Breakthrough Patient Recruitment

: When Every Word Counts: Language Barriers in Health Care and the High Cost to Patients

When Every Word Counts: Language Barriers in Health Care and the High Cost to Patients

Content Specialist

When a difference in language impedes communication between a health care provider and a patient, it compromises the quality of the medical care that a patient receives. "Language barriers" between physicians and patients are associated with:


  • Decreased patient satisfaction
  • Lack of preventive health services
  • Increased diagnostic testing
  • Repeat visits to the emergency room
  • Longer hospital stays
  • Non-compliance with treatment
  • Increased number and severity of medical errors
  • Decreased provider satisfaction
  • Problems in obtaining informed consent


Although awareness of the need for better language support services in health care has increased during the past decade, progress has been limited to the local level and lacks sufficient force on a national scale. States and institutions that have higher proportions of patients with limited English proficiency (LEP) have taken the lead in developing LEP programs, while most others lag behind.


With more than 27 million Americans reporting LEP, health care organizations must face the needs of this growing population on a national level. Not only does the lack of language services for LEP patients ignore federal law in its violation of Title IV of the Civil Rights Act of 1964, but the lack of national standards for language services also creates inconsistency that jeopardizes the effectiveness of these programs. For example, studies have highlighted the laxity or lack of instructor certification and training methods as a deterrent to effective patient and provider communication


Lost in Translation

Although there is no replacement for a shared language between health care providers and patients, studies have shown that remote simultaneous interpreting-where the interpreter is not in the room and the translation occurs like a voiceover-is the most accurate method to optimize use of translators. Other methods such as in-person interpreters and video remote interpreting remain common.

Interpreter services, while an obvious way to cope with a growing LEP population, are an incomplete solution to the language barrier in health care. One study found that in-person interpreters committed an average of31 errors per consultation with63 percent of those errors directly affecting the outcome of the clinical encounter. Such studies highlight the limitations of interpreter mediation.


Family: Friend or Foe?

Worse, unofficial or "ad hoc" translators make far more serious errors in their translations. The use of family members, particularly children, as interpreters raises ethical questions and introduces bias. A family member may omit information or adjust a provider's statements to spare their loved one from anxiety. Likewise, patients may not be completely honest if it will create an uncomfortable situation with their family member. Finally, patients and their families lack the expertise to accurately translate medical terminology.




What You Hear Isn't Always What Was Said

Providers often use bilingual staff as an alternative to professional translators. Although trained medical staff understand confidentiality and medical terminology, one study showed that they often do not act as objective translators. In fact, staff can introduce medical errors by conveying information that supports a physician's or their own analysis of a patient's narrative, even when the actual information that a patient provides is contradictory to those expectations. When employees act as interpreters it decreases their productivity in other areas and generates far more serious medical errors than when providers use professional translators.


Why Aren't Providers Using Translators?  

The data speaks strongly: The use of trained interpreters minimizes the risk of medical errors when compared to "ad hoc" translators. Yet, health care providers still underuse interpreters. Why? Limited interpreter shifts and long waiting times for translators certainly deter patients and physicians from requesting their service. For certain medical procedures or units, waiting may not be an option. Yet, with availability of interpreter services through video and phones, the greatest obstacle remains providers' lack of training on how and why to use interpreter services.


What's the Solution?

The emergence of health information technology (HIT) or eHealth presents a new opportunity to face the LEP challenge. For example, electronic health records would allow providers to share knowledge about an LEP patient across organizations, while apps and widgets provide instant access to medical translations. However, without prior planning for how to adapt technology to the special needs of LEP patients in a health care setting, institutions risk replicating current inequalities that already exist in access to health care.

Solutions to the language barrier in health care will require advances on multiple fronts-better national standards by which to measure efficacy, innovative ways of using technology, and diversification of the workforce. We've come a long way, but there's much work to do.

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