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Advice for clinicians caring for non-English speaking patients
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Society and healthcare are becoming increasingly more diverse. As a result, many patients seeking healthcare are now in need of more than healthcare. They need clinicians to be sensitive to their language barriers and provide a means to communicate to them effectively. In 2014, Dettenmeier pointed out that many patients in healthcare today have limited English proficiency, also known as (LEP). These individuals have a primary language other than English with limited ability to understand, read, or write English. As healthcare professionals, we must ask ourselves what roles do language barriers play in healthcare disparities? More importantly, how can we provide care to those with LEP who need medical assistance?
The American Community Survey Report found that 20% of the population speaks a language other than English at home, with a predominant proportion speaking Spanish. The results of the survey emphasized the need for more cultural diversity and sensitivity to decrease disparities in providing medical care. Healthcare systems need access to medical interpreters and audio-visual language assistance for patients with LEP. In 2000, President Bill Clinton issued an executive order (#13166) that advocated improving access to services for those with LEP. Since then, some improvements have been made, but there is more that can be done. Let’s examine a case study.
Case Study Example
Mr. Hilario is a 45-year-old male who presents to the office for an exam. He presents to the front desk and the office assistant flags his chart to indicate that he does not speak English. Nurse Smith puts Mr. Hilario in the exam room. Upon directing Mr. Hilario to sit on the exam table to take vital signs, instead of using a language line service, she pages the clinic translator who speaks Spanish. When the translator arrives to speak to the patient, the patient looks confused when the translator starts translating questions from the nurse.
What should the office assistant and Nurse Smith have done immediately?
It’s always important to clarify what language a person speaks. They should also have determined if the patient had anyone with him that spoke English. Often, patients who do not speak English will bring someone with them who can understand English and help translate information and answer questions. In this scenario the office assistant and nurse assumed the patient spoke Spanish. Mr. Hilario was from Portugal and it was flagged due to his name that he spoke Spanish. Although he understood some Spanish, he was still confused when the translator starting translating some of the nurse’s questions.
What Can Clinicians and Staff Do?
Clinicians and other support staff play a vital role in making sure while patients are being cared for they are also being heard. Some of this can occur in anticipation of a visit with a person who has LEP. Below are some tips that can be used when dealing with someone who has LEP:
- Look directly at the patient and speak slowly, unless a patient is hearing impaired.
- Ask what language he or she speaks and get assistance for them in that language.
- When possible, use picture cards or illustrations to help patients understand or communicate.
- Translate any information to be communicated to the patient in their language when possible or use a language line to discuss the information if a live person is not available.
- Have patients invite an English speaking family member(s) to the visit.
The following are important questions for all patients, whether they speak English or not, that establish rapport between patient and clinician, open the channel of communication, and reinforce understanding of the medical visit.
- What brings you here today?
- Do you have any questions?
- Do you understand everything I’ve told you today? Is the treatment plan clear to you?
- How do you feel about your visit today?
- Do you have any questions about your medications?
Using these techniques and questions can greatly benefit those with LEP, but can also help in providing quality care. Clinicians possess the critical components and skills to be able to address problems associated with language-associated healthcare disparities. By embracing the necessary skills and addressing the challenges, they can decrease and eliminate the barriers to healthcare for those living with LEP in order to provide quality healthcare.
Tonya Sawyer-McGee, DNP, RN, ACNP
Parkland Health & Hospital System
Community-Oriented Primary Care Clinics
Bluitt-Flowers Health Center
303 East Overton Road
Dallas, TX 75216
Published August 20, 2014
Dr. Sawyer-McGee is an acute care nurse practitioner, who currently works at Parkland Health and Hospital System in Dallas, Texas, in internal medicine at one of Parkland’s Community-Oriented Primary Care Clinics. She has been practicing as a nurse and practitioner since 1997 and specializes in medical and acute care of patients. Prior to Parkland, Dr. Sawyer-McGee was a gastrointestinal oncology nurse practitioner at the University of Texas Southwestern Medical Center. During her time at UT Southwestern, she was also a consultant for Amgen, a pharmaceutical company, a role in which she traveled across Texas educating practitioners, pharmacists, nurses and other medical and allied professionals on the latest treatments for colon cancer.
A native of Kentucky, Dr. Sawyer-McGee precepts nurses and nurse practitioner students, is an adjunct faculty for American Sentinel University, is a member of Sigma Theta Tau International Nursing Honor Society, Sigma Gamma Rho Sorority, Iota Phi Lambda Sorority, Inc., the North Texas Nurse Practitioners, and an E-advisory member for the Practicing Clinician’s Exchange.
1. Dettenmeier P When patients can’t speak English. Nursing2014. 2014;44(6):60-63.
2. Ryan C. Language use in the United States, 2011. United States Census Bureau. American Community Survey. August 2013; ACE#22. http://www.census.gov/prod/2013pubs/acs-22.pdf. Accessed August 13, 2014.
3. Diamond LC, Jacobs EA. Let’s not contribute to disparities: The best methods for teaching clinicians how to overcome language barriers in healthcare. J Gen Intern Med. 2010;25(Suppl 2):S189-S193.