Highlight the clinical consequences of language barriers.
Describe evidence for professional interpreters and for bilingual clinicians.
Describe the limited-English–speaking population in the United States.
Review policies pertaining to linguistic access in health care in the United States.
Describe institutional responses to overcome language barriers.
Summarize strategies to address language barriers in clinical practice.
Health-care providers are better educated and more scientific than ever before, but they have a great failing: providers sometimes do not communicate effectively with their patients or with the patient’s family.1
The current health-care system offers some of the most technologically advanced medicine in the world. At the same time, millions of people in the United States, and increasingly throughout the world, have limited access to the most basic feature of good medical care: adequate communication.2 Effective patient–provider communication is essential to providing good medical care. Taking an accurate history is fundamental to being a diagnostician; the history is the key to the final diagnosis in 56–82% of cases.3 Moreover, the quality of communication also affects patient and physician satisfaction, patient adherence, and clinical outcomes.4 Unfortunately, in the United States, many people are unable to reap the benefits of effective communication because they cannot speak English well.
The ability to navigate a health-care system depends in large part on the capacity to speak and understand the official language. Language barriers can hinder care from simple communications such as calling for an appointment, to emergent situations such as explaining symptoms to an ambulance paramedic, to more nuanced exchanges such as discussing treatment risks and benefits with a doctor. The consequences can be dire.
This chapter is designed to help readers understand the impact of language barriers on both patients and clinicians, and provide guidance to overcome them. Although many of the ideas in this chapter pertain to language barriers in any health-care setting, we will focus on language barriers in the United States. We begin with an overview of language barriers in health care, including who faces these barriers, how language barriers affect health care, and current policies regarding linguistic access in US health-care settings. We conclude with practical suggestions clinicians may draw from to better care for limited-English–speaking patients.
LIMITED ENGLISH PROFICIENCY AND HEALTH CARE
Miguel Hernandez immigrated to the United States 5 years ago. Despite working long days, he takes English as a second language (ESL) classes in the evenings and on weekends. He is able to say and understand basic things in English, but this becomes more difficult when he is under stress. When he presents to the emergency department with an episode of recurrent nephrolithiasis, he does not know enough English to share his past medical history, alert the nurse of his codeine allergy, or describe his symptoms in detail to his doctor.