For approximately 21.5 million people in the United States who have Limited English Proficiency (LEP), accessing healthcare can be a daunting challenge. Language barriers may result in less preventative care, more medical errors, lower patient adherence, and worse clinical outcomes for patients. Improving access to healthcare and language support services for individuals with LEP is one way to improve overall health equity in the U.S.
Defining Limited English Proficiency
People with LEP are those who self-identify on the US Census that they speak English less than "very well." These individuals may not speak English as their primary language or have trouble reading, writing, or understanding English. By far, the most common language spoken by people with LEP in the United States is Spanish (64%), followed by Chinese (6%), Vietnamese (3%), Korean (2%), and Tagalog (2%). LEP populations are concentrated in urban areas, but smaller metro areas are home to the fastest-growing LEP communities.
LEP and the Immigrant Experience
Within the LEP population, about 81% are foreign-born, and the remaining 19% are primarily second-generation children of immigrants. Due to immigration requirements regarding overall health and vaccinations, immigrants tend to enter a host country healthier than the general population — this is called the "healthy immigrant effect." However, that health advantage fades over time.
People with LEP are more likely to have lower incomes, and new immigrants often experience difficulty integrating economically and socially. They also encounter healthcare inequities. Both healthcare providers and patients with LEP acknowledge that language barriers can:
- Delay access to healthcare services
- Hinder the care relationship between patient and provider
- Reduce treatment adherence and use of preventative services
- Result in poorer health outcomes
The Affordable Care Act requires healthcare organizations to provide trained interpreters and translated materials at no extra cost. Qualified medical interpreters lead to improved outcomes, better patient satisfaction, and fewer readmissions for patients with LEP. The use of untrained interpreters, relatives, or community members to bridge language gaps creates problems of misinterpretation and breaches confidentiality.
When to Use a Medical Interpreter
Knowing when to call an interpreter for patient interactions can be difficult. For example, many people who speak with a heavy accent are proficient in English and do not require translation. Others may appear to speak and understand English very well but need assistance for more complex medical conversations.
It is best to ask rather than to assume. Use an open-ended question, such as, "What language are you most comfortable using to discuss your healthcare?"
But ultimately, a medical interpreter should be involved whenever there is a potential for miscommunication. If the patient or family is resistant, remind them they have a right to a medical interpreter at no cost and that professional interpretation is the best way to avoid misunderstandings that could affect their healthcare.
Successful Interpreter-Mediated Patient Interactions
Whether working with a medical interpreter in person, on video, or via telephone, it can be challenging to build successful patient relationships that an interpreter mediates. The most important thing to do is focus on the patient, not the interpreter. When speaking, make eye contact with your patient and speak directly to the patient (“Mrs. Padilla, your test showed…”) rather than speaking to the interpreter about the patient (“tell her that her test showed…”). When it's your turn to listen, note your patient's body language, facial expression, tone, and pace.
You can do more to improve your interactions with our tips and best practices for working with medical interpreters.
LEP Population and the Moral Imperative
Healthcare providers have a moral imperative to provide high-quality, equitable care to all patients. Too often, healthcare organizations and individual practitioners assume that substandard care for patients with LEP is unavoidable or too burdensome to address. But the healthcare industry can mitigate linguistic inequities by investing in technologically-advanced interpreter services, training staff on how to effectively communicate via medical interpreters, and developing organizational cultures that prioritize health equity for all patients.
