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Written by Nagapratham Rao ‘27
Editied by Yumiko Imai ‘26
Did you know 50% of adults with Limited English Proficiency are reported to face “at least one language barrier within the last three years” [2]? According to Wikipedia, “A language barrier is a figurative phrase used primarily to refer to linguistic barriers to communication, i.e. the difficulties in communicating experienced by people or groups originally speaking different languages, or even dialects in some cases” [3]. These language barriers can result in “misinformation, confusion, mistrust, uncertainty, frustration…deaths, tension, violence, among people” (Universidad del Zulia) [4]. They can be detrimental in professional applications like foreign affairs and medicine, where miscommunications have major repercussions. Specifically, the healthcare system in the United States is very homogeneous and has historically benefited a wealthier white demographic, and with the recent modern-day influx of immigrants and the increase of non-W.E.I.R.D (Western, Educated, Industrialized, Rich, and Democratic) demographics, this poses concerns about how effective healthcare is. With a seemingly apparent dialect/linguistic barrier between many patients and their physicians, there could be an increase in the number of people who are misdiagnosed and misprescribed, leading to problems in personalized medicine. How do these language barriers in healthcare affect physician-patient relationships and lead to a lower quality of personalized medicine, and what can linguistically change to fix this barrier?
In the NIH article “The ‘“Battle”’ of Managing Language Barriers in Health Care,” Dr. Emma M. Steinberg and other science professionals conducted a secondary study about pediatric healthcare experiences of (LEP) Latino mothers in Detroit and Baltimore. According to data they got from their interview studies, the majority of mothers described having more positive primary care experiences and a struggle to overcome language barriers in other child health services like emergency and special care. The participants in the study attributed the positive primary care experience to a greater sense of familiarity with the primary care system and better accommodation of language needs by the primary care nurses and doctors. Mothers wanted bilingual providers compared to interpreted providers due to a lack of communication and poor quality encounters with the interpreted providers. All these factors led to LEP families feeling like a burden in the hospital system, and this combined with the “tolerance of getting by” [5] led to an overall experience of discrimination and humiliation.
The systemic issue of LEP families facing discrimination and humiliation in healthcare arises from the lack of diversity in physician language capabilities. According to Steinberg, “Unfortunately, the physician workforce does not match the diversity of patients in the US healthcare system. In fact, in the past 30 years, there has been a decline in the number of Latino physicians ”[5]. While the Latino physician force seems to be decreasing, LEP families demonstrated no significant preference for a Latino physician, as long as the physician spoke Spanish adequately. The central problem is that there is no way to force physicians learning Spanish to positively impact the physician-patient relationship, simply because it isn’t necessary to practice medicine. The clear strategy right now is “getting by,” where providers and families just get by on their limited language skills. While this strategy may be the dominant one and has no signs of stopping, what can change linguistically to address this issue and lead to better-personalized medicine?
In the article, “How Should Clinicians Respond to Language Barriers That Exacerbate Health Inequality?” published in the AMA Journal of Ethics, Dr. Jason Espinoza and Dr. Sabrina Derrington suggested a linguistic redress. “...only 13% of hospitals are compliant with all 4 National Standards for Culturally and Linguistically Appropriate Services (CLAS) in health care,” [6] and this can be attributed to the inflated prices of interpreter services. As a result, telephone and video services are preferred by the hospitals, but they do not accommodate all the languages necessary. Also, if the hospital is in a remote location and doesn’t have a stable internet connection, this can lead to complications with the services.
With all these complications that LEP families face with personalized medicine, there are linguistic solutions that can be fairly effective such as cultural sensitivity training for its employees, expanded outreach to the Latinx community, hired more bilingual staff, included more languages in consent forms, and expanded the number of trained interpreters in the facility. Dr. Lisa D. Sanders and Helen J. Neville hypothesized in their experiment, “Speech Segmentation by Native and Non-Native Speakers: The Use of Lexical, Syntactic, and Stress Pattern Cues,” that non-native speakers could segment speech just like native speakers did. They found that certain segmentation indicators are more effective than others in second language processing, and this can be used in the healthcare setting when physicians and healthcare professionals talk to LEP families [7]. For example, word ordering doesn’t seem to necessarily matter to non-native English speakers, while word choice does. Therefore, healthcare providers should be more cognisant of this fact and try to use words that are better understood by LEP families, leading them to build more rapport with them and reduce discrimination/humiliation. This is a fix that can happen without any financial burdens for the hospital or making physicians learn a multitude of languages, and there would have to be further testing to see the effectiveness of keeping a linguistic-conscious mindset when caring for LEP families. Furthermore, this shows empathy on behalf of the hospital staff, and that would help LEP patients reduce their vulnerability when needing medical assistance.
Linguistic disparities in healthcare are a very prevalent topic in today’s day and age. With an increase in the immigrant population, there is a greater percentage of LEP families, and healthcare professionals should be able to communicate effectively to address their needs. There are a plethora of suggestions to decrease this increasing gap between the patient and physician such as: increasing the number of physicians who speak multiple languages, making sure drugs and paperwork are accessible in multiple languages, enforcing nationwide physician training for dealing with LEP families, and giving LEP families the same amount of attention as native families receive during their stay at the hospital. Many solutions that could be effective in destroying the linguistic barrier pose issues related to hiring, financial burdens, and access to resources. Therefore, the most immediate course of action that can occur free of cost is through the power of linguistics. Realizing that there is a good chance that LEP patients effectively respond to specific words that people use compared to the order in which they say them is instrumental for clearer communication. The use of “broken language” may be the solution to increasing rapport between providers and patients, which is just one of the many breakthroughs that the medical industry needs in a world of disparities.
References
Ruff N. How well does healthcare delivery work in language barriers? [Internet]. Language Unlimited. 2023. Available from: https://www.languagesunlimited.com/how-well-does-healthcare-delivery-work-in-language-barriers/
Gonzalez-Barrera A, Hamel L, Artiga S, Published MP. Language Barriers in Health Care: Findings from the KFF Survey on Racism, Discrimination, and Health [Internet]. KFF. 2024. Available from: https://www.kff.org/racial-equity-and-health-policy/poll-finding/language-barriers-in-health-care-findings-from-the-kff-survey-on-racism-discrimination-and-health/
Wikipedia Contributors. Language barrier [Internet]. Wikipedia. Wikimedia Foundation; 2019. Available from: https://en.wikipedia.org/wiki/Language_barrier
Buarqoub I. Language barriers to effective communication. Utopía Y Praxis Latinoamericana. 2019 Nov 12;24(6):64–77.
Steinberg EM, Valenzuela-Araujo D, Zickafoose JS, Kieffer E, DeCamp LR. The “Battle” of Managing Language Barriers in Health Care. Clinical Pediatrics [Internet]. 2016 Jul 19 [cited 2020 Jan 26];55(14):1318–27. Available from: https://jhu.pure.elsevier.com/en/publications/the-battle-of-managing-language-barriers-in-health-care
Espinoza J, Derrington S. How Should Clinicians Respond to Language Barriers That Exacerbate Health Inequity? AMA Journal of Ethics [Internet]. 2021 Feb;23(2):109–16. Available from: https://journalofethics.ama-assn.org/article/how-should-clinicians-respond-language-barriers-exacerbate-health-inequity/2021-02
Sanders LD, Neville HJ, Woldorff MG. Speech Segmentation by Native and Non-Native Speakers. Journal of Speech, Language, and Hearing Research. 2002 Jun;45(3):519–30.
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