Communication errors in healthcare due to primary language discordance between patients and healthcare staff are likely to increase in modern globalizing and linguistically diverse societies. In the existing literature, language barriers lead to miscommunications between healthcare professionals and patients, contributing to reduced satisfaction among both groups, decreased quality of care, and reduced patient safety. Language interpretation services are effective in improving care and are available in most large healthcare organizations, but may be absent in resource-limited settings and, when used, can increase the cost of care and the length of healthcare visits. Healthcare professionals may be tempted to forego interpreters in service of saving time; however, understanding the health impacts of suboptimal language and the ethical obligation of linguistic equity is central to providing competent healthcare.
TopBackground
Language barriers in healthcare occur when a clinician and a patient have a difference in fluency in their shared language. According to the 2020 United States Census, approximately 21.5% of respondents spoke a language other than English at home and 8.2% (increasing from an estimated 4.8% in 1980) of respondents reported speaking English less than “very well” (these patients can sometimes be labeled as having “Limited English Proficiency”; however, this moniker is controversial) (US Census Bureau, 2020). With an increasing number of patients reporting primary languages other than English and reduced English fluency accessing the US healthcare system, it is extremely important that healthcare staff are cognizant of the presence and impact of language barriers.
Effective patient-clinician communication is critical to quality healthcare delivery and the effects of language barriers have been well described to include a 50% increase in the likelihood of medical errors (such as misdiagnoses, medication errors, or adverse drug reactions) and increased risk of readmission (Al Shamsi et al., 2020; Cohen et al., 2005; de Bruijne et al., 2013; Stewart et al., 1995). Language barriers affect not only the quality of care but also increase the cost of providing care; for example, increased medical visit durations and increased health resource utilization have both been reported (Koff et al., 1999). Patients who were identified as having a language barrier also identified changes in the quality of care, reported poor satisfaction with care received, and reported barriers to seeking and receiving healthcare, with one study finding that 66.7% of these patients reported facing a barrier when accessing healthcare and 20% reported not seeking healthcare for fear of not understanding their healthcare provider (De Moissac et al., 2019; Wilson et al., 2005).
Efforts to determine the direct role of language barriers in safety events have been challenging due to frequent omissions from safety event reports (Benda et al., 2022). Additionally, several past studies have found inadequate detection, reporting, and attempts to bridge language barriers (Karliner et al., 2007). In part, this may result from a propensity of healthcare staff to overestimate a patient’s English fluency, with studies estimating the misclassification of 25% of patients with a preferred language other than English as English preferring (Balakrishnan et al., 2016; Boscolo-Hightower et al., 2014). In a large survey study, medical providers reported trouble understanding patients that necessitated medical interpreter use in only 36% - 43% of patients who did not speak the same language as the provider (Kale et al., 2010).