Improving Quality of US Health Care Hinges on Impr

Authors: Risa LavizzoMourey

Publish Date: 2007/10/24

Volume: 22, Issue: 2, Pages: 279-280

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Abstract

On behalf of the Robert Wood Johnson Foundation I am delighted to support this supplement on language services I believe that the quality of health care for all Americans will not be improved without a concentrated effort to ensure that people with limited Englishspeaking proficiency have access to language services and assistance in clinical encounters within America’s hospitals and health systemsIn 1999 Congress asked the Institute of Medicine IOM to analyze disparities in our health care system based on differences in patient race and ethnicity which can sometimes be accompanied by language barriers I was pleased to serve on the authors’ panel The resulting study Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care showed that patients of different ethnicities frequently received different levels of care even when all other factors such as income health status and insurance coverage were equal The differences in care these patients received were attributed to many different factors including whether or not patients and providers communicated effectivelyEight years later nearly one in five people in the USA now speak a language other than English at home and while most can comfortably speak English when needed experts estimate that as many as 20 million people in America—about one in every 15 people in the USA—speak and understand little if any English1 As America becomes increasingly multilingual physicians and other health care providers face a tremendous challenge—one that grows greater each year How will we communicate efficiently and costeffectively with patients who speak or understand limited EnglishBecause highquality patientcentered health care is contingent upon patients’ understanding and following their doctors’ advice—and upon health care providers listening to and understanding the needs of their patients—the stakes for meeting this challenge could not be higher If we are unsuccessful the result will be even bigger gaps in the quality of care that is provided to millions of nonEnglishspeaking patients We will have missed the challenge called forth in the IOM report and failed ourselves as health care leaders That is why more and more providers are trying to improve the quality of language services that they provide—because they know it is directly linked to the quality of medical care their patients receiveLanguage barriers impair discussions of symptoms and recommended therapies resulting in misdiagnoses or poor treatment decisions Communication barriers also impede adherence to treatment regimes Studies have shown that patients who need an interpreter but do not receive one are less likely to understand instructions for taking medications receive less information on medication side effects and experience lower satisfaction with their care23 One survey found that in the absence of an interpreter Spanishspeaking patients with limited English proficiency reported significant difficulty in being able to fully explain their symptoms or trust the medical recommendations of a provider who only speaks English4I guess this should not come as a surprise Even for the most fluent English speakers among us navigating a health care environment can be an overwhelming experience Physicians nurses technicians and other health care professionals typically use unfamiliar medical terminology that may sound foreign regardless of primary language For patients who speak and understand little or no English these challenges increase exponentially When patients and doctors cannot talk with each other about symptoms diagnoses test results medications treatment plans and followup care the result is bad medical careFar too often health care providers rely on a patient’s family member friend or even a member of the hospital’s nonmedical staff to communicate about clinical care—yet these individuals seldom have training in translating or interpreting medical terminology Additionally family members or friends may be reluctant to reveal some personal information about symptoms that could be embarrassing to the patient—information that may be critical to successful diagnosis and treatment Even seemingly simple things like requesting an additional blanket relaying information about a food allergy or asking about visiting hours can seem next to impossible

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