Communication is considered to be one of the cornerstones of practicing medicine and, naturally, it is a vital part of nearly any medical school curriculum. However, oftentimes, when students are taught how to properly interview and communicate with patients, it is under a very subtle yet important assumption: the physician and patient speak a common language. Consequently, it is not surprising that when language barriers do arise in the patient room, communication breakdown occurs as quickly as it does. As someone who speaks Spanish and is frequently asked to step in to mitigate these barriers, I have seen the real power that language possesses, and the important role is plays in effective patient interviewing. However, in many cases, I am the only person on the medical team who speaks a patient’s native language and can aid in these situations. With over 42 million people speaking Spanish at home and only 6% of physicians identifying as Spanish-speakers, I know my experience is not an isolated one1. Language barriers are no longer an issue we can continue to ignore or avoid; they are an everyday challenge in providing adequate healthcare and, at times, can even determine whether a patient ever comes back.
The lack of a common language during patient interviews has, unfortunately, led many providers to take “shortcuts” that, though quick and efficient, carry huge risks. One such example is the use of “ad hoc” interpreters—those who speak Spanish but are not formally educated or licensed in the field of medical interpretation. In other words, these “interpreters” are ordinary students, office staff, or even other patients who speak Spanish and are expected by physicians to interpret on their behalf. While it can provide a quick and easy fix for a physician waiting on the interpreter hotline for over an hour or for a provider trying to examine a crying baby, it also comes with grave risks such as inaccurate interpretation, translations without proper context, or important information being left out altogether2. I, myself, have had issues correctly interpreting information for patients, particularly when physicians used advanced medical jargon that I did not understand, even in English. However, when the hotline is busy, you have 10 other patients waiting on you, and you need to communicate important information to someone who does not speak English, I can see the appeal and rationale behind using such “interpreters.” Still, with the ever-growing Latino population in the United States, the demand for Spanish-speaking physicians is only increased over the upcoming years, and it is up to us, as the future of American healthcare, to address this issue, starting with ourselves.
Even if a patient and provider share a common language, effective communication is not marked by the ability to regurgitate facts and data to a patient. Rather, it is marked by the provider’s ability to convey this information in a sensitive and, when needed, direct manner. Physicians frequently are expected to give life-altering or devastating news to patients and, naturally, spend many years learning how to do so effectively. However, when patients do not speak the same language as the physician, the responsibility of delivering this devastating news falls on the interpreter who, in some cases, has not received this type of sensitivity training. This can drain any empathy or warmth the provider tries to convey to the patient while also potentially undermining the emotions felt by the patient as they hear this news. Whether it is an HIV diagnosis or the discovery of a malignant brain tumor, I, as a student, have had to deliver devastating news to patients and console them as their world falls apart. It is by no means easy for an interpreter to do properly, and, as data shows, many interpreters describe delivering such news as both emotionally challenging and guilt-inducing3. Physicians have a responsibility to their patients to provide information—good or bad—in a way that is clear, concise, and empathetic, regardless of what language their patient may speak.
Communication is an important aspect of medicine that becomes increasingly difficult to do correctly as more people are involved in the process. Physicians have a duty to ensure that the patient leaves the appointment informed and educated on what they need to do next—something that is hard to accomplish when relying on another person to convey information while also trying to keep the appointment within 10 minutes. As the Latino population in the U.S. continues to grow, learning Spanish, in particular, is no longer a convenience but a necessity. While I believe patients have some responsibility in reducing these barriers, as future physicians, we must also do our part in addressing these issues to ensure our patients receive the care they rightfully deserve.
References:
- Association of American Medical Colleges. (2021). The United States needs more Spanish-speaking physicians. Retrieved from https://www.aamc.org/news/united-states-needs-more-spanish-speaking-physicians
- Diamond, L. C., & Jacobs, E. A. (2010). Let’s not contribute to disparities: The best methods for teaching clinicians how to overcome language barriers to health care. Journal of General Internal Medicine, 25(2), 189–193. https://pmc.ncbi.nlm.nih.gov/articles/PMC4610127/#:~:text=Clinician%20coders%20rated%20the%20ad,interpretation%20(p%20%3C%200.05).
- Flores, G. (2014). Language barriers and communication in the primary care setting: The importance of the medical interpreter. Journal of the Royal Society of Medicine, 107(7), 278–287. https://journals.sagepub.com/doi/full/10.1177/0141076814527275
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