Language Barriers and Healthcare
Written by Hannah Martinez
It should be obvious to most of us that not speaking a shared language leads to a huge decrease in the effectiveness of communication. In the US, this, unfortunately, means that many immigrants are unable to have an informative conversation about their health.

This is an issue that impacts the Latinx community hard. Due to many immigrants often having low English proficiency (LEP), the Spanish-English barrier adds complication to healthcare. Patients with LEP are more likely to have longer stays in hospitals and clinics; they also have higher risks of readmission, implying that they were not treated properly in the first place due to miscommunications. Spanish-speakers are highly aware of this problem; half of Spanish-speakers say that language difficulty is their biggest problem in receiving good healthcare. 

English-speaking family members traditionally jump in to fill the gaps, but this is not always the best solution. Due to their restricted medical experience, Dr. Robert Caldas of Massachusetts-based Southcoast Hospital believes  family members are often unreliable. 

Family members would sometimes fill in the gaps, but you never know of their level of understanding of the topic and what they’re translating to their loved ones,” -Dr. Caldas

He also warned of the biases family members may carry, such as wanting to shield their loved ones from receiving bad news or protecting their privacy. 

Healthcare providers and government agencies have attempted to solve the issue of familial translation by instituting policies and regulations that require trained translators. The Affordable Care Act mandated that clinics and hospitals limit the amount that family members are allowed to translate and promoted the presence of a translator on-site. The U.S. federal law also demands that language services are given to patients with LEP. 

Two problems still persist in healthcare in regards to language barriers in spite of these actions.

The most staggering problem is that a large percentage of hospitals are not meeting the guidelines set by federal law. A study using the National Standards for Culturally and Linguistically Appropriate Services in Health Care, or CLAS, found that nearly one in five hospitals did not meet any of the standards mandated by CLAS. It also found that only thirteen percent of hospitals were meeting all of the standards. Many hospitals reported that they informed patients of the available language services, but most of this information was given in English. Hospitals also admitted to utilizing family members as translators or even untrained staff members, and only a few said that they provided important documents, like release forms or prescription drug information, in languages other than English.

It is alarming that despite mountains of legislation demanding better care for those who require LEP, many hospitals fail to provide proper care. When family members are used as interpreters between patients and physicians, much is often lost in translation. Untrained staffers often present issues as well, even if they do not hold the biases that family members do. Trained translators receive concrete instruction on how to be a caring and empathetic translator, as in the patient’s eyes, they are a surrogate physician who needs to gain their trust. Untrained staffers may be unable to extract information from a Spanish-speaking Latinx who has never used a translator before and is hesitant about divulging sensitive and private medical information to someone that they do not know. 

The consequences of miscommunication can be damning. The problem becomes even more severe if family members or other potential translators are not available for use. In the sector of medical care, it is extremely important that physicians receive every bit of information possible to make a correct diagnosis and to also give proper care. If something is miscommunicated, it can have extremely severe consequences on the patient.

Another problem is the lack of trust Latinxs with LEP have towards physicians and translators. Unless the translator is effective and empathetic, Latinxs are much less likely to talk about information that is considered private, especially with topics like sexual activity and mental health. Since Latinxs with LEP are unable to communicate verbally with their physician, they rely on nonverbal cues to determine whether or not to trust their physician. Physicians who become frustrated because of poor translation or angry at miscommunications may raise their voice or indicate their emotions through their body language, and the patient is prone to thinking that their physician is not compassionate about their situation or even mad at them. This leads to decay in the patient-physician relationship, a problem that would never occur if physicians received implicit bias training and effective, trained-translators, were available at every hospital.

If we are ever to fix the problems that Latinxs with LEP face in hospitals, we must demand that healthcare providers have effective, trained translators in their staff and that physicians have implicit bias training to treat their non-English speaking patients with empathy and compassion. Otherwise, these problems will persist, and Latinxs with LEP will continue to face preventable subpar healthcare services.