Through the fault of none-or perhaps the fault of many-
non-English speakers in the United States often experience
miscommunication regarding their health care. To improve
services to these patients, it's important to engage in a deeper
discussion to understand each patient and to address their health
from a linguistic and cultural point of view.
For the purposes of this post, let's focus on Spanish-speaking
patients. According to 2011 estimates from the American Community Survey of
the U.S. Census Bureau, almost
43.7% of Americans who speak Spanish at home, speak English less
than "very well." In the absence of readily available qualified
medical interpreters, health care providers often turn to people
without sufficient skills to interpret for them.
Individuals, such as family members, friends, or untrained staff
are substantially more likely to make mistakes and to neglect
valuable information when interpreting. It is only natural to
skip or misinterpret a word or sentence that one does not
understand and to simply convince oneself that the few missing
words probably weren't important anyway.
Let's take a look at a few examples of miscommunication
False cognates are particularly dangerous when interpreting
information. These are words that sound the same in both English
and Spanish, but mean something different.
Intoxicated vs. intoxicado/a
"Intoxicado" in Spanish is an all-encompassing word that means
there's something wrong with you because of something you ate or
drank. It is not alcohol related.
The danger of this false cognate is demonstrated in the
particularly sad case of Willie Ramirez.
Embarassed vs. embarazada
Another false cognate that causes problems in the medical
community if misunderstood is "embarazada." In Spanish, this word
does not mean embarrassed; it means pregnant. Imagine, for
instance, a woman with rudimentary knowledge of English, trying to
explain to medical staff that "I am embaras." If medical staff
misinterprets the word, they may conduct procedures harmful to a
Cultural differences further complicate the language issue. As
health providers communicate with Spanish-speakers, they need to
tend to cultural differences as well. While they may believe they
are communicating adequately and effectively, their own beliefs and
strategies for handling situations will affect patient care issues.
Understanding and respecting such differences is essential to
Let's consider the below …
In the Spanish-speaking community, health care providers
(particularly doctors) are often viewed as authority figures who
are not to be contradicted. In an effort to ensure they show no
disrespect, patients may be hesitant to ask questions, which could
ultimately affect their care. Thus, health care providers need to
consider who their patient is and what their background and beliefs
system is. They need to ask questions, listen to the answers, be
sensitive, show respect, and build trust.
Sharing negative information
Cultural differences affect how people react to ailment, respond
to symptoms, look for medical care, and perceive health care
providers. All this, ultimately, impacts how they will react to and
respond to treatment. It is the provider's responsibility to the
patient and the family to communicate negative information in a
caring, kind, and respectful manner. Taking time to be with
patients and discussing information in a deliberate, unhurried
manner is particularly important when discussing serious
What we say, how we say it, when we say it, and to whom we say
it is critically important. Miscommunication-and health care
concerns stemming from it-is not unique to Spanish speakers.
Similar issues affect other linguistic minorities in this country.
For more information on how language and cultural nuances affect
patient care, refer to
this blog post written by my colleague Veronica Badillo.