7 December 2022
Language Disparities in Hispanic Patient-Doctor Interactions
This essay will look into the effects that linguistic barriers have on the Hispanic population within the United States. From the many factors that contribute to low health literacy among the Hispanic communities, linguistic barriers have been chosen as the focus of research and deliberation. Language, spoken or written, holds power and value when it comes to creating a connection between two individuals, and it becomes increasingly important when that connection helps dictate the health of an individual. The implications of language barriers affect access to adequate healthcare, such as limited understanding between the patient and their doctor. More importantly, these implications could possibly result in severe effects on the health of patients. Thus, it is important to recognize this problem and its effects on the Hispanic population in the United States.
The Hispanic population within the United States has some of the lowest rates of receiving adequate healthcare treatment. A multitude of reasons have created a culture among the Hispanic population that limits the overall health outcome of the community. A prevalent reason is the language barrier that many patients see as an obstacle to gain access to healthcare professionals. In a survey presented to Hispanic Americans by the Pew Research Center, it was found that “44% say that more communication problems from language or cultural differences are a major reason why Hispanic people have generally worse health outcomes than other adults in the U.S” (Funk and Lopez 22). These language barriers that the Hispanic community faces in healthcare can have detrimental effects. A patient could misunderstand the severity of their diagnosis, what recommendations the doctor is giving them to improve their health, or may even fail to understand medication instructions. With this in mind, the implications that linguistic barriers have on the Hispanic community, specifically those in direct patient-doctor interactions, will be discussed in an effort to determine what can be done to mitigate their effects.
The relationship between patients and their healthcare provider is one of the most important foundations for quality healthcare. A feeling of trust between them is one of the biggest factors that help foster successful doctor-patient relationships. When patients have a conversation about their health in their native tongue with a doctor, the sheer amount and quality of information that can be conveyed between the two significantly improves the outcome of the visit. In a study conducted to see how Spanish-speaking patients differed between bilingual and monolingual doctors, it was found that “the recall rate in the bilingual physician group was 72.7% compared to the 54% in the monolingual physician group” (Seijo et al. 10). The recall aspect of a visit is crucial. A patient's ability to remember what the doctor discussed and instructed them to do is necessary to follow treatment or preventative measures for their health. Failure to recall what the doctor had said could have adverse effects on the overall health of the patient.
Another aspect of the healthcare process that suffers due to language barriers is that of the patient's own initiative to seek patient care and attend their appointments. In a study that examined health disparities in the Latino community, it was found that “when no Spanish-speaking PCPs worked in a community, Latinos with LEP had significantly more frequent care delay” (Oh et al. 12). The lack of Spanish-speaking primary care providers in communities where Latinos are the primary population creates a lack of patient care follow-ups. Patients who receive care and find that the experience was unsatisfactory due to the communication barrier are more prone to missing future appointments with the thought that they’d return and struggle to understand again. In an attempt to see if Spanish-speaking providers were a factor in patient retention, further research was conducted and it was found that “delayed care decreased significantly among Latinos with LEP when the proportion of Spanish-speaking PCPs increased from 0% to 50%” (Oh et al. 14). This further drives the point that similar language creates an environment for patients in which they feel their health is receiving the attention they deserve.
It allows the patient to ask any questions necessary for the understanding of their diagnosis. In the same study that compared patient visits between monolingual and bilingual providers, patients that saw “bilingual doctors asked more questions than did those who saw English-speaking doctors” (Seijo et al. 11). With language barriers, the patient doesn’t have the ability to ask these questions to get a full grasp of a diagnosis or treatment plan. They have to settle with a limited understanding of the conversation with their doctor. However, with providers who speak the same language, patients can ask more questions, and get more insight into their diagnoses and how to improve their health.
I will be conducting an interview with a Spanish-speaking family member with limited English proficiency about their experiences with primary care providers to get first-hand insight into the implications that arise due to linguistic barriers for Hispanic patients. I know they have visited a variety of health specialists over the years with access to translators on only some of their visits so this interview will provide a better understanding of the effectiveness of translators in patient-doctor interactions affected by a language barrier. The interview questions are as follows:
- Have you ever had an appointment with a healthcare provider that didn’t speak the same language that you are the most familiar with?
- Did you find yourself asking the provider questions? If they had spoken the same language, would you have asked more questions throughout the appointment?
- How well did your appointments go? Did you understand all of the instructions the provider gave you for medication and preventative care?
- Did you ever require the assistance of a translator during a visit? If so, do you feel as though you were able to leave with a good understanding of what was discussed?
- How would you compare visits to providers who spoke a different language to those that spoke the same language as yourself?
A possible limitation of this method is the lack of interviewees, which would make it difficult to generalize the interviewee's experience with the whole Hispanic community.
The interviewee, whom we will call Elisa, was asked the aforementioned questions. Her responses have been translated into English for the reader's sake. In response to the first question she responded by saying yes. She explained how the “majority of providers that she has seen typically do not have an understanding of Spanish other than very basic phrases that simply aren’t enough to communicate [in the context of patient health].”
When asked question two, she responded by saying “I didn’t ask a lot of questions because I wasn’t sure how to ask them when there wasn’t a translator. When there was a translator, I would ask them to ask the doctor what I was wondering. If the doctor spoke Spanish, I think I would have asked them a lot more questions if I felt like I needed to.”
When asked about the effectiveness of her appointments, she responded “Usually, they went fine, I could get a general idea of what was said but when it came down to the specifics it was harder to really understand unless there was a translator. I also felt that the doctor wasn’t as engaged because of the language barrier. For the instructions I would ask for more clarification as they are hard to understand sometimes, the translator would help me with that, or I would ask a family member to explain them to me when I’d get home.”
When asked if she’d ever used the services of a translator, she said “Yes, I’ve had translators help me during visits to the doctor. I think they did a good job of telling me what the doctor was saying and expressing any concerns that I had for the doctor. They would also help me understand the forms you fill out when you first get to the office because they make you sign agreements and I couldn’t make sense of what was written.”
And finally, when asked to compare visits between Spanish-speaking and non-Spanish-speaking providers, she stated, “Well, obviously with doctors that speak Spanish it is easier to communicate with them about my health. Having a translator works, but sometimes they might not translate something correctly or not express my concerns the way I’d like. I feel like with a doctor that speaks Spanish, they understand and care more about the concerns I have.” These responses help open up discussion for the implications that language barriers can have on patient health outcomes.
With the responses from Elisa, the issue of language barriers is apparent. From her experiences, she’s encountered few Spanish-speaking healthcare providers which has given her ample interaction with providers in the presence of a language barrier. This has affected her during her face-to-face conversations with providers and at home as she attempts to follow through with prescriptions. She mentioned that she’d often have trouble making sense of prescription labels, claiming that she’d have to ask others to help her make sense of them. This problem is one that afflicts many LEP patients throughout the country. In a Wisconsin study done to measure the accessibility of pharmacies to non-English speaking patients, it was found that “47% of the pharmacies never/only sometimes can print non-English-language prescription labels… and 64% never/only sometimes can verbally communicate in non-English languages” (Bradshaw et al. 1). Understanding the instructions of the medication is the most important factor when it comes to maintaining your health. Medications are made to be taken a certain way and if taken improperly, could result in no improvement in health.
Elisa also mentioned how she had difficulty filling out forms at some of her visits. She had trouble understanding what was being asked and what her signatures were being used for. Having your patients’ trust is important, and if patients are worried about signing forms that they do not understand, it can undermine that trust they have. In addition, it was found that “more than half of the participants (52.6%) reported either sometimes having difficulty or always having difficulty with written health information, and 25% reported almost always asking for help or not being so confident in completing health forms'' (Christy et al. 2). If the first thing a patient experiences in a clinical setting is confusion, it makes the patient’s visit too much to handle. The confusion builds up throughout the visit. Patients that find themselves leaving confused will likely not return, as they may feel that they'll be left confused each time they visit. For patient health outcomes to improve, increasing the accessibility of prescription labels and health forms to non-English speaking patients is a crucial step that healthcare providers should be taking in order to increase the health outcomes of their patients.
The effects that language barriers have in the field of healthcare are immense. From beginning the appointment process of filling out forms, to following the suggested treatment, language barriers are a burden on patients’ health outcomes. One would think that with such a large body of healthcare workers available in the U.S. language wouldn’t be as big of an issue as it is today. However, the reality is not so. There is an immense underrepresentation of minorities in the health field, especially in the Hispanic community. In fact, Latinos only account for “7% of the physician and surgeon workforce” (Flores 1), despite making up about 20% of the US population. Quality patient-doctor interactions with Hispanic patients are a lot more difficult to construct due to these ethnic and language differences. It is important for healthcare providers and companies to create more accessible modes of information in different languages as well as promote healthcare professions to the Hispanic community to inspire more youth to pursue those careers and create a welcoming environment for Hispanic patients.
Bradshaw, Michael, et al. “Language Barriers to Prescriptions for Patients With Limited English Proficiency: A Survey of Pharmacies.” Pediatrics (Evanston), vol. 120, no. 2, 2007, pp. e225–e235, https://doi.org/10.1542/peds.2006-3151.
Christy, Shannon M., et al. “Characterizing Health Literacy Among Spanish Language-Preferring Latinos Ages 50-75.” Nursing Research (New York), vol. 70, no. 5, 2021, pp. 344–53, https://doi.org/10.1097/NNR.0000000000000519.
Flores, Edwin. “There's a Big Disparity in the Number of Latino Doctors and Surgeons. Advocates Are Working to Change That.” NBCNews.com, NBCUniversal News Group, 30 Sept. 2022, https://www.nbcnews.com/news/latino/big-disparity-number-latino-doctors-surgeons-advocates-are-working-cha-rcna48778.
Funk, Cary, and Mark Hugo Lopez. “Hispanic Americans’ Trust In and Engagement With Science.” Pew Research Center Science & Society, Pew Research Center, 16 June 2022, https://www.pewresearch.org/science/2022/06/14/hispanic-americans-trust-in-and-engagement-with-science/
Jimenez, Elisa. Personal Interview. 13 November 2022.
Oh, Hyunsung, et al. “Addressing Barriers to Primary Care Access for Latinos in the U.s: An Agent-Based Model: Journal of the Society for Social Work and Research: Vol 11, No. 2 Journal of the Society for Social Work and Research, https://www.journals.uchicago.edu/doi/full/10.1086/708616#_i15
Seijo, R., Gomez, H., & Freidenberg, J. (1991). Language as a Communication Barrier in Medical Care for Hispanic Patients. Hispanic Journal of Behavioral Sciences, 13(4), 363–376. https://doi.org/10.1177/07399863910134001