This article discusses the negative impact of language discordance between provider and patient on patient health, and specifies the regulatory guidelines requiring language access. It also provides tips for better communicating with patients who have limited English proficiency.
Nearly one in five people in the U.S. speak a language other than English at home according to the 2022 Census Bureau report, nearly tripling from four decades ago. Spanish is the non-English language spoken most frequently (61.6%), followed by Chinese (5.2%), Tagalog (2.6%), Vietnamese (2.3%) and Arabic (1.9%). Finding ways to communicate with patients who may have limited English proficiency is important for both health and regulatory reasons.
Impact of language differences on patient health
Research published in the Journal of General Internal Medicine indicates that roughly 25 million people in the U.S. have limited English proficiency. Additionally, 66% of studies have demonstrated that patients have better healthcare outcomes with language-concordant care.
Language concordance was determined by the physician being fluent in the preferred language of the patient. This fluency can help reduce miscommunication, also enabling healthcare professionals to better educate their patients about their care plan and adequately answer questions they may have.
A 2020 review adds that language concordance between health providers and patients can also reduce patients’ anxiety levels, increasing their willingness to use services offered by a provider who speaks a different first language.
Language-related legal requirements
Communicating with patients who don’t speak English as a first language isn’t only a matter of health, it’s also a legal requirement.
The Agency for Healthcare Research and Quality (AHRQ) reports that practices participating with Medicare or Medicaid must provide language access for patients with limited English proficiency. This is due, in part, to Title VI of the Civil Rights Act of 1964 which prohibits discrimination based on race, color, or a person’s national origin, and also mandates that recipients of federal funds take reasonable measures to make their services accessible to people with limited English proficiency.
Based on Chiropractic Economics’ annual survey, this regulation applies to many practitioners as, on average, 9.5% of chiropractic services are paid by Medicare with 5% being paid by Medicaid. Some states also have regulatory requirements related to language access in healthcare settings.
Communicating with patients with limited English proficiency: Cross the language barrier
The AHRQ offers numerous tips for helping practitioners overcome language issues when communicating with patients. They include:
- Ask patients about their preferred language and record this information in their medical records. If you have trouble identifying their first language, the use of an “I Speak” brochure can help.
- Notify patients of language access services. For example, you could hang an Interpreter Services poster in your waiting room or print it as a document that can be included in new patient information packets. Also, create a list of available language access services, including bilingual staff members and qualified healthcare interpreters.
- Offer information in languages other than English. Translate essential information and documents into the first languages spoken by your patients. This includes intake forms, appointment reminders, helpful exercises and patient care instructions.
- Create policies and provide training for staff. Decide how staff will respond to patients with different language needs, then train them on these processes. This may include establishing procedures to document interpreter use or schedule interpreter services, whether in person or by phone or video.
What about translation apps?
A variety of apps offer language translation services, making them a consideration when communicating with patients. These may be workable solutions, especially when an interpreter isn’t available.
A 2021 review in the Journal of Medical Internet Research concluded these apps are often acceptable and can improve communication and reduce consultation time, though they do have limitations. One is they may hinder the therapeutic relationship. Another is these apps could limit patient-provider dialogue.
Final thoughts on communicating with patients
Developing a list of all available communication options for patients with limited proficiency provides your practice the ability to choose the ones most suitable. It also positions you to promote patient health while remaining in compliance with regulatory requirements.
