In the healthcare and medical fields, the inability to communicate clearly can result in lives being put on the line…
This means that working out how to overcome language barriers in healthcare is high on the list of concerns of all kinds of doctors, nurses, and hospital administrators.
If you are facing a communication challenge in your hospital or clinic, this article is for you:
Here we’ll take a look at some examples of language barriers in healthcare before examining both general and specific strategies for overcoming them.
Examples of language barriers in healthcare
Some of the most prominent factors relating to language barriers in healthcare in 2019 – and on into the future, no doubt – include:
1) Communication with emergency patients
Being able to get all of an accident or emergency patient’s details correctly is a vital step in ensuring they receive the highest level of correct care.
Here’s a well-known example of what can go wrong if a strategy for achieving this isn’t in place:
In 1980, 18-year old Willie Ramirez of Florida arrived in hospital. His friends and family tried to explain his condition…
But, only able to communicate in Spanish, they told a bilingual member of hospital staff that he was “intoxicado,” meaning that they thought he had been poisoned in some way.
The bilingual staff member thought this to be a cognate of the English word “intoxicated” and understood that Willie was very drunk. This was what they relayed to the doctors deciding on his treatment.
The result was that the doctors did not search for the true cause of Willie’s condition – an intracerebral hemorrhage – and Willie was left, a quadriplegic. His family successfully sued the hospital for $71 million.
This is an extreme example, perhaps. But it is still a real-life situation that actually happened.
2) Patient stress
Most people find a trip to the hospital or medical clinic a stressful experience even when they can communicate with the medical staff they interact within a language they know.
How much more so for people who need to convey the detail of their condition in a language which isn’t their own?
The stress and nervous reactions, which are the results of an inability to communicate properly, have been found to dramatically impact the quality of care a patient receives – on top of the risk of miscommunication and misunderstanding.
3) Basic hospital information and instructions
It can be easy to overlook the importance of providing solid basic information to patients and visitors in a language they understand. This might include:
- Basic information like visiting hours, maps, direction signs, and evacuation plans
- Warning signs such as prohibited areas or no smoking or mobile phone-free areas
- Important information leaflets, such as those relating to specific illnesses or vaccinations
- Basic hospital policies
4) Patient charts, medical histories, intake forms, and doctor’s instructions
These are perhaps the clearest candidate for written medical translation services.
Having clear, accurate information is vital in order to diagnose a patient – and then proceed with treatment correctly.
If this is required regularly, automatization of the translation process can be achieved through Translation Management Systems and related software.
You should consult your Language Service Provider (LSP) if this is one of your areas of concern.
How language barriers impact patient care
Back in 2007, an American study found that 52% of adverse events experienced by patients with Limited English Proficiency (LEP) in hospitals – including misdiagnosis and inappropriate treatment – were likely caused by language barriers.
Some of these outcomes occurred because hospital staff was forced to resort to ad hoc solutions in order to understand what a patient or their family members were trying to say about their condition.
Language barriers impact patient care in all kinds of ways:
1) Miscommunication on medical matters
The danger of poorly relayed information is the most obvious example of why overcoming communication barriers in healthcare is so important:
i) Verbal interpreting
In verbal interpreting, only professional medical interpreters have the high-level mastery of both languages and – critically – the understanding of the medical concepts and terminology necessary to enable clear communication across language barriers.
Relying on the family and friends of patients – especially young children – as well as other patients, visitors, or even bilingual staff who do not have proper training in medical interpreting is always a bad idea. You only need to remember the example of Willie Ramirez to understand why.
This is only thrown into sharper relief by the fact that medical translation and interpreting services are more convenient and affordable now than they have been before.
The best-case result is wasted time. The worst-case, serious injury, or even death.
ii) Written translation
When it comes to written translation, only a professional medical translator will understand the importance of the separate steps of translation, editing, and proofreading – and possibly back translation and reconciliation for highly sensitive or complicated documents.
A trained linguist will also be able to adapt the language involved for an audience from a different culture – a necessary step in encouraging understanding as well as later compliance with treatment recommendations.
2) Impact on staff time and availability
Almost any healthcare center you care to name, from dental surgery to optician clinic to hospital, is a busy environment. Staff cannot afford to waste any of the limited time they have available.
Having to spend vital minutes repeatedly explaining basic hospital policies or procedures to visitors or patients with Limited English Proficiency can be hugely distracting as well as a massive time-sink.
Having things like information booklets, intake documents and signs already translated removes this hurdle.
3) Difficulty remaining impartial
Impartiality is a vital part of a healthcare professional’s job. It’s the reason why treating a family member or loved one is usually regarded as bad practice.
It’s also the reason why relying on the family members or loved ones of patients to provide medical interpretation is a bad idea.
As well as the high risk of inaccurately conveyed terminology, a family member may seek to cushion the blow of diagnosis or even become upset when delivering it.
None of these situations will result in a high level of patient care.
4) Difficulty discussing personal issues
Having to relay sensitive personal issues through even a close relative can be difficult for many people.
This can be exacerbated when younger children are used as translators. It can also be challenging when the people involved are from cultures in which it is considered inappropriate for some things to be discussed between genders or even between people.
This also makes it difficult to achieve that vital connection of honesty between doctor and patient.
Unsurprisingly, the American College of Emergency Physicians found that non-professional interpreters caused significantly higher numbers of treatment errors than professionals.
Strategies to overcome language barriers in healthcare
That’s enough about how language barriers impact patient care. Let’s move on to some solutions:
1) Formalize your strategy
The changes required to handle communication with individuals across language barriers need to be implemented across your entire organization.
Preparation will come in the form of training for every member of your team.
You should also put systems in place which will allow you to gather feedback from patients and staff. You will then be able to use this information to pinpoint areas where you are succeeding and areas where you could do better.
Setting up a series of procedures that describe what your best communication practices actually consist of comes next.
Confirming that these are always ticked off is also vital.
ii) Assessment and screening
Systems for multilingual patient assessment and screening for potential language barriers will be a key part of your strategy. You should also have procedures in place which identify cultural differences that may affect treatment.
Correct assessment before the patient’s arrival – if possible – ensures you have the chance to bring in a properly trained interpreter when necessary and that you can deliver the highest level of treatment.
Regarding the assessment of your ongoing efforts, regular team meetings that address and assess performance and situations which have arisen should also be a part of your overall strategy.
Following up with each patient is a standard part of many medical practices. It’s especially important when language barriers have been present during treatment.
Follow-ups have been proven to hugely increase patient satisfaction levels. They also provide you with the additional information you need to assess your communication strategy.
You might want to consider:
- Follow-up visits
- Follow-up calls
- Surveys (online, written or by phone – of course, these also need to be accurately translated)
- Post-care instruction
2) Don’t make assumptions – ask questions
Any medical professional knows the importance of acting without assumptions. This remains as true when developing language barrier solutions in healthcare as it does when actually delivering treatment.
Linguistic or cultural assumptions can even endanger patients when they end up barring certain diagnoses or avenues of treatment from being considered.
This makes instituting a system of in-depth questioning an important part of the intake process for patients who may have cultural or language barriers in the way of their getting effective treatment.
Learning more about any given patient’s background and their beliefs as well as any alternative medical theories they may give credence to is also important. Sometimes this can only be achieved with the help of a professional interpreter.
The goal here is to ensure that doctors and nurses can gain a patient’s agreement with a diagnosis and course of treatment. This is easiest to do when healthcare professionals have not made assumptions or ignored a patient’s beliefs or cultural concerns.
3) Listen – and show you understand
You might feel that this is something that your medical team does well in all circumstances anyway.
But one of the most common bits of feedback that patients with Limited English Proficiency give about healthcare professionals is that they do not feel listened to.
This makes it vital – no matter the cultural differences and language barriers which may be in place – that you have instituted a system where patients are prompted with questions and their answers are heard.
Again, the goal is to achieve a patient’s willing compliance with the chosen course of treatment. Study results have shown that if a patient’s emotional memory of their appointment is a negative one (where they feel like they were not listened to), they are less likely to follow the treatment.
If you need professional assistance developing lists of questions like this, consulting a Language Service Provider which can source specialists with expertise in the medical field, is a sensible way to proceed.
4) Confirm understanding
In multilingual situations, it can be easy to assume that a polite nod or a smile is actually a confirmation of understanding. This can be risky.
Even a definite “yes” or “no” should not be taken as a sign of understanding in a multilingual situation. For instance, a patient may only wish to avoid appearing rude or stupid by asking for another explanation.
It’s recommended that healthcare professionals ask open-ended questions and encourage the patient to repeat back any explanations given to them in their own words.
Avoiding yes/ no questions such as “do you understand?” encourages a patient to articulate exactly what they mean and demonstrate that they have truly understood what their doctor or nurse has said in return.
Working with a medical interpreter
Many strategies for overcoming communication barriers in healthcare rely on working with professional medical interpreters.
Luckily, these days there are several different options when it comes to how healthcare interpreting services are delivered:
- In-person interpreting – is always to be preferred. The linguist will be able to see body language and gestures which affect the meaning of speech in many languages.
- Over the phone interpreting – this is often a lower-cost alternative. It has the benefit of being available almost on-demand.
- Video remote interpreting – can be something of a middle ground between the two other options. Not needing the interpreter to be on-site can reduce costs, while the video link allows most of the body language and non-verbal queues to be picked up.
No matter how you decide to have your language support delivered, there are several steps you can take to make working with a medical interpreter easier and more effective for everyone involved:
1) Meet with your healthcare interpreter first
A pre-session meeting allows you to brief your linguist about the patient and/or the points you will wish to touch on relating to their condition.
Any medical interpreter of decent quality will have a healthcare background – either training or experience or preferably both – but it is always useful to pinpoint the specific terminology which they may need to use with any given patient.
You can also discuss any cultural issues which are likely to arise – your linguist should be able to brief you on this – or any sections of the discussion which are likely to be emotive and which need to be delivered in a different tone or register.
2) Learn a little about how interpreting works
Your interpreter is there to facilitate communication. They’re not usually a part of the conversation.
This means that, after politely greeting your linguist, you or the member of your team involved should speak directly to the patient and let the interpreter do their job.
You should make sure that everything that you or the patient (as well as any family members who are present) says will be interpreted. If you feel it isn’t being, you should request that your linguist does so.
3) Speak slowly and clearly
Many people naturally want to raise the volume at which they speak to facilitate better communication. Of course, this tends to have the opposite effect!
Speaking slowly and clearly will give your linguist the time they need to do their job. You might also consider speaking in shorter segments than you normally would and avoiding things like:
- Complicated sentences
- Idioms and cliches
- Changing your question or idea partway through a sentence
- Asking more than one question at once
4) Allow time
Not all terminology or concepts have a direct equivalent in another language or culture. This is why briefing your medical interpreter beforehand is so important.
If unexpected concepts crop up, you will need to allow time for your linguist to determine the best way to convey the message.
In general, most interpreted conversations may take twice the length of time of a normal conversation (because the linguist needs to translate what is being said after each participant has spoken). This means you should allow additional time in appointments where interpreting will be a feature.
5) Respect your interpreter’s judgment
If they have the requisite experience, your interpreter should be able to tell you when certain lines of questioning are culturally inappropriate or need to be asked in another way.
When your language expert offers advice or observations in this vein, it’s best to listen to them.
6) Don’t blame the messenger
As a healthcare professional, you’ll know that sometimes patients can be accidentally or deliberately obstructive.
It’s important to remember that your linguist is not at fault here. They are just the messenger!
If you are struggling to get the information you need, consider asking your interpreter for their advice or re-framing the question.
7) Always confirm understanding
As we’ve already seen, a key part of any strategy to defeat language barriers in the medical field is to confirm that the patient has understood what they have been told.
Again, get a patient to repeat back what a doctor or nurse has said in different words rather than allowing a yes/ no response.
Overcoming language barriers in healthcare
Language barrier solutions in healthcare are best implemented as an organization-wide effort:
Welcome, and front-line staff will be all too aware of the languages they come into contact with during their working day. They will also have the most on-point knowledge as to which basic information – such as signs and written instructions – hospital users engage with most frequently. Plumb the depths of their knowledge.
Doctors, nurses, and other caregivers will have the greatest need for professional medical interpreting services – and knowledge as to how to interact with them – in their daily work. Make sure they have access to them.
Finally, administrators will, of course, be best placed to put procedures in place and analyze the organization’s efforts as a whole.
Working together, your team can ensure communication barriers in healthcare can easily be overcome.
Do you need to know more about medical translation and interpreting services?
Asian Absolute has language specialists with experience and qualifications in all kinds of specific medical fields.