The rich cultural and linguistic diversity of the US also means that we have patients entering our healthcare system with limited English proficiency (LEP). While there are requirements put in place to provide interpretation services to patients with LEP, barriers remain due to inadequate staffing, functional limitations of video/phone consultations, and interpretative inaccuracy. Communication barriers affect providers’ understanding of patient complaints and patients with LEP in return are less satisfied, have decreased comprehension of medical instructions, and when compared to English-proficient patients, have increased morbidity and mortality. Additionally, communication barriers may result in increased psychological stress and medically significant communication errors for already anxious patients. In summary, language barriers have the potential to be a significant driver of health disparities, especially in minoritized groups. Clinics can work to be more equitable by 1) asking patients and their families about their language preferences, 2) responsibly staffing interpretive services, and 3) providing information about interpretive services and clarifying any questions about cost prior to the visit. Providers can also help link their patients with interpretation services, advocate for systems-level change, and work to develop their own cultural humility. Please see below for more resources:
- How Should Clinicians Respond to Language Barriers That Exacerbate Health Inequity? (AMA Journal of Ethics) Link here
- Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language (Meuter et. Al, 2015). Link here
- Language-Based Inequity in Health Care: Who Is the “Poor Historian”? (AMA Journal of Ethics). Link here
It is important to take language barriers into consideration when engaging with pediatric patients and their families. For immigrant families, the child is more likely to be English proficient and may be asked to take on the role of “language broker” to interpret for their parents or guardians. This is a problematic practice because the child may have a conflict of interest, lack proficiency in both languages and in general are not equipped to provide accurate medical interpretation. This practice is also associated with the child experiencing stress, anxiety, and depression. Additional social determinants of health are also important to take into consideration as children of parents with LEP are more likely to be uninsured, lack a medical home, and experience more errors compared to children of parents who are English proficient. Additionally, health disparities due to language barriers are further exacerbated in racial and ethnicity minoritized children and in children with special needs. Please see below for more resources:
- The Complexities of Assessing Language and Interpreter Preferences in Pediatrics (Ragavan & Cowden, 2018). Link here.
- Parental Limited English Proficiency and Health Outcomes for Children With Special Health Care Needs: A Systematic Review (Eneriz-Wiemer et al. 2014). Link here
- Cultural Humility: A Critical Step in Achieving Health Equity (AAP Journal of Pediatrics). Link here