Language barriers compromise health care for 50 million Americans who do not speak English

While passions flare on all sides of the language debate, the sad truth is that the language barrier negatively impacts health care for 50 million (19 percent) U.S. residents who do not speak English at home and the 22 million (eight percent) with limited English proficiency.

Writing in the July 20 issue of the New England Journal of Medicine, Glenn Flores, M.D., one of the foremost experts on the issue of multicultural health care communication in the U.S., highlights the many deleterious and sometimes tragic effects of language barriers on health and health care for these patients. Lack of effective communication also contributes to the high cost of healthcare, according to Dr. Flores, professor of pediatrics, epidemiology and health policy at the Medical College of Wisconsin, and director of the Center for Advancement of Underserved Children at the Medical College and Children's Hospital of Wisconsin.

"No American should suffer from medical mistakes, preventable hospitalizations, and substandard medical care just because he or she doesn't speak English," Says Dr. Flores.

His perspective article includes examples of tragic consequences of miscommunication between the physician and ad hoc medical interpreters for patients with limited English proficiency:

  • The misinterpretation of a single word led to a patient's delayed care, preventable quadriplegia and a $71 million malpractice settlement. The patient was wrongfully treated for drug abuse when he actually was complaining that he felt sick to his stomach. The delay in treatment resulted in rupture of a brain aneurysm.

  • An ad hoc interpreter told the mother of a seven-year old girl to put an oral antibiotic in the girl's ear to treat her middle ear infection.

  • A resident physician who interpreted a Spanish speaking mother's explanation that her daughter had "hit herself" when she fell off her tricycle assumed the fracture had resulted from abuse, and called the social services department who had the mother sign over custody of her two children.

"As these cases illustrate, it can be dangerous to have children, family members and friends provide medical interpretation," points out Dr. Flores.

Yet many patients who need medical interpreters have no access to them. According to one study, there was no interpreter used in 46 percent of emergency-department cases involving patients with limited English proficiency.

"Communication is essential to high-quality care and positive health outcomes in any physician-patient interaction," Dr. Flores says. "When a language barrier exists without a qualified medical interpreter the situation can be potentially explosive. This is particularly true of young children who are unlikely to have full command of two languages and medical terminology and who generally avoid discussing sensitive issues."

Dr. Flores's review of the literature and his own studies show that patients who face such barriers find it more difficult to access care, and are less likely to have a usual source of medical care. They receive fewer preventive services and are at increased risk of nonadherence to medication. Asthmatic children are at greater risk for intubation, are less likely to return for follow up visits after being seen in the emergency department, and have higher rates of hospitalizations and drug complications. This results in greater expenditure of healthcare dollars, and patients report lower satisfaction with care.

On the other hand, the provision of adequate language services results in optimal communication, patient satisfaction, outcomes, resource utilization, and safety. "The time has come for the federal government to require all payers to reimburse providers for interpreter services in healthcare," Dr. Flores concludes.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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Let me listen to me and not to them.
-- Gertrude Stein