It is no secret that physicians sometimes struggle to explain medical terminology to their patients. Imagine how insurmountable this challenge must feel when doctor and patient literally speak different languages.
According to a new study, a significant gap exists in America between patients’ languages and the languages doctors speak. The study also suggests that health care organizations are not doing all they are required to when it comes to providing meaningful language access to patients who are limited English proficient (LEP).
Fortunately, near-term remedies exist that can meaningfully diminish these language barriers between doctors and multicultural patients.
Conducted by Doximity, a social network for physicians and advanced practice clinicians, the study is titled “Language Barriers in U.S. Health Care.” It analyzes the languages – other than English – spoken by 60,000 U.S. physicians.
By comparing these findings against U.S. Census data, the report discovered a substantial disparity between languages spoken by physicians and their multicultural patients.
“The most important conversations we have as physicians are with our patients,” said Nate Gross, MD, co-founder of Doximity. “A growing body of research has shown patients achieve better health outcomes when they can communicate with their caregivers in the same language. Understanding imbalances between languages can help address communication challenges across our health care system.”
While Spanish is by far the most common non-English language spoken by both physicians and patients, the study finds that the two groups only intersect on six of the Top 10 languages overall.
There are significant mismatches among the languages physicians speak and the languages patients speak. The following 10 languages have more patients proportionately who speak them than physicians. Patients who speak these languages are most likely to have challenges finding physicians who speak their language:
- Swahili/Sub-Saharan African
- Hamitic and Near East Arabic
- Burmese and Southeast Asian
The Doximity study also examined America’s top 50 metro areas, contrasting languages spoken by physicians there against those spoken by area residents. According to the study, “Almost all top 50 metro areas have weak matches when comparing the languages physicians and patients speak.”
The study found that nearly half (44.7 percent) of all physicians who speak a non-English language graduated from a medical school outside the United States. One challenge is that immigrant patients often come from different countries than these physicians.
“Previous research has not determined which non-English languages are most commonly spoken by physicians, or how those languages compare to patient populations,” said Christopher Whaley, PhD, the study’s lead author and adjunct professor at the University of California, Berkeley School of Public Health. “Understanding the scope of this problem is the first step to creating solutions for people with limited English proficiency.”
Failing to Provide Meaningful Access
In the U.S., 8.5 percent of the population age 5 and older is considered limited English proficient (LEP), meaning they speak English “less than very well.” That number has grown 80 percent since 1990, from 14 million to the current 25.1 million.
Studies have shown that poor communication leads to worse health outcomes for LEP patients. This happens when doctors cannot understand a patient’s description of symptoms, as well as when the patient does not understand the provider’s instructions.
“(Lack of understanding) has been shown clinically to lead to lower medication adherence and lower adherence to following clinician guidance,” Whaley said.
Despite this fact, the study cites that relatively few health care organizations – anywhere from 38 to 68 percent – employ professional interpreters, who assist patients either in person or remotely via phone or video, according to the study.
In lieu of a bilingual physician or medically qualified interpreter, patients have to sometimes rely on family members and gesturing.
“It can be embarrassing when someone is dealing with a health condition and they’re bringing in their 10-year-old kid (to interpret),” said Nancy Dung Nguyen, executive director of VietLead, a nonprofit community group for U.S. citizens of Vietnamese origin. “The patient is left trying to make decisions without full understanding.”
Out of Compliance
Health care organizations that receive federal funding from the U.S. Department of Health and Human Services (HHS) must comply with Section 1557 of the Affordable Care Act. These entities must “take reasonable steps to provide meaningful access to each individual with limited English proficiency.”
Section 1557 set new requirements on who can act as an interpreter for LEP patients. It requires that health care organizations use “qualified” interpreters to communicate with LEPs. Three main points define “qualified” interpreters:
- Interpreters must possess proficiency in speaking and understanding English and one additional language. Being bilingual in and of itself does not meet the requirement.
- Interpreters must be able to recognize and use specialized terminology when necessary in order to accurately convey information.
- Interpreters must adhere to ethical principles such as client confidentiality.
Under Section 1557, covered entities, including hospitals and healthcare providers, cannot rely on unqualified bilingual staff to provide interpretation. Furthermore, except in an emergency, adult family and friends of LEP patients are barred from interpreting unless the LEP specifically requests that the accompanying adult help facilitate communication. (In this instance, a physician can insist that a medically qualified interpreter be incorporated if he or she suspects critical information is not being conveyed.) Minor children may not act as interpreters for LEP patients except in emergency situations.
Organizations that violate Section 1557 are out of compliance and potentially liable should an otherwise preventable breakdown in communication between a physician and LEP patient result in a poor health outcome.
Steps That Health Care Providers Can Take Today
The study suggests that the stark disparity between physician and patient languages might be remedied through adjustments to immigration law, as well as by making language classes part of the curriculum in medical schools.
More near-term solutions exist, however, which can serve to provide better patient care for LEPs, while also ensuring that health care organizations remain compliant with Section 1557.
Hospitals and health care providers can immediately take these two steps:
- First, test bilingual staff to ensure their language skills rise to the level of a “qualified” interpreter, as detailed in Section 1557. In 2013, the American Medical Association recommended that all bilingual healthcare providers have their language proficiency tested.
- Second, address remaining language gaps by partnering with a language services provider (LSP).
LanguageLine Solutions provides two assessments to test the bilingual proficiency of health care workers:
- Bilingual Fluency Assessment for Clinicians (BFAC): The BFAC assesses the candidate’s oral proficiency in English and a target language, as well as knowledge of specific medical terminology in both tested languages. It is often used to assess the fluency of clinical staff in a health care setting, such as physicians, nurses, and technicians. Iterations of the BFAC exist for medical specialties, including pediatrics, cardiology, oncology, nutrition, ophthalmology, gastroenterology, mental health, and family medicine.
- Medical Language Proficiency Test (LPT): The LPT is a comprehensive test to assess language and interpreting skills. Language proficiency requires knowledge of grammar, vocabulary, and syntax. The test is an oral proficiency interview conducted entirely in the tested language. A specific Medical LPT assesses the level of fluency in English and another language within the context of a medical setting.
It is also imperative that in-house interpreters access and maintain their skills for qualification. Again, a bilingual person must demonstrate a high level of proficiency to meet Section 1557 standards. For these individuals, LanguageLine offers an Interpreter Skills Test (IST). The IST measures interpreting skills and knowledge, while identifying areas for improvement. Specifically this test covers advanced language proficiency in English and the target language; interpreting skills and protocols; and knowledge of terminology.
Working with a language services provider (LSP)
For example, LanguageLine offers on-demand access to interpreters in 240 spoken languages, as well as American Sign Language. Arrangements are pay-as-you-go, with no up-front financial commitment or recurring fees. Clients on pay for the minutes they use at a pre-determined rate.
To learn more about working with an LSP, we recommend reading our “Complete Guide to Selecting a Language Services Provider.”