Doctors Underestimate Language Gaps

Physicians who speak a second language are likely to overrate their ability to communicate medical information, new research shows.

Navigating the health care system is difficult for anyone, but it’s even more of a challenge for patients who don’t speak English.

For these patients, finding a physician who speaks their language is critical—so much so that health organizations are required by law to offer the services of either an interpreter or bilingual staff person. But a new study shows even physicians who say they’re bilingual tend to overestimate their skills in the second language.

“Part of the problem is that there are no standards for how bilingual staff are assessed, so it’s left to organizations to decide for themselves,” said lead author Lisa Diamond, MD, of the Immigrant Health and Cancer Disparities Service at Memorial Sloan-Kettering Cancer Center in New York. She says a better system is needed to ensure equality of care for non-English speakers.

For example, physicians who describe their knowledge of Spanish or Chinese as “basic” or “conversational” may not have the skills to effectively communicate how often to take a medication, or what to do if a certain side effect occurs. Patients could leave their appointments with unanswered questions and lingering uncertainties that put them at risk for medical errors.

Dr. Diamond’s ongoing research focuses on identifying specific, objective descriptors that providers nationwide could use to assess language proficiency. For the recent study, she examined the use of a modified version of a scale known as the Interagency Language Rountable (ILR), which rates proficiency as either poor, fair, good, very good, or excellent.

At San Francisco’s Palo Alto Medical Foundation (PAMF), which served as the proving ground for the modified ILR, patients with limited English proficiency can search for a bilingual physician using the PAMF Web site. Before the new scale was put into place, physicians rated their skills in a second language as “basic,” “medical/conversational,” or “fluent.”

Under the new system, physicians were given detailed descriptions of each of the modified ILR’s 5 proficiency categories. For example, “Fair” was defined as “…can get the gist of most everyday conversations but has difficulty communicating about health care concepts.” Following its implementation, 75% of the 342 physicians who reported speaking another language changed their rating on the Web site.

Analysis of the post-ILR ratings also showed that:

• 31 physicians who had considered themselves “fluent” in another language downgraded their skill level to “good” or “fair.”
• Only 11% reported that their proficiency in a second language was “excellent”—the highest ranking.
• 17% rated their proficiency as “very good,” and more than one-third (38%) said they were “fair.”

Without accurate standards to assess and report language proficiency, even patients who do their research beforehand risk being unable to communicate with their physicians. “This is a very tricky area,” said Joseph Betancourt, MD, director of the Disparities Solutions Center at Massachusetts General Hospital in Boston. “This can lead to miscommunication and even medical errors,” he added in a news release.

In fact, research shows that the availability of a competent bilingual interpreter can make or break clinical outcomes for patients with limited English proficiency. According to a brief by The National Health Law Program, more than 25% of patients with limited English proficiency who needed, but did not get an interpreter said they did not understand their medication instructions.

The results of Dr. Diamond’s study appear in the October 27 online issue of Health Services Research.

For other articles in this issue, see:

• OTC Thyroid Drugs Pose Health Risks
• Weighing Obesity’s Impact on Flu Shots