The Problem
As the world becomes smaller, effective communication between people is getting harder and harder due to language problems. People that used to be geographically separated now live close to each other, but the rate of language acquisition and assimilation is not as fast as the rate of immigration. According to a 2009 report from the US Census department the percent of the US Population that speak English "less than well" has climbed to over 9%. That is over 27 million people that don't know English well enough to tell a doctor what is wrong if they are sick.
Language services in healthcare are vitally needed because the number of Limited English Proficient (LEP) people in the United States are mushrooming. Louis Provenzano, President of Language Line, recently said,
"The growing linguistic diversity of the United States is having a dramatic impact on the delivery of essential social services, particularly health care services. Each day, thousands of patients arrive at hospitals, urgent care centers and primary care medical offices, and before their temperature is taken or their blood pressure is gauged, they face a potentially devastating barrier that could affect the quality of care they receive, the outcome of their visit, and their future health. These patients have limited English proficiency, defined as speaking English less than very well or not at all, and the language barrier they face has a detrimental effect on their care and overall health."
There are 38.1 million foreign-born individuals in the USA. Of the 47 million Americans who do not speak English at home, 24 million are considered LEP. More than 176 languages and various dialects are spoken across the country.
Language barriers are especially critical in matters of life and death (i.e. Healthcare and Public Safety). Unfortunately it is quite clear from many studies that insufficient language services result in poor medical assessment and subsequent care, especially for the nation's medically underserved populations, which are often more "heavily burdened with preventable and/or treatable diseases." Hispanics and Asian Americans stand out repeatedly as the population groups for whom the absence of "cultural competence" is a serious healthcare issue.
Unfortunately competent trained interpreters are frequently unavailable. The current recognized standard in language services is the live trained interpreter via a dedicated, private telephone line, video network, or in-person. An important 2009 survey of patients requiring language services established baseline measures of the favorable impact when those services were available, compared to when they were not. When an interpreter was present, 70% of patients said they fully understood what the doctor was saying. However, fewer than half surveyed (48%) said they had an interpreter (trained or otherwise) when one was needed. When an interpreter was available they reported that person was a trained medical interpreter only 1% of the time, a family or friend 43%, and a staff person 53% of the time.
There is a profound shortage of providers, including physicians, nurses, social workers and psychologists capable of communicating in languages other than English. While a few studies have demonstrated that competent translation services provided by trained personnel yield superior medical interventions, there are for more patients than providers from LEP cultures. It is therefore necessary to have language service help. However, "next-best translation" (e.g. bilingual staff, or, more likely, family members including children) occurs far too commonly. Problems with "ad-hoc" or no interpreter at all result in "miscommunication and a lower quality of care."
When information is passed from doctor to interpreter to patient and then back via the same path it takes longer and there are a number of ways that message can change:
- First, errors often occur because interpreters vary in their accuracy; omit or add information; are falsely fluent (believing that they are communicating correctly, but actually saying something different from what was originally communicated); substitute information that wasn't quite equivalent; along with other types of errors. The literature also suggests that all members of the communication trio—patient, provider, interpreter—must be aligned with a common message, yet not all share the same level of medical knowledge nor vernacular.
- Second, interpreters have been found to be intrusive, making some patients reluctant to convey their true concerns.
- Finally, a patient may fear that the interpreter cannot be trusted to either interpret correctly or keep confidentiality. The last is especially true in close-knit communities where everybody knows everybody.