Does a patient’s English proficiency impact their care?

By Jules Murtha | Fact-checked by Jessica Wrubel
Published August 4, 2022

Key Takeaways

  • A recent study found that patients who speak limited English are less likely to ask for clarification, question doctors’ decisions, or speak up, which may impact their hospital safety.

  • Implementing Medical Spanish education and assessment in medical schools and health systems could promote linguistically appropriate care for Hispanic populations.

  • Doctors can provide better care to patients with limited English proficiency by using interpreters and advocating for system-level changes that encourage diversity through language skills.

When 13-year-old MM showed up to the emergency room with her father, the doctor who saw them—Dr. J, a second-year emergency department (ED) resident—struggled to understand them. Relying solely on the bits of English the patient and her father knew, Dr. J diagnosed MM with gastroenteritis, according to an article published by the AMA Journal of Ethics.[]

But days later, MM returned to the ED, this time in need of emergency surgery due to an abdominal abscess from a ruptured appendix and subsequent septic shock. Like others who speak limited English, MM received inequitable healthcare as a result of a language differential.

Potential solutions exist for this problem. Doctors can better care for patients by using an interpreter and advocating for language skills to help diversify health systems.

Hospital safety and limited English proficiency

The healthcare system may be tricky to navigate for patients who have limited English proficiency (LEP).

A 2022 study published by JAMA Pediatrics looked at differences in hospital safety climate scores between patients and families who have LEP and those with English proficiency.[]

From April 2019 to March 2020, researchers randomly selected Arabic-, Chinese-, English-, and Spanish-speaking pediatric patients from 21 US hospitals. Prior to discharge, these patients and their families were asked to provide health literacy data and their level of language proficiency.

When asked how well they speak English, participants who selected “very well” were said to have English proficiency. Those who selected any other answer were documented as having LEP.

Of the 533 eligible participants who completed the survey, 75 (14.1%) had LEP. The results showed that those with LEP were less likely to speak up if they noticed there was something potentially detrimental to their care.

Patients and families who spoke limited English had reportedly lower odds of questioning or challenging providers’ courses of action compared with English-proficient counterparts. The same applied to those who lacked health literacy or higher education.

These results point to the possibility that patients and families with LEP may be subject to greater hospital safety risks.

To combat the disparities that some patients face due to LEP, clinicians can embrace language skills as a facet of diversity—as opposed to a barrier.

How you can help

There are actions you and your colleagues can take to help patients with LEP attain equitable care.

According to the AMA Journal of Ethics article, physicians can use professional medical interpreters to decrease health disparities for patients and families with LEP.

Using medical interpreters in patient-physician interactions improves patient comprehension, decreases medical errors, and leads to better overall patient and clinician satisfaction.

Another tip from this article’s authors is for physicians to frame language skills as an important part of diversity, rather than a barrier to overcome. You can advocate for systemic change that embraces this perspective, which may help reduce inequities faced by patients with LEP.

The authors elaborated on the importance of addressing patients with LEP, writing, “There will be prejudices and assumptions to overcome and financial and logistical barriers to cross. However, in this globally connected world, there is no place for linguistic isolationism."

"We can change the system, and we should."

Derrington, et al.

An article in Academic Medicine suggested that Medical Spanish should be implemented in medical schools and health systems to help address language disparities among Hispanic populations and provide proper care to Spanish-speaking patients and their families.[]

What this means for you

Patients with limited English proficiency (LEP) may receive lower-quality care than their English-proficient counterparts due to language difficulty that impacts their ability to speak up if something seems wrong, ask questions, or challenge providers. Implementing Medical Spanish may help address these disparities among Hispanic patients. You can also advocate for patients with LEP by using a medical interpreter and shifting the narrative that language poses a “barrier” by instead promoting language skills as a facet of diversity.

Share with emailShare to FacebookShare to LinkedInShare to Twitter