Communication is the foundation of all doctor-patient relationships with the most critical being those who are able to intervene first, routine general physicians. The principle of preventive care lies in the power in the ability to be proactive over one’s health before a problem escalates to an emergency room visit. However, as with other determinants in preventive healthcare, there are obstacles observed by studies and experienced by several patients that block the crucial line of communication between the patient and the provider. In oral interviews provided by the Southern Oral History Program, both patients, providers, family members, and staff have expressed their personal frustrations in miscommunications occurring due to a lack of English proficiency or overwhelmed by medical jargon that providers that are equally as foreign. The following sections explore the complications that thousands of patients face as they walk into the doctor’s office seeking out help before it’s too late.
English Proficiency: How It Matters in Healthcare in America
Entering the doctor’s office can be an intimidating experience as it involves admission of vulnerability to seek out help. It takes courage to reach out in order to get ahead of the game to ensure a healthy lifestyle. However, for many people, it becomes difficult to reach out when health services seem ambiguous and intangible when the person you’re seeking assistance from doesn’t even speak the same language as you. In the interviews, there are several testimonies that center around CommWell Health in Dunn, NC, a non-profit organization that offers outreach programs and accessible healthcare practice at affordable rates. Staff members such as Maria Torres, a CNA interpreter, expresses the gratitude she has been shown from patients to be able to share their stories and struggles in their own language as in previous experiences the lack of interpretation services has barred them from accessing healthcare services (00:08:40). Goenka compiled a study review that included the National Survey of Children’s Health stating that non-English primary language households have lower access to healthcare services, particularly those preventive services such as dentistry and physicals, lack health insurance, and minimal mental health interventions (pg. 663). In such instances, the overwhelming need for interpreters can be shown to help facilitate communication between patients and providers, whether for better or worse.
The patient stories extend to the provider’s perspective in efforts to communicate vital information to the people who need it. As much as a tool that interpretation is, it is not without its flaws such as misinterpretation and privacy concerns, especially in the healthcare fields. From a provider’s perspective, Jane Hammond, P.A., expresses her frustrations with interpreters paraphrasing her already simplified instructions to the Latinx patients as she wants them to have the information available. In addition, she notes the lack of connection between herself and the patient as they are talking to the interpreter, instead of with each other, along with the inability to convey tone to display their level of concern (00:14:03). Jane is not alone with her concerns as other nurses have noted the difference between having an interpreter and having a direct line of communication with bilingual nurses to be able communicate their concerns (Ali and Johnson, pg. 429). BMC Health Services Research had patients interviewed and surveyed from ESL classes to speak on their experiences with interpreters, the good and the bad, where they have found privacy issues can often hinder patients from confessing their pain or issues to their providers, often out of embarrassment or reluctance to admit there is a problem (pg. 5). Though having an interpreter is a helpful bridge between patient and provider, the language barriers that thousands face can often be intimidating for receiving life-saving information from a second handed perspective. Part of the problem is the lack of education over the second language that providers speak fluently, medical jargon, that is simplified to the interpreters and then handed down to the patient.
The Vital Role of Medical Literacy
Though non-English speaking individuals make up a large portion of the patient population, the English proficiency language barrier is not the only hindrance to communicating with healthcare providers. In various interviews such as Tammy Blackman, many family members’ and patients’ frustrations are about not being able to communicate properly as they don’t comprehend the questions or the information that the providers are trying to ask them (00:25:34). A huge contributor in communication pathways between patient and provider is medical literacy. Health literacy is the ability to properly comprehend medical information and to put it into use by taking preventive measures to maintain a person’s health (pg. 1). As the foundation of communication is laid out with a physician, patients often begin to feel overwhelmed to comprehend the information that providers relay that is crucial in preventive care as they hand them to tools to be proactive over their health. Various studies looking into medical literacy have profiled that those that score on low had more chronic conditions such as diabetes and obesity, low socioeconomic status, lack of access to healthcare services, and lack of health insurance (Joshi pg. 8; Taggart pg. 9). From a provider’s perspective, Hammond and Torres expressed concern oversimplification as their patients and community at large may not comprehend how essential diets, exercise, and taking medication can help an issue from escalating. Though imagery such as models can assist the patient’s understanding of where the problem is, they still require the patient’s primary knowledge of basic anatomy or comprehension issues with medications as others have expressed concerns with taking pills rather than holistic measures.
Interventions for Communication Barriers
The established barriers toward healthy communication lines between the patient and their providers are meant to be broken to allow all patients to become proactive over their health. In the United States, many local community college classes offer English as Second Language (ESL) courses at little to no costs for those struggling with English proficiency. (“ESL Information and Resources”) In addition, the aid of trained interpreters that are culturally sensitive to both languages, the non-English and medical terminology, that they are exchanging information to ease the conversation between patient and provider (Pandey, pg. 6). As for health literacy, Australian studies have demonstrated the number of lifestyle modification courses referrals that are available to patients with particularly low health literacy and their relative improvement in health afterwards (Joshi, pg. 8). It is in hopes that such intervention can stop the next ER visit with a measure as simple as an honest conversation with a provider to build a trusting repertoire over time.
Works Cited
“About the National Survey of Children’s Health”The National Survey of Children’s Health. www.childhealthdata.org/learn-about-the-nsch/NSCH.
Ali P.A. and Johnson S. “Speaking my patient’s language: bilingual nurses’ perspective about provision of language concordant care to patients with limited English proficiency”. Journal of Advanced Nursing, volume 73, issue 2, 2017, pg. 421–432. doi: 10.1111/jan.13143
Abdi Almachavan, Sohelia. “The Role of Health Literacy in Enhancing Preventive Healthcare: A Comprehensive Review of Challenges, Interventions, And Future Directions.” Journal of Research in Clinical Medicine, vol. 12, no. 36, 2024, https://doi.org/10.34172/jrcm.35126.
Blackman, Tammy. Interview with Maddy Kameny. 25 June 2018 (Y-0010). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
“ESL Information and Resources.” ESL Directory, www.esldirectory.com/esl-info/.
Goenka, Pratichi K. “Lost in translation: impact of language barriers on children’s healthcare”. Current Opinion in Pediatrics, vol. 28, issue 5, pg. 659-666, October 2016. www.doi.org/10.1097/MOP.0000000000000404
Hammond, Jane Sabra. Interview with Maddy Kameny. 27 June 2018 (Y-0028). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Joshi, Chandni, et al. “Does health literacy affect patients’ receipt of preventative primary care? A multilevel analysis.” BMC Family Practice, vol. 15, no. 171, 2014, https://doi.org/10.1186/s12875-014-0171-z.
“Our Mission – CommWell Health.” Commwell Health, April 14, 2023. https://commwellhealth.org/about-us/our-mission/.
Pandey, Mamata, et al. “Impacts of English Language Proficiency on Healthcare Access, Use, and Outcomes among Immigrants: A Qualitative Study.” BMC Health Services Research, vol. 21, no. 741, 2021, pp. 1-13. ProQuest, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06750-4
Taggart, J., Williams, A., Dennis, S. et al. “A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors.” BMC Family Practice, volume 13, issue 49 (2012). https://doi.org/10.1186/1471-2296-13-49
Torres, Maria. Interview with Joanna Ramirez. 25 June 2018 (Y-0056). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.