An increase in globalization contributes to many positive aspects in our world; however this diversification brings challenges among physicians and patients in healthcare. Physicians face the dilemma of communicating effectively with patients who immigrate to the United States and are not proficient in the English Language. Health care professionals must overcome the linguistic and cultural barriers that impede essential communication in the medical field.
Physician and patient communication is crucial. Miscommunications often arise in health care even at times when both parties speak the same language. Nevertheless, there are approximately 311 languages spoken in the United States1 and not a sufficient amount of physicians that speak these languages.
Serious problems develop when non-English-speaking patients do not use an interpreter to communicate with medical staff. Additionally, when patients are not able to fully communicate with their clinician, they feel distanced or excluded2. A sense of mistrust builds within the patient when they are not able to understand their doctor. “Recent immigrants with limited English proficiency... may be more vulnerable to poor quality care2.”
Interacting with patients who have limited English proficiency is always an obstacle but “using a trained medical interpreter is the right medicine1.” Although difficulty in communication exists physicians agree that it can be improved with language interpreters.
The most exceptional kinds of interpreters preferred by physicians include the following: bilingual health care providers, hospital interpreters, bilingual staff, and volunteers3. While it is not recommended, a family member may be used as an interpreter when no other interpretation service is available.
Adequate communication between a physician and patient improves the quality of life. Studies show that an interpreter can increase the patient’s understanding, improve physician-patient relations, overall health status of the patient, and follow-up examinations4. Medical interpreters help resolve the confusion that comes accompanies how patients should properly follow the prescription labels, make appointments, and understand discharge instructions. The main tasks for interpreters are to eliminate misunderstandings and reduce errors. “Bilingual, bicultural social workers and health care advocates may play key roles in improving patient care2.”
Some physicians however oppose the use of medical interpreters. The main issues that arise with the use of interpreters in health care are money, time, and unnecessary errors. Many health care facilities do not have the resources to provide interpretation services. Health care systems with restricted budgets find it difficult to fiscally support interpreter services2.
Clinicians spend a significant amount of time making phone calls and scheduling appointments in an attempt to find appropriate interpretation services. An excessive amount of time is also consumed during the actual process of interpretation between the physician, interpreter, and patient. Various physicians sense it is a waste of time. An anonymous doctor states that finding interpreters are not exactly his duty as a physician; his responsibilities include “diagnosing, treating, looking at the results, analyzing, etc5.” In the mind of some physicians, medical interpreters are seen as a burden.
Interactions between physicians, interpreters, and patients, can cause error in their conversation. Interpreters significantly reduce what is actually being said by physicians and patients. A recent study shows that in a typical conversation, physicians usually speak 49% of the visit, interpreters translate 27%, and patients speak 24%6. In actuality interpreters should be speaking 50% of the conversation.
In addition to reducing the time spent speaking, interpreters also alter the content of the conversation. Interpreters are at fault of omitting and revising content6. In other words, interpreters exclude significant information and modify critical matter in conversation.
Furthermore, “small talk” is almost entirely nonexistent when an interpreter is utilized6. Small talk is a method for physicians to interact with their patients by speaking about issues unrelated to medicine. Without “small talk,” the clinician-patient relation is weakened.
When speaking to individuals who lack proficiency in English, it seems most logical to use a medical interpreter. Although misunderstanding and issues arise as interpreters are employed, it appears that interpreters are responsible for more benefits than disadvantages. Physicians and patients would not be able to communicate in the first place if interpreters were not used. There is more chance of misdiagnosis, deterioration of health, or even death if an interpreter is not present. Although medical interpreters do not completely eliminate the language barrier that exists in the medical field, it certainly does improve the possibility of overcoming this obstacle.
References
1. Chen, A. Doctoring across the language divide. Health Affairs [database]. 2006 [cited 2008 Apr 06]; 25 (3): 808-813. Available at Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu:90/.
2. Ngo-Metzger, Q., Massagli, M., Clarridge, B., Manocchia, M., Davis, R., Lezzoni, L., Phillips, R. Linguistic and cultural barriers to care. Journal of General Internal Medicine [database]. 2003 [cited 2008 Apr 06]; 18 (1): 44-52. Available from Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu:90/.
3. Phokeo, V., Hyman, I. Provision of pharmaceutical care to patients with limited English proficiency. American Journal of Health-System Pharmacy [database]. 2007 [cited 2008 Apr 15]; 64 (4): 423-429. Available at Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu:90/.
4. Wilson, E., Chen, A., Grumbach, K., Wang, F., Fernandez, A. Effects of limited English proficiency and physician language on health care comprehension. Journal of General Internal Medicine [database]. 2005 [cited 2008 Apr 06]; 20 (9): 800-806. Available from Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu:90/.
5. Contextualizing cultural competence training of residents: results of a formative research study in Geneva, Switzerland. Medical Teacher [database]. 2006 [cited 2008 Apr 15]; 28 (5): 465-471. Available at Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu:90/.
6. Aranguri, C., Davidson, B., Ramirez, R. Patterns of communication through interpreters; a detailed sociolinguistic analysis. Journal of General Internal Medicine [database]. 2006 [cited 2008 Apr 15]; 21 (6): 623-629. Available at Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu:90/.
*I had trouble formating the superscripts in the in-text citations so I know they look weird right now. Also I could not get my indentions to line up for my references.
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7 comments:
As a whole, I enjoyed your paper and thought it was well done. However, there were a couple small things I would suggest. First, it may be good to elaborate a little more on the issues of communication in medicine without the language barrier. For instance, you mentioned "Miscommunications often arise in health care even at times when both parties speak the same language.", and I think if you further explained why it may add a little more to your paper. My second suggestion, again, is nitpicking. You talked about the problems of interpreters, and I was wondering if patients might feel less forthcoming with personal information to an interpreter than they would to a doctor, because of embarrassment. This may have been what you were getting at and I just missed it, or I may be mistaken entirely, but it may be worth looking into. Otherwise, like I said, it seems like a good rough draft.
This was a very well written paper with a very interesting, unique topic. You made a very good point about globalization being a communication barrier, maybe you could build a little on this topic explaining how hard it really is to communicate with patients who speak a different language. When you get into the part about the interpreters, maybe talk a little more about how some small talk should be thrown in to help the patient feel more comfortable being there. One last suggestion would be to expand on the importance of interpreters and how they make the medical world that much better.
Very interestingt topic; I think I have read some different articles about this in the past. And I see why our country needs the multi-lingustic people to become physicians. I thought your paper did an excellent of utilizing the references and making the issues easy to point out. The only problems I see with this paper is the low order concerns; just some different word choices here and there, and some commas in some places. After that I think you will be in great shape.
Your essay is very well written and it is obviously well thought out. There were only a few mistakes that I could suggest trying to fix. Just a few times you would begin to make a point and not expand on it as much as you could. For example, in the third paragraph you start to talk about serious problems that develop because of language barriers and I think that if you just listed a few of those, your point would be strengthened. There were very few grammar mistakes. Overall, I really liked your essay and thought it was full of useful content.
It seems like a lot of people may be doing a medical field for their topic so my main suggestion is just to expand on all your research. You definitely have the research that makes your paper reliable but I feel like you leave some open ends. An interesting time to do this would be when talking about globalization Also I really enjoy how you talk about the language barriers because I think you bring up a lot of good points there. Basically your paper is really good but you could expand a lot if you wanted to.. if that's too overwhelming I would suggest expanding where you feel like your main points are.
Overall I feel like this is a good paper. I am doing a paper on politics but even in politics you still are faced with the issue of globalization so that is interesting to see how they overlap. Lots of people are doing medicine, but you picked a very interesting topic. There were a couple of minor mistakes but nothing really major. You could add a couple more examples or the communication barriers between english speaking patients but other than that great paper.
Watch the transition between you last two paragraphs. I got confused because you go from pointing out a problem with interpreters to recommending them. How can you smooth this out and indicate the contrast/transition between these ideas?
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