A person with language skills that are still developing can navigate many situations. In a post office, train station or restaurant, there are ways to get by without being fluent. Communication in medical situations is not as flexible. People who prefer other languages and have Limited English Proficiency (LEP) need to exchange precise messages with their healthcare providers. People strongly prefer to communicate about medical, financial and legal matters in their first language.
Beyond preference for a certain language, safety and proper execution of self-treatment are concerns when treating patients with limited English. According to a telephone survey executed in 11 languages, almost 50% of patients have struggled to comprehend a medical situation. A third of respondents cited trouble understanding the procedure for medication.
Limited English Proficiency (LEP) Defined
Patients with limited English appear in emergency rooms and urgent care centers. Many people who speak well in regular situations struggle with comprehension in medical environments. They do not deserve to have their health compromised. The increased risk of poor communication should be a concern for medical facilities.
Bearing in mind that languages are comprised of four skills, Limited English Proficiency (LEP) is a bigger continuum than is commonly acknowledged. The skills of reading, writing, speaking and listening make each speaker of a language a separate mosaic of abilities. That’s even the case with anyone’s native language. When it comes to second and third languages, people’s language skills become more uneven. Since it’s difficult to quickly gauge a speaker’s proficiencies, it’s best to err on the side of caution. In medical environments, this means having a proactive language-access strategy. It may include bilingual staff, language professionals and written communication.
Ramifications of LEP speaking challenges
Patients who prefer other languages need the same medical care as everyone else. Having limited English proficiency can inhibit the quality of health care in a number of ways. Healthcare research and quality programs have identified specific consequences for treating patients with LEP concerns and their likelihood of occurring. Here we present an overview of the challenges, without delving into topics like the risk of malpractice suits.
Pre-treatment Concerns
Foremost in the order of medical operations, patients with LEP situations can struggle to accurately describe their symptoms. The exact location and sensation of internal problems may escape their English vocabulary. This is probably the healthcare moment during which interpreter services can be most vital to improving LEP patients’ health.
Without a proper diagnosis or at least a correct list of symptoms, prospects for treatment outcomes are much lower. How can health be restored without identifying the problems? Communicating an LEP patient’s medications and their purposes correctly is also critical for avoiding interaction issues.
Treatment and Post-Treatment Concerns
Many treatments prescribed by health care providers resolve some symptoms but not others. After diagnosis, relaying the effectiveness of treatment can be difficult for patients with limited English. When surgeries or wounds are healing, the effects of poor communication can compound to truly affect the quality of care. The same goes for when different treatments are being tested over time. Continuous conversations in the primary language prevent health care disparities due to language barriers.
Patients who do not read and write well
When people envision communication in the patient-provider relationship, conversations in an exam room come to mind. Nevertheless, written communication is important to prevent adverse events due to language barriers. If a provider or hospital system lacks a comprehensive language solution, many challenges result. Prescription information and treatment steps the patient must follow, often cannot be translated prior to a speedy discharge. Sometimes even general medical education documents cannot be translated into languages in time for an LEP patient to leave the office. Unfortunately, we know that persons with limited English may not receive the same follow-up on unresolved issues as others.
Supporting patients with LEP challenges through prepared routine written communication in pertinent languages is one step in the right direction. Long-term language solutions that meet persistent limited English proficiency disparities drive providers toward high-quality care.
Patients who do not speak any English
So far, we have iterated the issues for patients with limited English. They prefer another language. With no English skills, a patient relies on interpretation and translation—hopefully by a decent-quality translator or interpreter services. Sometimes, hospitals and rural areas must make do with the language resources available. While it’s undoubtedly difficult to serve all world languages, innovative language companies are breaching linguistic division like never before through technology.
Provider differences and shortcomings
North American medical education institutions attract students from different countries. Meanwhile, some doctors immigrate and practice. They may be able to deliver stellar health care. However, some patients do not do well with accents, especially ones they’ve never heard. Some providers practice well but still have language shortcomings. When they do, accent reduction training can help healthcare organizations equip providers for expanded success.
To meet the needs of a limited English proficiency (LEP) patient population, a healthcare entity may need providers who speak that language. They may greatly boost the quality of care with one hire. For example, hiring a Mandarin-speaking nurse in San Francisco can help alleviate the constant need for costly medical interpretation in a language so different from English. By improving the English of a professional who speaks a valuable language, a provider can improve the quality of care with better communication in two languages with one hire, one salary and one set of benefits.
Limited English Proficiency Solutions Are Vital in Healthcare
Most people have trouble understanding or at least adhering to pharmaceutical and medical instructions. That’s especially the case when they don’t feel well. When a medication is new and the patient has no established habit of taking it, the challenges can compound.
Overall, 21% of the US population does not have high proficiency in English according to the US Census Bureau. A fifth of Americans can face LEP medical challenges. The most challenging patients to accommodate are those who prefer languages other than Spanish (and English). Proactivity can go a long way in preventing medical shortcomings.
Dual-language speakers who want to enter into interpreting or translating can help resolve health disparities. With the aging and increasingly diverse population of the US, interpreting is a career with a promising outlook. In fact, it’s expected to have high as 20% job growth until 2031, according to the Bureau of Labor Statistics. That is a much higher-than-average outlook.
Preventing Linguistic Shortcuts
Large healthcare operations like hospitals and medical schools usually educate their providers about the need to rely on medical interpreters and translators whenever possible. Regardless, the temptation to take communicative shortcuts is always there. Patients and providers often resort to the paths of least resistance for methods of communication. Shortcuts leave a lot of room for error, especially when “medicalese” is involved.
Family members and friends
When communication about health needs to happen quickly, it’s not uncommon to resort to using family members who speak English to a better degree. LEP patients and family members run the risk of miscommunications with nurses and doctors. Infrequent communication is another problem. Without detailed exchanges at a frequency approaching the normal rate of patient-provider communication, shortcomings are bound to lower the quality of care.
Illustrating the risks of miscommunications underscores the need for accessible medical language solutions. When a young Spanish-speaking person was poisoned by a substance, they were taken to the hospital by their family. They told the hospital staff the patient was “intoxicado.” The staff took this to mean “intoxicated” by alcohol instead of poisoned, the true meaning in Spanish. They prepared to pump the patient’s stomach with the usual process for alcohol instead of administering treatment for the poisoning. It’s this sort of miscommunication that can lead to complications, mistreatment or even death. Relying on interpreter services is key.
Using online translators
Another problem is using online translators such as Google Translate. Online translators still often convert individual words from one language to another. They also don’t recognize sayings and expressions as well.
For example, imagine that during check-in, a nurse asks an LEP mother whether her two-year-old with a bandaged stomach is “pushing through” the pain and discomfort. The mother says yes, the patient is “pushing through.” The nurse thinks the child is coping okay and doesn’t check the bandage. The problem is that with an expression like “pushing through,” the mother might have just tried to agree that the child’s breathing was making the bandage come undone, or that the squirrely two-year-old had been trying to pull the bandage off himself. The nurse leaves, thinking everything is alright. The mother waits for the nurse to return with new bandages to re-dress the wound that the child has already partially taken off. Mom hopes the nurse will return with a sturdier bandage or a sleeve that he can’t undo himself, so Mom doesn’t have to keep telling him not to pull at it. However, the nurse isn’t coming back because she’s got sicker patients than the two-year-old and the mother said everything was fine.
“Pushing through” would have been translated as “coping” or “dealing okay” by a professional interpreter. It’s the attack of the “miscommunication based on sayings.” When relying on Google Translate or trying to make do with limited language abilities, there is no way to ensure proper communication. Interpretation by a true bilingual ensures every saying and nuance is converted properly.
Holding communication
Another concern in the hospital room, waiting room or exam room is holding communication, essentially waiting. Without a comprehensive language solution and sufficient medical interpreters to meet needs, Limited English-proficient patients’ health care will suffer. That’s because patient-provider conversations will need to wait until an interpreter can visit or be reached by phone. They should wait because miscommunications without a medical language professional can be dire. However, problems can worsen while awaiting an interpreter or a more proficient family member. These shortcuts and mistakes in preserving the integrity of medical information and decisions can be costly.
LEP Patient Rights in Healthcare
State of current rights and expectations
Since the Civil Rights Act of 1964 sought to guarantee equal treatment for citizens regardless of race, color and national origin, services and treatment of LEP individuals have been improving. In the year 2000, executive order 13166 expanded this effort. It drew specific attention to language concerns in Federal agencies for LEP individuals. Often, Federal efforts are undertaken in hopes that such standards will trickle down to state, local and community standards. Sometimes, they are statement actions hoping to change the national culture’s approach to certain groups.
While these governmental regulations helped, difficulties still remain. The United States and Canada are very diverse countries. Most regions of the United States have been comfortably operating as monolingual English communities for centuries. Nevertheless, the U.S. has no official language. Luckily, technology is facilitating access to translation and interpretation services.
Current enforcement, access, and patient experience
Unfortunately, healthcare safety issues still threaten to afflict all of the US population regardless of language. That’s unsurprising considering that health and anatomical information is not familiar to most people. Even those with healthcare experience or deep knowledge of their own conditions can get overwhelmed in an exam room or hospital when explaining symptoms or listening to bad news. Patients with limited English struggle with understanding health information, as providers have jam-packed schedules. With scheduling difficulties, they cannot take the time to help LEP patients understand or to wait for an interpreter.
To provide an educational liaison to having less-than-fluent English language skills, let’s look at the understanding of discharge information for English speakers. Research has shown that English speakers who haven’t completed high school have more trouble understanding English discharge instructions. That’s not to say that an LEP patient who is more educated or intelligent can only understand concepts at less than a high school level. However, the perception of dense or multi-step information in another language can be fuzzy, even for decent speakers. The facts may take longer to register in one’s mind or may not come through cleanly. Having digestible information in a patient’s first language upon discharge is vital.
Room for improved rights
LEP patients’ rights can be expanded so that they can receive proper care. Technology can facilitate quick, easy access to medical interpreters at every juncture. With state laws and commitment from medical facilities, the timeline of a globalized medical future can collapse into the present.
Room for improved commitment in patient-provider relationships
Providers can commit to a greater multi-linguistic strategy with their facility-wide policies. With a commitment outlined in writing along with consent forms at the beginning of a visit, linguistic rights would remain on the minds of providers and patients.
LEP Patients can take proactive steps to know their rights and anticipate their reception at certain providers and clinics. Preparing to explain their ailments and current health situation will save everyone time and money. Some insurances offer interpretation services by telephone and other technology.
Technology and Healthcare Communication
Although we’ve peppered in technological concerns already, it’s time to take a deeper look at the possibilities when melding technology and language. The risks of relying too much on technology also complicate the picture in busy healthcare environments.
The promise of technology
Both interpretation and translation benefit from technological advancements. Logistical concerns about connecting with a language professional have eased with stronger and more widespread internet connections. As telehealth executed by webcam helps patients, interpreters are available through video remote interpretation. This helps bridge long distances. It also widens the availability of rare languages. Meanwhile, translation technology can check for errors and inconsistencies across vast documents.
Risks in Modes of interpretation selection
Honestly, there is both promise and risk with technology helping language conversion and language access. Not every language-converting technology is the same. Risk has already invaded medical environments when telephone interpretation is chosen instead of in-person interpretation. Nowadays, choosing an option that displays gestures and allows an opportunity for writing in-person or onscreen is better. Remote video interpretation or telephonic interpretation are excellent options that solve logistical and geographic problems. However, gestures and facial expressions can provide important nuance for meaning, especially when patients are explaining symptoms or need to clarify instructions.
Risks with auto-translation
Translation-accuracy risks are omnipresent when auto-translation technology is used. AI technology is not a human brain. One problem is with words that are spelled the same but have different meanings. AI does not always suggest the correct meaning of a word in different contexts. Take the word “present,” which can be a verb to describe the symptoms a child patient has in the present (time). The child patient may get a present of a teddy bear from the hospital gift shop while they’re admitted. AI technology is still not great at recognizing the correct meaning of the different versions of words like “present” based on context. For that reason, human discretion needs to be used alongside translation software and apps that speed up the rate of translation.
ALTA Helps Deliver Better Health Care
ALTA Language Services understands the utility and necessity of having clear, consistent communication in medical environments. We empower medical professionals and language professionals to break through language barriers. An enterprise-level language services company with many lines of business, including medical interpreter training, ALTA operates with a 360-degree view of linguistic healthcare challenges. With this view in mind, we commit to helping patients stay healthier and for providers to practice well with any patient in front of them.
Whether your healthcare environment would benefit from interpretation, translation, or accent reduction for stellar medical professionals who are not native speakers, ALTA has a solution. Language testing can help you find the best bilingual medical professionals.
Medical Interpreter Training
ALTA’s interpreter training was crafted and gets updated with new material based on developments we see from our enterprise-level vantage point in the language services industry. Our eagle-eye view of different lines of business that intersect with medicine helps us design and execute training for a globalizing, multilingual 21st century.
Language Testing for Medical Professionals and Interpreters
Administering language testing for medical professionals who want to utilize their skills is among ALTA’s fortés. We provide transparent results that help companies make hiring and placement decisions.
Translation Services
With over 35 years of experience translating medical documents, we offer translation in over 100 languages.
Accent Reduction Training
Smart and effective medical professionals can take their careers to the next level with accent-reduction training. Whether they’re refining syllable stress and intonation or need to attack pronunciation in general after a reading-and-writing-centered language education, ALTA drives forward professionals’ speaking effectiveness until it sounds native.