Not being able to speak in the same language as the people around you makes navigating through daily life complicated, but it's more than a nuisance when you're not well. Not being able to communicate to your healthcare providers is downright dangerous and potentially fatal. For instance, complications from improperly administered prescription drugs, lack of preventive care and lack of regular access to the medical system are just a few of the negative outcomes resulting from language barriers.
Over the past 15 years, the number of ESL/no English patients that doctors have been seeing has increased exponentially. With this in mind, here is a list of best practices for communicating with ESL patients that doctors, and other healthcare professionals, should keep in mind when confronted with an ESL/no English patient.
Medical information can be challenging for the layperson to understand at times. The challenge is even greater for those who do not speak English or have limited proficiency in English. Despite federal regulations requiring language access services and evidence demonstrating the impact of language barriers on the quality of patients' health care, not all hospitals provide interpreters or translations.
A 9-year old Vietnamese girl suffering from an infection was rushed to the hospital by her parents and 16-year old brother. Her parents spoke primarily Vietnamese. The hospital failed to provide an interpreter at any point in the medical encounter, relying instead on the girl and her brother to interpret for the physician and parents.
The population of the U.S. has become increasingly diverse. Approximately 57 million people in America speak a language other than English at home. That figure represents 20 percent of the population. Approximately 25 million are defined as being Limited English Proficient (LEP).
Training the medical team on procedures for using interpretation services will help ensure quality care.
What does this mean for the medical profession?
LEP Population at Increased Risk for Potential for Medical Mishaps
When a patient with limited English proficiency enters a healthcare facility without access to an experienced interpreter, that patient is at a higher risk for medical mishaps than those in the general population. Without an interpreter to help LEP patients effectively communicate with healthcare personnel, it is estimated that medical errors increase by 20 percent.
Translation of medical device packaging and instructions can be a life or death situation.
As we enter 2016, the United States remains the largest medical device market in the world, outperforming other developed markets. There are more than 6,500 medical device companies in the United States, and these companies exported more than $44 billion in products in 2012 (the most current year of available data). One of the forces that drives this market growth is the ability to quickly translate and publish medical device documentation, making it available and accessible to users worldwide. But, before medical devices are approved for market entry, all of this information must be carefully adapted to comply with international, regional and local laws. Translated documentation must meet strict language criteria and abide by regulations enforced by international governmental bodies.
The correct usage of a medical device is crucial, and can be a life or death situation, depending on the device and its use. The importance of accurate and precise translation cannot be overstated for these devices when they are released in overseas markets – there is no room for error.
Experts in healthcare interpretation services have found that qualified
interpreters can improve the care for limited English proficiency patients.
The National Council on Interpreting in Healthcare is an organization dedicated to creating equal access to health care through accurate interpretation and translation. Besides advocating for interpretation rights for patients, the organization also provides training for interpreters.
Healthcare interpreting can take place in many different settings. Hospitals, clinics, doctor's offices, home visits, and public health presentations all involve different kinds of crucial health conversations, and it’s essential for this information to be properly understood by the patient. Interpreting may be necessary between doctors, nurses, and other healthcare providers, and the patient and their family members, depending on the situation.
Professional interpreting services will help your entire medical team provide better care to patients.
Working with diverse patients who have Limited Proficiency in communicating in English (LEP for “Limited English Proficiency”) presents some unique challenges for medical professionals. Understanding medical terminology and instructions can be difficult even without a language barrier, so it's easy to see how it could be especially difficult to diagnose and treat patients who don't have a good understanding of the language their medical professionals speak when they have difficulty in providing feedback during an exam.
Communicating with LEP patients poses many challenges. Patients may be embarrassed about their lack of English skills and pretend they understand a doctor's instructions when in fact, they don't understand. They may believe they are saving everyone trouble by using their children, a family member, or a friend to interpret for them, but does their chosen interpreter understand the terminology used? And from a liability perspective, do the patient and interpreter know the implications of what they’re committing to?
In emergency situations, interpreting errors can create life-or-death situations.
When non-English speaking patients require urgent care, there is a limited amount of time to find someone who can interpret for the medical staff and patient - and even if someone who is bilingual is found, the interpretation is unlikely to be reliable and free from error. If there are medical complications due to inaccurate information, who is responsible?
Hospitals and medical clinics are required by law to provide professional interpreting services to all patients who request them, which is estimated to be about 9% of all Americans. But too often, hospitals bypass professional interpreters in emergency situations in order to expedite treatment or because professional interpretation services have not been arranged for ahead of time.
Using an interpreter can lead to better patient outcomes.
When there is a language barrier between doctors and patients, it's important to make sure both sides fully understand each other. In the arena of medical care, misunderstandings due to a language barrier can sometimes have dangerous--even fatal--consequences.
When thirteen-year-old Gricelda Zamora was taken to the hospital with severe abdominal pains, her parents misunderstood the doctor's directions. Normally, Gricelda served as interpreter for her Spanish-speaking parents, but she was too ill to do so in this case. The doctor told her parents to bring her back immediately if symptoms worsened, or to follow up with a doctor in three days. Her parents thought the doctor said to wait three days to see the doctor. After two days, Gricelda became so weakened that they finally brought her back to the hospital, where she died of a ruptured appendix.
Although most medical-related misunderstandings aren't nearly this serious, Zamora's situation highlights the need for qualified interpreters in the health care field. In fact, for hospitals and practices getting federal subsidies, including patients who get government-subsidized health care, providing interpretation services is a requirement under Title VI of the 1964 Civil Rights Act.