there were 10 percent fewer medical errors when trained interpreters were employed, as opposed to untrained interpreters.7 Flores’ study also concluded that using untrained interpreters was just as harmful as providing care without an interpreter.7 Utilizing qualified interpreters improves patient care while employing untrained interpreters produces the very errors interpretive services seek to avert.
However, a variety of factors prevent the widespread use of fully-trained translators. There is often a lack of access to fully-trained interpreters. Patients frequently elect to use family members as interpreters due to the high cost of hiring a trained interpreter. Medical professionals sometimes rely on their own, often inadequate, language skills in an effort to save time. Ultimately, each of these attempts fails to eliminate the language barrier.
The United States’s healthcare system has advanced as medical professionals and patients alike have become more cognizant of the language barrier and its potentially deleterious effects. Still, avoidable problems persist, and human fallibility can be further minimized with widespread and affordable trained interpreter services.
Zong, J., & Batalova, J. (2015, July 8). The Limited English Proficient Population in the United … Retrieved October 23, 2016, from http://www.migrationpolicy.org/article/limited-english-proficient-population-united-states/
Flores, G. (2006). Language barriers to health care in the United States. New England Journal of Medicine, 355(3), 229-231.
Chen, M.D., P. W. (2009, April 23). When the Patient Gets Lost in Translation. Retrieved October 23, 2016, from http://www.nytimes.com/2009/04/23/health/23chen.html
Quan, JD MPH, K., & Lynch, MPH, J. (2010). The High Costs of Language Barriers in Medical Malpractice. Retrieved October 23, 2016, from http://www.pacificinterpreters.com/docs/resources/high-costs-of-language-barriers-in-malpractice_nhelp.pdf
McCabe, K. (2012, June 27). Foreign-Born Health Care Workers in the United States … Retrieved October 23, 2016, from http://www.migrationpolicy.org/article/foreign-born-health-care-workers-united-states/
Jacobs, E. A., Shepard, D. S., Suaya, J. A., & Stone, E.-L. (2004). Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services.American Journal of Public Health, 94(5), 866–869.
Hoffman, A. (2015, September 28). Millions of Americans Are Getting Lost in Translation … Retrieved October 23, 2016, from http://www.smithsonianmag.com/innovation/millions-americans-are-getting-lost-translation-during-hospital-visits-180956760/