Breaking Through the Language Barrier Issues in The US Healthcare System

Healthcare Flaws

    The healthcare system in the United States has failed to address the problems of the citizens with language barriers. According to the American Medical Association, over 25 million Americans are classified as having limited English proficiency, also known as LEP. These people struggle consistently with communicating with their providers and therefore fail to receive adequate medical attention. The government has implemented laws, such as requiring hospitals to have translators, to decrease obstacles but, due to the lack of enforcement and financial constraints of healthcare providers, LEP patients still face difficulties and discrimination when receiving hospital treatment. Hospitals claim to not have enough money for LEP services but, the financial consequences are far less important than not supporting LEP patients. These individuals and their lives should be more important than the cost of treating them. The damage done to them in the healthcare system can be irreversible. Instead of continuing with the negligent treatment of LEP patients, hospitals can implement feasible solutions such as professional translators and new technologies to aid patients with language barriers.

The Past and the Present of Language Barriers in US Healthcare 

    There are clear racial disparities in the United States’ healthcare system and these issues have been occurring for a prolonged time without good reason. In 1990, Chinese-American author Amy Tan wrote the nonfiction essay “Mother Tongue”. Within the paper, she recounts an experience of language barriers and discrimination. Tan’s mother arrived at a clinic to receive results from a CAT scan but to no avail. The hospital had lost her results. She was persistent in trying to get more information but, due to her limited English proficiency and the discriminatory practices of the hospital, she was left worried with no reassurances at the time. She was anxious because her husband and son had passed away because of brain tumors. To be aware and on top of her health, she had scheduled the appointment only for the hospital to lose the results of her scan and not show any sympathy for her situation. Situations like this are why LEP residents do not feel comfortable at the hospital and stay home, rather than seeking help. Tan’s mother was insistent that they call her daughter. As Tan wrote in her article, “And when the doctor finally called her daughter, me, who spoke in perfect English-lo and behold-we had assurances the CAT scan would be found, promises that a conference call on Monday would be held, and apologies for any suffering my mother had gone through for a most regrettable mistake.” (Tan) More recently, in 2017 an article in the American Medical Association Journal of Ethics, Alexander R. Green, MD, MPH, an associate professor of medicine at Harvard Medical School, and Chijioke Nze, an MD/MPH candidate of 2017 at Harvard Medical School, wrote “Language-Based Inequity in Health Care: Who Is the “Poor Historian”?”. Similarly to Tan, Nze recounts a time in his third year as a medical student when a Brazilian man, Mr. S, was struggling to communicate with his doctors. The doctors had marked him with the label of poor historian, unable to relay information to them and dismissed the idea that putting in extra time and using an interpreter would be useful. Nze decided to take it upon himself to call an interpreter and gained information that otherwise would not have been known. He discovered that Mr. S had been taking high doses of medication for his postsurgical pain. This new information led to him being correctly diagnosed with nephritis which had been caused by the medication. “I remember feeling partly triumphant and partly shocked that a student’s effort had prevented a missed (or at least delayed) diagnosis.” (Green, Nze) Both Nze and Tan’s account support the language barrier issue in the US. Tan’s article was published almost three decades before Green and Nze published theirs, amplifying the issue and the fact that in 27 years there has barely been any change to the system.

The Use of Professional Translators and Communication Services 

    Hospitals utilize ad-hoc interpreters, which are unprofessional translators such as the patient’s family members, but fail to realize the safety concerns of this method. These types of interpreters are used to reduce hospital costs and expedite treatment, but they cannot prevent risks to the patients. Eva Vega-Gamez and other PhD nursing students wrote an article that appeared in the RN Journal of Nursing titled “Impact of Language Barriers on Patient Safety”. In this article, they explain the miscommunication problems that occur when hospitals use family members to translate. “Ad hoc interpreters are unfamiliar with the safety risks associated with medications and thus may impact the quality of care by misinterpreting pertinent information.” (Gamez et al.) 

    Flora Yu, a multilingual journalist who has gone through similar experiences with her own family, supports and extends this idea in her article “Hazards of Language Barriers Between LEP Patients and Healthcare Providers” with an anecdote. Yu describes the story of a 9 year old girl who had her 16 year old brother act as an interpreter. They were given documents in English that their parents had to sign. Their parents were not proficient in English. All of this led to the young girl being misdiagnosed and given the wrong medication leading to her death. Both of these articles push the idea that unprofessional interpreters can cause more damage than good. Yu also states clinics cite the reason for not hiring professional interpreters is the expense. She rebuts this claim stating “However, when it comes to your patient’s life and your clinic’s reputation of care- the costs of not having professional translation and interpretation resources can be damaging.” (Yu) 

    By enlisting professionals to help interpret, hospitals can also decrease the likelihood of getting sued due to mismanagement with an LEP patient. Gamez et al. develop this idea of the cost effectiveness with hiring nurses who are multilingual. They claim that having nurses speak the same language as the patient lowers the cost of care, makes both parties feel more comfortable and lowers the risk of complications from a misunderstanding. The Agency for Healthcare Research and Quality, an official agency of the US Department of Health and Human Services, wrote an evidence summary titled “Why focus on safety for patients with limited English proficiency?”. Their research reinforces the idea of hospitals trying to comply with laws by using family members or house staff interpreters but there is numerous evidence that ad hoc interpreters significantly increase the chances of clinical consequences. They also strengthen this evidence with cases where hospitals were sued and had to pay an extreme fine, all of which could have been significantly less money, had followed protocol and paid for LEP services. “A malpractice carrier operating in four States found that LEP claims accounted for 2.5 percent of all claims (35 claims total) and cost more than $5 million over a 4-year period. Almost all of these claims related to poor communication and failure to provide a competent interpreter”. (AHRQ) 

    It is understandable to know that interpreting services are expensive but this has a simple solution. Hiring full time interpreters for the most commonly spoken languages in the US as well as providing video and telephonic services for other languages. This is a much lower cost than constantly paying for an interpreting service as well as allows the hospital to have permanent interpreters. Cutting corners by using ad-hoc interpreters puts both the hospitals and the patients in dangerous situations. Providing more funding specifically allocated for translators can alleviate this struggle.

New Resources to Alleviate Language Barriers 

    Technology continues to improve with more products being developed to aid healthcare professionals to better support their LEP patients, which hospitals should be taking advantage of. Health and Fitness writer Erica Nahmad published an article for BeLatina, “This Latina Is Helping Her Community Fight Language Barriers With Her Medical Translation Badges”, highlighting a product created by medical student Yogi Henriquez. Henriquez created medical translation clip badges for healthcare workers to wear. The badges contain the most commonly used terms as well as frequently asked patient questions and provides translations for the second most used language in the US, Spanish. Her cards allow patients to feel more comfortable with their doctors and nurses. It will temporarily reduce the miscommunications and they will be able to more clearly speak on all of their symptoms to get an accurate diagnosis. LEP patients constantly do not have their problems heard leading to overlooked symptoms, incorrect diagnoses, and ineffective treatments. These cards aim to reduce these events from occurring and to help when translators are not available. “I had just started to work in the emergency room, and I saw how many Spanish-speaking patients came in not knowing how to communicate the reason they came into the ER. Doctors would try to get translators, but the phone service would always take too long,” Yogi told BeLatina. “I wanted to find a simple solution to bridge that gap between healthcare providers and patients to ensure the patient received the best quality care and wouldn’t come back in worse condition. Not everyone has a family member that can come with them to advocate or translate for them. Because of this, so many symptoms get overlooked, and so does the patient.” (Nahmad) When a doctor is sincerely putting effort into communicating with an LEP patient, this will make the patient feel more comfortable to speak about any family medical conditions and their own previous medical history. This reduces the time of their hospital stay and the chance of readmission. 

    News station, Arizona’s Family, did a segment on an Arizona State University graduate who developed an app to be used in healthcare settings to communicate with patients in their video “New tool helps overcome language barrier between doctors and patients”. In the news clip, the reporter states “According to the American Medical Association, more than 3/4 of medical misdiagnoses are because of a breakdown in communication between doctors and patients leading to between 40,000-80,000 avoidable hospital deaths each year in the US,” (Gordon) Aziza Ismail developed the app “Literaseed” which uses jovial and simplistic pictures to depict symptoms such as fever, sore throat, and more. Ismail expands on Henriquez’s product with a digital app to solve language gaps in healthcare. Both of these creators have had first hand experiences with their families and the barriers in the healthcare system due to language barriers. They similarly used their experiences to inspire development for their respective products. There are resources with the ability to bridge the gap between healthcare workers and patients. The lack of funding is not an excuse when easily accessible resources become widely available. With the United States continually creating more technology and more students applying to higher education, expect to see more products to eliminate barriers.

How The Healthcare System Can Implement Change 

    The American Healthcare system has no excuse for the discrimination it perpetuates everyday. The research outlined gives plausible solutions to hospital’s reluctance to give equal care to LEP patients. “Equal access is a right, not a privilege,” Yogi stresses. “Just because you don’t speak English does not mean that you should be treated differently.”’ (Nahmad) Hospitals should invest in recruiting multilingual healthcare professionals. According to Doximity, there currently is a language gap between the physicians and their patients. Popular languages are not spoken by those in healthcare and that needs to change.

Non English Languages Most Spoken by US Physicians 

5. Chinese (5.2%)

4. Persian/Farsi (7.6%)

3. French (8.8%)

2. Hindi (13.8%)

1. Spanish (36.2%)

Languages Spoken by Patients With The Least Overlap With US Physicians 

5. Filipino 

4. Burmese & Southeast Asian

3. Polynesian 

2. Hamitic & Near East Arabic

1. Swahili & Sub-Saharan African

America is a melting pot of cultures and languages and systems that cater to all citizens should reflect that through their employees and their care for those citizens. The underlying racism and discrimination that occurs through the result of LEP patient neglect is unacceptable. All citizens of America deserve equal hospital treatment regardless of language. Hospitals should advocate for more funding and resources to provide better care to LEP citizens. Hospitals implementing services such as language apps like Literaseed, translation badges, and multilingual nurses could greatly improve LEP patient care. If healthcare providers can take care of a drunk driver, someone who has committed a crime and possible damage to others, and give them access to great care, why can’t immigrants and residents with limited English proficiency not get the same treatment?

Works Cited

“New tool helps overcome language barrier between doctors and patients” YouTube, uploaded by AZFamily 3TV and CBS 5 News, 3 May 2021, https://youtu.be/T6rWBHz-Ktg .Accessed 9 Nov. 2022.

First-Ever National Study to Examine Different Languages Spoken by U.S. Doctors. doximity, 17 Oct. 2017 https://press.doximity.com/articles/first-ever-national-study-to-examine-different-languages-spoken-by-us-doctors . Accessed 9 Nov. 2022.

Evidence Summary: Why focus on safety for patients with limited English proficiency?. AHRQ, Dec. 2012, https://www.ahrq.gov/teamstepps/lep/handouts/lepevidencesum.html . Accessed 9 Nov. 2022.

Green, Alexander R. Nze, Chijioke. Language-Based Inequity in Health Care: Who Is the “Poor Historian”? AMA Journal of Ethics, 2017, https://journalofethics.ama-assn.org/article/language-based-inequity-health-care-who-poor-historian/2017-03 . Accessed 9 Nov. 2022

Kovacevic, Maya. BREAKING DOWN THE LANGUAGE BARRIER. Frontiers Washington University Review of Health, 20 Nov. 2020, http://frontiersmag.wustl.edu/2020/11/20/breaking-down-the-language-barrier/ . Accessed 9 Nov. 2022.

Nahmad, Erica. This Latina Is Helping Her Community Fight Language Barriers With Her Medical Translation Badges. BeLatina, 30 Sep. 2021, https://belatina.com/latina-fight-language-barriers-medical-translation-badges/ . Accessed 9 Nov. 2022.

Vega-Gamez, Eva et al. Impact of Language Barriers on Patient Safety. RN Journal, 2018, https://rn-journal.com/journal-of-nursing/impact-of-language-barriers-on-patient-safety . Accessed 9 Nov. 2022.

Yu, Flora. Hazards of Language Barriers Between LEP patients and Healthcare providers. JR Language, 5 May 2021, https://blog-english.jrlanguage.com/medical-translations-interpretations-protect-lep-patients/ . Accessed 9 Nov. 2022.