Language Matters | Soledad Jorge, MD, MPH

Soledad Jorge, MD, MPH

Nearly 70 million U.S. residents, 22% of the population, speak a language other than English at home. Of these, 25.5 million, 8.2% of the population, have “limited English Proficiency” (LEP), defined as a self-rated English-speaking ability of less than “very well.” LEP has a negative impact on health; reduced access to and utilization of health care services and poor patient-provider communication affect patient satisfaction and trust, care quality and patient safety, leading to worse health outcomes and perpetuating health disparities. 

The use of relatives, friends or unqualified staff as interpreters, or the use of basic language skills by providers to “get by,” have been identified as key contributors to inaccurate communication and adverse outcomes, while the use of qualified health care interpreters has been shown to mitigate these effects. However, language services remain underutilized. According to recent studies conducted at large academic medical centers, up to two-thirds of hospitalized LEP patients never had a documented interpreter visit, and only 40% of LEP patients had a professional interpreter present at informed consent. Beyond clinical care, LEP patients are also woefully underrepresented in research. At our institution, for example, we found that LEP patients were 3.4 times less likely to participate in clinical trials than fluent English speakers.

What can providers do to improve the care of LEP patients? Optimizing the use of language services is key. Make every effort to have a professional medical interpreter present at every interaction with a LEP patient, at times of initial assessment, disease progression and new treatment discussions at a minimum. This means planning ahead of time to avoid overbooking and scheduling extra time for LEP patient encounters. Ascertain that a medical interpreter who speaks the patient’s language and dialect is available, preferably in person or via an audiovisual platform rather than over the phone. Whenever possible, request an interpreter who is not only bilingual but also bicultural, and can serve the dual role of cultural broker or navigator. It is helpful to brief the interpreter, before entering the room, on what to expect from the visit. Once in the room, adhere to best practices for working with interpreters to maximize both accuracy and efficiency. Face and speak to the patient, not the interpreter. Use the second person (“you”), not the third person (“she/he/them”). Ask questions or make points one at a time, avoiding acronyms, idioms and medical jargon. Ask the patient to “teach back” information through the interpreter to ensure comprehension at key steps along the way. Finally, help ensure LEP patients are not unnecessarily excluded a priori by clinical trial eligibility criteria. Anticipate the need for resources—such as interpreters, bilingual/bicultural research staff, translated consents and other translated study documents—and build those costs into the study budget to broaden eligibility and outreach.

I recognize that these measures demand more effort and time. It is thus critical to remember that the underlying principle of health equity is precisely the willingness to allocate resources differentially to achieve health care outcome equality.

Soledad Jorge, MD, MPH, is assistant professor of gynecologic oncology at the University of Washington Medical Center.

This column is sponsored by an unrestricted grant from GSK. Sponsorship excludes editorial input. Content developed by the SGO Diversity, Inclusion & Health Equity Committee.