Miguel Gonzalez
M2, The University of Chicago, Pritzker School of Medicine
Given the rise of the Latinx population in the United States, it has become increasingly more common to encounter patients that do not speak English, otherwise known as limited English proficient (LEP) patients. In 2013, 8.5% of the United States population reported that they were LEP or spoke a language other than English at home “not very well,” “not well”, or “not at all.” Additionally, since 1990, the LEP population has grown over 80%. While there has been a rise in English-speaking Hispanics, one-third is still not English proficient.1,2 More importantly, compared to English-speaking Hispanics, Spanish-speaking Hispanics have been shown to report a worse health status and receive less preventative care even after adjusting for demographic and socioeconomic factors.3 Thus, language barriers continue to be a prevalent issue in the healthcare field. There are a wide variety of services available for language interpretation including in-person, over-the phone, and video interpreters however it can still be a challenge to navigate those available options and effectively use them with LEP patients. Additionally, Spanish proficiency overconfidence in medical professionals has also been a rising problem for Latinx LEP patient encounters. As a nationally certified Spanish medical interpreter who worked during the COVID-19 pandemic at a major hospital, I witnessed multiple patients arrive to our emergency department (ED) frightful and perturbed due to a lack of clear communication from a previous appointment about their own health. Many of these admissions to the ED could have been prevented if appropriate language concordant care had been administered in the first place. The misuse of interpretation services and overconfidence in medical Spanish can lead to serious healthcare problems with LEP patients; therefore, medical Spanish courses in medical schools should not be encouraged, but rather the use of interpretation services should be fundamental in the curriculum.
Advancement in technology has allowed interpretation services to grow in new ways, allowing technology to continue to help bridge that relationship between the patient and the provider, which was especially evident during the COVID-19 pandemic. However, the number of companies that provide remote interpretation services and the avenues in which they are available can complicate a provider’s decision to use them. Factors such as access codes, wait time, and difficulties communicating over video/phone are other barriers in using remote interpretation services. The biggest obstacle faced when using technology as a replacement for in-person interpretation is the lag and possibility of disconnection during an appointment. A recent study showed some of the most important aspects of using interpreters are the technical equipment, documentation of the patient’s language ability, interpretation environment, respect for the appointed time, and the level of availability and service provided by the interpreter agency.4 When the signal is lost during an appointment, providers are forced to restart the entire process over again, this can lead to frustration and resistance in reconnecting with interpretation services. More specifically, in times of emergency, the provider might not have the time to input all the login information in order to connect with a new interpreter again. Despite these potential obstacles, remote interpreter services offer a huge advantage in the form of convenience and availability.
The other main form of interpretation misuse is through noncompliance and overreliance on insufficient language skills. Since there is a heavy intercultural exchange with the Spanish language in the United States through music, restaurants, and language requirements in schooling, there is a common misconception in one’s own fluency. The consequences of this overconfidence are especially seen in the medical field. This issue is further exacerbated by medical schools promoting medical Spanish courses to their students. Many of these courses follow no national guidelines and have a low time commitment. Without a standardized curriculum and appropriate time to extensively immerse yourself in the complexity of another language, it makes it difficult to completely understand and explain medical conditions to patients. In one study, medical Spanish courses for residents resulted in significant major errors with understating LEP patients and a decrease of using interpretation services.5 Additionally, these classes have caused a false understanding of the Spanish level needed to provide proficient care to Latinx LEP patients. A misunderstanding caused by poor interpretation can lead to mishandling of the patient’s healthcare concern and ultimately cause harm to the patient.
Therefore, without a national standard and practice, I caution medical schools to seriously consider the potential consequences of including medical Spanish courses without a strong emphasis on interpreter services in the curriculum. Currently, within the standards of the “Functions and Structure of a Medical School,” the Liaison Committee of Medical Education (LCME) does not require a working knowledge of interpreting services as a means of accreditation.6 Incorporating the utilization of interpretation services into the LCME accreditation criteria would lead to better patient satisfaction, care, and outcomes for all LEP patients. By having providers learn the best ways to effectively use interpreter services for their LEP patients, they will be fully equipped in knowing how to request one, facilitate communication, and appreciate their importance in healthcare appointments. Additionally, interpreters will no longer have the burden of educating providers on how to use interpreter services. If medical schools placed a heavier emphasis on training their students to use interpretation services throughout their medical school career, future providers will feel more comfortable in utilizing them and limit their reliance on basic Spanish knowledge.
Notably, increasing Latinx representation within the medical workforce would be another substantive solution. By having more Latinx providers, it would simultaneously make appointment times more efficient and make Spanish-speaking LEP patients feel more comfortable having someone from a similar background providing their care. Although there has been a push for an increase in Latinx medical students, only 5.8% of physicians in 2018 identified as Latinx/Hispanic according to Association of American Medical Colleges.7 Furthermore, that number shrinks substantially when accounting for Latinx/Hispanic physicians that are capable of communicating directly with Latinx LEP patients. Though this solution would take longer, it would be the best option to this healthcare problem. Overall, by implementing an interpreting training course in the curriculum of medical schools, limiting medical Spanish courses, and attracting more Latinx physicians, Latinx LEP patients will receive a higher standard of healthcare and attention they deserve.
References:
1. English Use on the Rise Among Latinos. Pew Research Center’s Hispanic Trends Project. Published May 12, 2015. Accessed February 27, 2022. https://www.pewresearch.org/hispanic/2015/05/12/english-proficiency-on-the-rise-among-latinos/
2. Proctor K, Wilson-Frederick SM, Haffer SC. The Limited English Proficient Population: Describing Medicare, Medicaid, and Dual Beneficiaries. Health Equity. 2018;2(1):82-89. doi:10.1089/heq.2017.0036
3. DuBard CA, Gizlice Z. Language Spoken and Differences in Health Status, Access to Care, and Receipt of Preventive Services Among US Hispanics. Am J Public Health. 2008;98(11):2021-2028. doi:10.2105/AJPH.2007.119008
4. Hadziabdic E, Albin B, Heikkilä K, Hjelm K. Healthcare staffs perceptions of using interpreters: a qualitative study. Primary Health Care Research & Development. 2010;11(3):260-270. doi:10.1017/S146342361000006X
5. Prince D, Nelson M. Teaching Spanish to emergency medicine residents. Acad Emerg Med. 1995;2(1):32-36; discussion 36-37. doi:10.1111/j.1553-2712.1995.tb03076.x
6. 2018-19_Functions-and-Structure.pdf. Accessed February 27, 2022. https://medicine.vtc.vt.edu/content/dam/medicine_vtc_vt_edu/about/accreditation/2018-19_Functions-and-Structure.pdf
7. Figure 18. Percentage of all active physicians by race/ethnicity, 2018. AAMC. Accessed February 27, 2022. https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018