Improving patient care by smoothing out the language barriers

By Kristen Fuller, MD | Fact-checked by MDLinx staff
Published November 11, 2022

Key Takeaways

I have had extensive experience working with non-native, English-speaking patients in the US and abroad. Often, they were desperate for help but had no way of communicating their issues—especially if their matters were private or culturally unacceptable.

From a vaginal prolapse in India or a young girl who needed birth control in Africa, to many cases of Hispanic patients who struggled to explain their level of pain, language problems have been a worldwide hindrance to patient care, in my experience.

"Some things are always lost in translation, but we often don’t consider medical language barriers—specific ones created by doctors."

Kristen Fuller, MD

Using medical jargon with patients

An older gentleman who had been my patient for about 3 years came into my outpatient clinic complaining of intermittent chest pain. As I examined him, I asked if his parents had a history of cardiac problems at a young age.

He stared at me, confused, and asked if I could repeat the question. After I did, he still looked as if he didn’t understand. A few seconds later, he said, “I'm sorry. What do you mean by ‘cardiac’”?

"I had unexpectedly created a language problem that was impacting my ability to provide quality care. "

Kristen Fuller, MD

Even though we both spoke fluent English, we were not communicating on a deeper level, one that truly mattered. I started to let medical jargon slip into my conversations with patients without realizing it was creating a huge obstacle to their care. It was only after I reworded the question to “heart problems” that my patient was able to answer.

Language issues impact patient care

We are not only failing limited English proficiency (LEP) patients; we are also failing native English speakers when we create language difficulties in medicine. And when a non-native, English-speaking patient comes into our office, we may rely on their family members to help translate our conversations or use our limited (non-fluent) second-language skills.

We also may refer LEP patients to outside social programs and organizations without knowing if they provide the appropriate language or cultural care. And as we use complicated medical language and references on morning rounds with colleagues, our medical vocabulary often becomes our daily language to the extent that we speak it by default with patients and their families.

All of these factors can impact patient care. Patients may pretend to understand because they're too embarrassed to ask the physician to clarify their statements.

Patients may not know that healthcare facilities are required to provide professional medical interpreters under the Civil Rights Act of 1964. Physicians should recognize when interpreters are needed.

The authors of a review published in Journal of General Internal Medicine wrote that, “While communicating in a patient's native language may build rapport, non-fluent clinicians must know when to call an interpreter and have an accurate gauge of their own limitations.”[]

Related: Real Talk: When physicians 'trash talk' about patients

Benefits of concordance

As diversity increases in our nation and its hospitals, the issue of healthcare equality for LEP patients is becoming more pronounced. When patients understand what’s being said about their care, treatment, and services, they are more likely to fulfill critical healthcare responsibilities—and as a result, take better care of themselves.

A study published in BMC Medical Education found that language concordance—defined in the article as “a clinical encounter where the patient and doctor speak the same non-English language”—improved patient trust of doctors, increased understanding of and adherence to treatment plans, reduced medical errors, and led to improved patient satisfaction with care.[]

The Journal of General Internal Medicine authors found that LEP patients who had language-concordant doctors felt better educated about their care, felt more comfortable asking questions, were better about taking medications, and had fewer visits to the ER.

Compared with English-speaking patients, patients who used interpreters were more likely to use recommended preventive services, made more office visits, and had more prescriptions written and filled, according to the article.

Fostering inclusive, supportive communication

Physicians play a vital role in fostering a supportive, inclusive culture for all patient populations.

Here are some steps we can implement in our practices to improve patient outcomes for LEP patients:

  • Set clear guidelines about when and how to use translation services, and openly track their enforcement.

  • Consistently communicate with medical students, residents, and staff that effective communication with LEP patients is essential for their care.

  • Use medical staff members as interpreters only if they are fluent in the patient's native language and interpretation services are among their designated duties.

Working with interpreters

Famed Canadian physician and co-founder of Johns Hopkins Hospital William Osler, FRS, FRCP, said, “Listen to your patient; he is telling you the diagnosis.”

Using a medical interpreter or translation service may seem awkward, cumbersome, and time-consuming, but remember that nothing is more pressing than hearing your patient tell their story.

Here are some guidelines for communicating with a patient through a medical interpreter, as suggested by an article published by Wolters Kluwer:[]

  • Try to identify patients who will need an interpreter in advance.

  • Make eye contact and speak directly to the patient, not the interpreter.

  • Be seated in front of your patient. Have the interpreter sit behind or next to them.

  • Ask only one question at a time and use short sentences.

  • Respect patients’ cultural differences.

Read Next: Real Talk: Breaking patient confidentiality
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