Working in a diverse hospital system, I often encounter patients with low English proficiency (LEP). I find that many of us are ill-equipped to handle the unique challenges of caring for this population, and I frequently observe differences in healthcare delivery to LEP patients. With almost 1 in 5 people in the U.S. speaking a language other than English (and around 30% of that population without English proficiency), effective modern healthcare requires continuous attention to the barriers faced by this vulnerable and growing patient population1.
Understanding medical jargon is challenging enough for a native speaker, and this task can be almost impossible for non-native speakers. Importantly, poor communication comes with real risk: patients without language-concordant providers are more likely to experience adverse events and are less likely to comply with medications or follow medical advice, whereas language concordance between healthcare providers and LEP patients improves health outcomes2. Interestingly, the AAMC’s 2019 National Sample Survey of Physicians indicated that while approximately 40% of physicians speak a language other than English, only 9.6% reported using their multilingual skills always or often in patient care3. Are physicians’ second languages simply not represented in patient populations, or is some of this discrepancy perhaps explained by decreased provider confidence or a perceived increase in time or effort required for non-English patient interactions?
To address communication and comprehension issues broadly, a multi-pronged approach involving all levels of the medical system is required. Professional medical interpreters can improve the degree of health education patients receive and increase the delivery of care to LEP patients2. However, the consistent use of these services is marginal even when they are widely available and even though their use does not significantly increase overall patient interaction times4. Advocacy for the increased use and availability of these services is paramount.
Additionally, we must consider improved medical language education for physicians. Spanish is the most common spoken language other than English in the U.S., and improving access to medical Spanish training at all levels of healthcare can improve healthcare delivery, as patients receiving care from Spanish-speaking physicians report significantly higher satisfaction than those receiving care through interpreter services1,5. For physicians, medical school can play a major role in the development and competence of medical Spanish. Medical Spanish courses have increased in prevalence throughout medical schools in the U.S., though at only about 17% of schools do they meet all basic programming standards6. With the ever-changing landscape of medical education and the rising need for bilingual physicians, more medical schools should consider making foreign language and cultural competency a standardized component of medical education, tailored to the needs of the local population. Outside of medical school, professional organizations like the American Academy of Physician Assistants (AAPA) offer reduced rates for online medical Spanish courses and CME credit, to which national physician groups could employ a similar model.
With the rising number of low-English-proficient patients in the United States, delivering patient-centered healthcare faces a significant challenge. While physicians and hospital systems have made important initial strides to address language barriers in medicine, these issues require ongoing work and advocacy to ensure delivery of high-quality healthcare to all.
1United States, Congress, U.S. Department of Commerce, et al. Language Use in the United States: 2019, 2022.
2Lopez Vera, Alexandra et al. “A Case Study of the Impact of Language Concordance on Patient Care, Satisfaction, and Comfort with Sharing Sensitive Information During Medical Care.” Journal of immigrant and minority health vol. 25,6 (2023): 1261-1269. doi:10.1007/s10903-023-01463-8.
3Felida, Natalie, et al. “Language profile of the United States Physician Workforce: A descriptive study.” Patient Education and Counseling, vol. 109, Apr. 2023, p. 28, https://doi.org/10.1016/j.pec.2022.10.075.
4Tocher, T M, and E B Larson. “Do physicians spend more time with non-English-speaking patients?.” Journal of General Internal Medicine vol. 14,5 (1999): 303-9. doi:10.1046/j.1525-1497.1999.00338.x
5Seible DM, Kundu S, Azuara A, Cherry DR, Arias S, Nalawade VV, et al. The influence of patient-provider language concordance in cancer care: results of the Hispanic Outcomes by Language Approach (HOLA) Randomized Trial. Int J Radiat Oncol Biol Phys. 2021;111:856–doi:10.1016/j.ijrobp.2021.05.122.
6Ortega, Pilar et al. “Medical Spanish in US Medical Schools: a National Survey to Examine Existing Programs.” Journal of general internal medicine vol. 36,9 (2021): 2724-2730. doi:10.1007/s11606-021-06735-3
Evan Straub
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- Breaking Down Language Barriers in Medicine - October 7, 2024