Caring for Patients with Limited English Proficiency: The Perspectives of Small Group Practitioners

Abstract

BACKGROUND: Language barriers in medical care are a large and growing problem in the United States. Most research has focused on how language barriers affect patients. Less is known of the physician perspective and the efforts they are making to overcome these barriers.OBJECTIVE: To learn about current approaches to communicating with limited English-proficient (LEP) patients and the associated financial and nonfinancial constraints that private practice physicians and managers perceive in providing these services. DESIGN:Computer-assisted telephone focus groups with open-ended discussion guide.SETTING: Small private practices in geographic areas that have experienced recent dramatic increases in LEP populations.PARTICIPANTS: Primary care physicians, specialists, and practice managers.APPROACH: Focus group transcripts were systematically coded using grounded theory analysis. The research team then identified common themes that arose across the groups. RESULTS:Citing the cost, inaccessibility, and inconvenience of using professional interpreters, physicians commonly used family and friends as interpreters. Few recalled any actual experience with professional interpreters or were well-informed about the cost of their services. Physicians and office managers voiced uniform concern about how language barriers impede quality and safety of patient care and increased malpractice risk.CONCLUSIONS: Health care providers in private practice recognize the importance of overcoming language barriers. However, perceived barriers to implementing cost-effective strategies to these barriers are high. Physicians in private practice would benefit from information about how to best overcome language barriers in their practices efficiently and affordably. INTRODUCTIONThe 2000 U.S. Census reported that 47 million residents speak a language other than English at home, and almost half of them speak English less than "very well" by the U.S. Census definition. This limited English proficient (LEP) population is projected to increase dramatically by the year 2010, and immigrants and refugees are increasingly settling in areas of the country with relatively homogeneous English speaking populations 1 . This has created a situation in which many physicians previously unaccustomed to addressing language barriers in their practices now face the challenge of communicating across a language gap. Many health care systems and physician offices have responded to the challenge of communicating with LEP patient populations by using a variety of interpreters. They provide language access services in the form of face-to-face and telephonic professional interpreters and trained bilingual staff, rely on "ad hoc" interpreters such as untrained bilingual staff, and family and friends.2 Despite the fact that research has highlighted the poor quality of "ad hoc" interpretation and that it likely increases medical errors [3][4][5][6][7] , physicians are reluctant to work with professional interpreters, citing their cost and inefficiency 8 . However, it is no...

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“…21,22 At the encounter level, provider decision-making includes considerations of their own and the patient's or family's language proficiency, convenience, and the expected complexity of the clinical encounter. [23][24][25] Unfortunately, clinicians do not reliably assess their own proficiency, 24 and a priori decisions about an encounter's complexity necessarily account only for the clinician's agenda, not the family's. In addition, some families, not accustomed to being offered professional interpretation, bring untrained friends or family members to interpret.…”

The War on Language: Providing Culturally Appropriate Care to Syrian Refugees

“…There is an apparent absence of both motivation and resources to offer sufficient access to language services [11]. According to Gadon et al (2006), physicians are aware of the need for language services, but little is being done about it [15]. The resource provided by the government of Ontario is available in both official languages of Canada.…”

“…Recent health outcome disparities were found within immigrant subgroups, most notably in refugee communities [18]. The need to address current language barriers has been recognized by physicians, but overcoming them using costeffective strategies has proven difficult [15]. Recent cases have revealed the use of ad hoc interpretation instead of formal services due to cost effectiveness, availability, and the interpreter's understanding of the patient's culture [15].…”

“…The need to address current language barriers has been recognized by physicians, but overcoming them using costeffective strategies has proven difficult [15]. Recent cases have revealed the use of ad hoc interpretation instead of formal services due to cost effectiveness, availability, and the interpreter's understanding of the patient's culture [15]. Physicians in this same study voiced concern regarding the impact of language barriers on quality of care and patient safety, as well as an increased risk of malpractice [15].…”

“…Recent cases have revealed the use of ad hoc interpretation instead of formal services due to cost effectiveness, availability, and the interpreter's understanding of the patient's culture [15]. Physicians in this same study voiced concern regarding the impact of language barriers on quality of care and patient safety, as well as an increased risk of malpractice [15]. As discussed, the most recent guidelines to support health care providers to practice in a culturally competent and appropriate way do not directly address language.…”