Strong relationships between providers and their patients are built on effective communication. This trust enables organizations to deliver high-quality clinical care and positive patient experiences.
While the country’s ever-increasing ethnic, cultural and language diversity is arguably one of its greatest strengths, it often creates communication challenges for healthcare providers and patients and the potential for negative care experiences. A 2017 report from the Centers for Medicare & Medicaid Services (CMS) found that 8% of Medicare’s 52 million beneficiaries have Limited English Proficiency (LEP).
A person with LEP is defined as someone who “may feel more comfortable speaking or reading a document to someone in a language other than English,” according to the report.
Medical practices like New Jersey Urology (NJU) and Millennium Physician Group have made efforts to overcome language barriers by implementing a digital platform that offers patients the option to complete intake forms in their preferred language.
“In the age of COVID-19, it is vital to be able to communicate with the patient to determine the best care,” said Becki Kelley, Clinical Application Manager at Millennium Physician Group, which has more than 100 locations across Florida. “Knowing where the patient has been or possibly who they have been in contact with will aid in understanding the virus more and allow for better treatment options to be developed. As with any visit, communicating in the patient’s preferred language plays a huge part in ensuring they’re receiving the correct diagnosis and treatment.”
NJU’s Englewood, N.J. office treats a large Korean patient population. According to Illeana Llanes, the office’s Practice Manager, more than 90% of those patients speak no English. Removing that language barrier during intake helps capture important data before their in-person or telehealth visit and makes their patients feel more comfortable.
“Some patients can be embarrassed about the issues we treat here,” Llanes said. “They don’t want to convey those issues to someone else to translate. With everything coming first-hand from the patient, they feel much more comfortable in sharing. It also allows for better privacy and accuracy, which enables us to deliver better care.”
As the COVID-19 pandemic continues, LEP individuals are at higher risk for contracting the virus because they are more likely to live in poorer communities. As of 2013, 25% of LEP individuals lived in households with an annual income below the federal poverty line, nearly twice the percentage of English-proficient households. In addition, low-income communities often share overcrowded living conditions, which can intensify the impact of a pandemic.
Non-English speaking communities already tend to suffer from poorer health outcomes than the general population. LEP individuals also are overrepresented in essential-service jobs and healthcare occupations where they are at greater risk for COVID-19 exposure.
Consequences of provider-patient language barriers
Language barriers in healthcare are particularly dangerous. With more than 20% of the U.S. population lacking full English proficiency, LEP patients are not only vulnerable to poor communication with their healthcare providers, their safety is also at risk.
For example, a recent article from ProPublica found that non-English-speaking patients in New York City who came to hospitals with COVID-19 symptoms waited longer for care and diagnoses, in part because providers sometimes struggled to communicate with them.
Providers often use telephonic interpretation services to address language barriers, or they may bring in bilingual staff members or even patients’ family members to translate for them. A 2017 CMS report found that nearly 40% of healthcare providers had asked a family member to translate for an LEP patient.
But second-hand information gathered through an interpreter doesn’t necessarily take care of all potential communication problems, and still poses a higher patient-safety risk. Evidence shows that relying on non-medical interpreters such as family members, can increase the chances of symptom misunderstandings, create unnecessary complications, and in some cases, increase the likelihood of a patient’s disability or death.
Logically, language barriers reduce patient satisfaction and create an uncomfortable environment that discourages patients from sharing important medical information. Research has shown that when providers can’t communicate with patients in their preferred language, those patients often feel judged, vulnerable, disrespected and helpless about their care.
First-hand communication in the preferred language improves patient care and experience
Healthcare providers only have a limited window of time to capture a patient’s medical history, family history and symptoms and then develop a treatment plan. A language barrier shrinks that time window.
For example, Millennium Physician Group serves a large Spanish-speaking patient population across its 100-plus locations in Florida, as well as patients who speak French, German, Haitian Creole, Italian and Portuguese.
Kelley says, “As medicine evolves, we need the ability to tailor care to each patient. Instead of getting the information through a family member or translator, we’re getting everything directly from the patient when they fill out their forms in their most comfortable language on the digital intake platform. We’re able to truly understand the patient’s background and what they’re experiencing.”
By communicating with patients in their preferred languages, medical practices like NJU and Millennium are able to overcome the problems—and potential misdiagnoses—that incomplete medical histories and inaccurate translations may lead to because of poor provider-patient communication.
“Language barriers make it very difficult to provide good patient care,” Kelley says. “You’re typically at the mercy of a family member or having to go back and forth with an interpretation service, which can take up time. Through our multi-language intake capabilities, we want to signal to our patients that not only is their patient journey important, but that we care about providing them with an efficient, high-quality experience, regardless of their language needs.”
Using technology to communicate with patients in their preferred language can better support staff, too.
Before implementing its multi-language capabilities, NJU often had to depend on staff members to translate for its large Korean patient population. Llanes explains that it was difficult to completely rely on the accuracy of patient information gathered this way, and it also took staff members away from their primary job responsibilities.
“[Staff members] would have to stop what they were doing and work with patients to translate for them to get everything filled out,” Llanes says. “As a result, they wouldn’t be able to handle their responsibilities or even answer patient phone calls during those times. It wasn’t great for customer service.”
As all patients increasingly prefer convenient digital healthcare experiences, effective communication is an even greater priority. Allowing LEP patients to communicate directly with their providers in their preferred language ultimately improves the quality of their care and their overall experience.
“It shows you’re willing to take extra steps for those patients to feel comfortable,” Llanes says. “For patients to know you’re taking the time to communicate their medical information in their preferred languages—it speaks volumes to them.”