Healthcare Communication Problems with Linguistic Minorities

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Painting of a nurse

By Gabriel Émile Édouard Nicolet (Swiss, 1856-1921) [Public domain], via Wikimedia Commons

Effective communication between healthcare providers and their patients is an important factor in patient satisfaction. Global patient satisfaction with healthcare has been found to be lower among patients who have more provider-patient communication problems (Charles, Goldsmith, Chambers, Haynes, & Gauld, 1996).

The most commonly reported problems involve failures on the part of providers to communicate when communication is expected, such as failing to explain what the provider is intending to do while examining a patient, keeping the patient in the dark about daily routines, and failing to communicate adequately during discharge planning.

Dissatisfaction with Healthcare Communication in the Second Language

Global dissatisfaction with healthcare becomes more acute, however, when the provider and patient cannot effectively communicate in each other’s language. In a study of 26 international medical graduates enrolled in an Internal Medicine residency program at Wayne State University, a significant correlation was found between language proficiency and patient satisfaction (Eggly, Musial, & Smulowitz, 1999). In another study, Spanish-speaking patients in San Francisco were also found to be less satisfied with the care they received from non-Spanish speaking physicians (Fernandez et al., 2004), and in the North-eastern United States, a variety of non-English speaking patients reported less satisfaction than their English-speaking counterparts with emergency room care, courtesy and respect, and with discharge instructions (Carrasquillo, Orav, Brennan, & Burstin, 1999). Comparisons made between members of the same linguistic minority group also showed a correlation between language proficiency and satisfaction levels. For example, low-English-proficiency Korean patients over the age of 60 in the U.S. were less likely to be satisfied with the healthcare service they received than Koreans with higher levels of proficiency (Jang, Kim, & Chiriboga, 2005).

Indeed, not speaking the language of the patient adds to a patient’s suffering. One emergency department study found that Spanish-speaking Hispanic patients were half as likely to receive analgesia in the treatment of their long bone fractures as their English-speaking counterparts (Todd, Samaroo, & Hoffman, 1993). Worse still, a failure to anticipate communication problems and accommodate low-language proficiency clientele can turn fatal, as was recently illustrated in a news story of an Albanian immigrant who killed himself, thinking his wife had been diagnosed with AIDS when hospital staff told him his wife’s blood type was A-positive (The Canadian Press, 2007).

Improving Healthcare Access for Linguistic Minorities

One obvious solution to increasing healthcare access to linguistic minorities is to use interpreters. Whereas the use of hospital-trained interpreters in pediatric emergency departments was found to increase parents’ satisfaction with their physicians and nurses (Garcia, Roy et al., 2006), in primary care medical interviews a reliance upon interpreters is somewhat more problematic. Aranguri, Davidson, and Ramirez (2006) observed that during regular doctors’ appointments with Hispanic patients about half of the words exchanged between doctor and patient were missing from interpreters’ translations. All small talk, known to increase patients’ emotional engagement in their treatments and their doctors’ ability to get a comprehensive patient history, was eliminated. Patients’ questions, an important indication of patients’ engagement with their own care, were also significantly reduced when an interpreter was used.

To reduce the heavy reliance on interpreters in healthcare, Zambrana et al. (2004) recommend hiring more minority, linguistically competent, and culturally competent healthcare providers in managed care networks. They argue that having healthcare providers that speak the same language as their patients will lead to lowered costs, greater healthcare access, better health outcomes, patient satisfaction, and patient compliance. There is evidence to support this claim. One study investigating patient outcomes found that asthma patients cared for by doctors who spoke their language were more likely to take their medication and less likely to miss office appointments or make resource-intensive emergency room visits than patients with doctors who did not speak their language (Manson, 1988). Another study found that patients whose doctors spoke their language asked more questions and had a better recall of their doctor’s recommendations (Seijo, Girmez, & Freidenberg, 1991).

A Resource Medical Professionals Learning English

The Virtual Writing Tutor grammar checker is equipped with a number of pronunciation tools, including a text-to-speech engine that can help medical professionals refine their pronunciation in English.

To practice the questions needed to perform a medical history interview, the Virtual Writing Tutor provides a Flash-based simulation of a medical history interview with an English-speaking diabetic man.

To help medical professionals become better aware of their medical English and to develop their medical vocabulary, the Virtual Writing Tutor also has a vocabulary checker.

References

Aranguri, C., Davidson, B., & Ramirez, R. (2006). Patterns of Communication through Interpreters:  A Detailed Sociolinguistic Analysis. Journal of General Internal Medicine21(6), 623–629.

Carrasquillo, O., Orav, E. J., Brennan, T. A., & Burstin, H. R. (1999). Impact of language barriers on patient satisfaction in an emergency department. Journal of General Internal Medicine14(2),  82–87.

Charles, C., Goldsmith, L. J., Chambers, L., Haynes, R. B., & Gauld, M. (1996). Provider-Patient Communication Among Elderly and Nonelderly Patients in Canadian Hospitals: A National Survey. Health Communication8(3), 281.

Eggly, S., Musial, J., & Smulowitz, J. (1999). Research and Discussion Note The Relationship between English Language Proficiency and Success as a Medical Resident. English for Specific Purposes18(2), 201–208.

Fernandez, A., Schillinger, D., Grumbach, K., Rosenthal, A., Stewart, A. L., Wang, F., & Perez-Stable, E. J. (2004). Physician language ability and cultural competence an exploratory study of communication with Spanish-speaking patients. Journal of General Internal Medicine19(2), 167–174.

Jang, Y., Kim, G., & Chiriboga, D. A. (2005). Health, healthcare utilization, and satisfaction with service: barriers and facilitators for older Korean Americans. J Am Geriatr Soc53(9), 1613–7.

Manson, A. (1988). Language Concordance as a Determinant of Patient Compliance and Emergency Room Use in Patients with Asthma. Medical Care26(12), 1119–1128.

Seijo, R., Girmez, H., & Freidenberg, J. (1991). Language as a communication barrier in medical care for Latino patients. Hisp J Behav Sci13(363).

The Canadian Press. (2007, December 11). Caregivers must be open to cultural differences, commission told. Retrieved January 2, 2008, from http://www.cbc.ca/canada/montreal/story/2007/12/11/qc-bouchardtaylor.html

Todd, K. H., Samaroo, N., & Hoffman, J. R. (1993). Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA269(12), 1537–1539.

Zambrana, R. E., Molnar, C., Munoz, H. B., & Lopez, D. S. (2004). Cultural competency as it intersects with racial/ethnic, linguistic, and class disparities in managed healthcare organizations. Am J Manag Care10 Spec No, SP37–44.

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