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Let’s Not Contribute to Disparities: The Best Methods for Teaching Clinicians How to Overcome Language Barriers to Health Care

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Abstract

Clinicians should be educated about how language barriers contribute to disparities for patients with limited English proficiency (LEP). However, educators must avoid developing educational interventions that increase health disparities for LEP patients. For example, studies suggest that teaching “Medical Spanish” or related courses may actually contribute to health care disparities if clinicians begin using these non-English language skills inappropriately with patients. We discuss the risks and benefits of teaching specific cultural competence skills and make evidence-based recommendations for the teaching content and methods for educational interventions focused on overcoming language barriers in health care. At minimum, we suggest such interventions include: (1) the role of language barriers in health disparities, (2) means of overcoming language barriers, (3) how to work with interpreters, (4) identifying and fixing problems in interpreted encounters, and (5) appropriate and safe use of one’s own limited non-English language skills.

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References

  1. Shin HB, Bruno R. Language Use and English-Speaking Ability: 2000. October 2003; http://www.census.gov/prod/2003pubs/c2kbr-29.pdf. Accessed October 23, 2006.

  2. Woloshin S, Schwartz LM, Katz SJ, Welch HG. Is language a barrier to the use of preventive services? J Gen Intern Med. 1997;12(8):472–7.

    Article  CAS  PubMed  Google Scholar 

  3. Morales LS, Cunningham WE, Brown JA, Liu H, Hays RD. Are Latinos less satisfied with communication by health care providers? J Gen Intern Med. 1999;14(7):409–17.

    Article  CAS  PubMed  Google Scholar 

  4. Wilson E, Chen AHM, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20(9):800–6.

    Article  PubMed  Google Scholar 

  5. John-Baptiste A, Naglie G, Tomlinson G, et al. The effect of English language proficiency on length of stay and in-hospital mortality.[see comment]. J Gen Intern Med. 2004;19(3):221–8.

    Article  PubMed  Google Scholar 

  6. Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19(2):60–7.

    Article  PubMed  Google Scholar 

  7. Flores G, Laws MB, Mayo SJ, et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111(1):6–14.

    Article  PubMed  Google Scholar 

  8. Baker DW, Hayes R, Fortier JP. Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients. Med Care. 1998;36(10):1461–70.

    Article  CAS  PubMed  Google Scholar 

  9. Jacobs EA, Lauderdale DS, Meltzer D, Shorey JM, Levinson W, Thisted RA. Impact of interpreter services on delivery of health care to limited-English-proficient patients. J Gen Intern Med. 2001;16(7):468–74.

    Article  CAS  PubMed  Google Scholar 

  10. Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–54.

    Article  PubMed  Google Scholar 

  11. Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275(10):783–8.

    Article  CAS  PubMed  Google Scholar 

  12. Burbano O’Leary SC, Federico S, Hampers LC. The truth about language barriers: one residency program’s experience. Pediatrics. 2003;111(5 Pt 1):e569–73.

    Article  PubMed  Google Scholar 

  13. Yawman D, McIntosh S, Fernandez D, Auinger P, Allan M, Weitzman M. The use of Spanish by medical students and residents at one university hospital. Acad Med. 2006;81(5):468–73.

    Article  PubMed  Google Scholar 

  14. Schenker Y, Wang F, Selig SJ, Ng R, Fernandez A. The Impact of Language Barriers on Documentation of Informed Consent at a Hospital with On-Site Interpreter Services. J Gen Intern Med. 2007;22(S2):294–9.

    Article  PubMed  Google Scholar 

  15. Diamond L, Schenker Y, Bradley E, Curry L, Fernandez A. Getting By: Underuse of Interpreters by Resident Physicians. J Gen Intern Med. 2009;24(2):256–62.

    Article  PubMed  Google Scholar 

  16. Institute of Medicine, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: National Academies Press; 2003.

    Google Scholar 

  17. Karliner LS, Perez-Stable EJ, Gildengorin G. The language divide. The importance of training in the use of interpreters for outpatient practice. J Gen Intern Med. 2004;19(2):175–83.

    Article  PubMed  Google Scholar 

  18. Beach M, Price E, Gary T, et al. Cultural Competence: A systematic review of health care provider educational interventions. Med Care. 2005;43:356–73.

    Article  PubMed  Google Scholar 

  19. Copeman R. Medical students, Aborigines and migrants: evaluation of a teaching programme. Med J Aust. 1989;150:84–7.

    CAS  PubMed  Google Scholar 

  20. Nora L, Daugherty S, Mattis-Peterson A, Stevenson L, Goodman L. Improving crosscultural skills of medical students through medical school-community partnerships. West J Med. 1994;161:144–7.

    CAS  PubMed  Google Scholar 

  21. Culhane-Pera K, Reif C, Egli E, Baker N, Kassekert R. A curriculum for multicultural education in family medicine. Fam Med. 1997;29:719–23.

    CAS  PubMed  Google Scholar 

  22. Godkin M, Savageau J. The effect of a global multiculturalism track on cultural competence of preclinical medical students. Fam Med. 2001;33:178–86.

    CAS  PubMed  Google Scholar 

  23. Kalet A, Mukherjee D, Felix K, et al. Can a web-based curriculum improve students’ knowledge of, and attitudes about, the interpreted medical interview? J Gen Intern Med. 2005;20(10):929–34.

    Article  PubMed  Google Scholar 

  24. Napholz L. A comparison of self-reported cultural competency skills among two groups of nursing students: implications for nursing education. J Nurs Educ. 1999;38:81–3.

    CAS  PubMed  Google Scholar 

  25. Gany F, de Bocanegra H. Maternal-child immigrant health training: changing knowledge and attitudes to improve health care delivery. Patient Educ Couns. 1996;27:23–31.

    Article  CAS  PubMed  Google Scholar 

  26. Lee KC, Winickoff JP, Kim MK, et al. Resident physicians’ use of professional and nonprofessional interpreters: a national survey. JAMA. 2006;296(9):1050–3.

    Article  CAS  PubMed  Google Scholar 

  27. Mazor S, Hampers L, Chande V, Krug S. Teaching Spanish to pediatric emergency physicians: effects on patient satisfaction. Arch Pediatr Adolesc Med. 2002;156(7):693–5.

    PubMed  Google Scholar 

  28. Prince D, Nelson M. Teaching Spanish to emergency medicine residents. Acad Emerg Med. 1995;2(1):32–6.

    Article  CAS  PubMed  Google Scholar 

  29. Reuland D, Frasier P, Slatt L, Aleman M. A longitudinal medical Spanish program at one US medical school. J Gen Intern Med. 2008;23(7):1033–7.

    Article  PubMed  Google Scholar 

  30. Farnill D, Todisco J, Hayes S, Bartlett D. Videotaped interviewing of non-English speakers: training for medical students with volunteer clients. Med Educ. 1997;31:87–93.

    Article  CAS  PubMed  Google Scholar 

  31. Jacobs, EA, Diamond, LC, Stevak, L. The Importance of Teaching Clinicians When and How to Work With Interpreters. Patient Educ Couns., In Press.

  32. Cheng EM, Chen A, Cunningham W. Primary Language and Receipt of Recommended Health Care Among Hispanics in the United States. J Gen Intern Med. 2007;22(S2):283–8.

    Article  PubMed  Google Scholar 

  33. Diehl A, Westwick T, Badgett R, Sugarek N, Todd K. Clinical and sociocultural determinants of gallstone treatment. Am J Med Sci. 1993;305(6):383–6.

    Article  CAS  PubMed  Google Scholar 

  34. Todd KH, Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate emergency department analgesia.[see comment]. JAMA. 1993;269(12):1537–9.

    Article  CAS  PubMed  Google Scholar 

  35. National Committee on Interpreting in Health Care. Guide to Interpreter Positioning in Health Care Settings. (November 2003). Available at: http://data.memberclicks.com/site/ncihc/NCIHCWorkingPaper—GuidetoInterpreterPositioninginHealthCareSettings.pdf. Accessed November 8, 2009.

  36. Downing, B. and Roat, CE. Models for the Provision of Language Access in Health Care Settings (March 2002). Available at: http://data.memberclicks.com/site/ncihc/NCIHC Working Paper — Models for Provision of Language Access.pdf. Accessed November 8, 2009.

  37. Diamond L, Reuland D. Describing Physician Language Fluency: Deconstructing Medical Spanish. JAMA. 2009;301(4):426–8.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Dr. Diamond was supported during this research by The California Endowment. Dr. Jacobs was supported during this research by The California HealthCare Foundation.

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Authors and Affiliations

  1. Palo Alto Medical Foundation Research Institute, Ames Building, 795 El Camino Real, Palo Alto, CA, 94301, USA

    Lisa C. Diamond MD, MPH

  2. Division of General Internal Medicine and Rush Institute for Healthy Aging, John H. Stroger Hospital of Cook County & Rush University Medical Center, Chicago, IL, USA

    Elizabeth A. Jacobs MD, MPP

Authors
  1. Lisa C. Diamond MD, MPH
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  2. Elizabeth A. Jacobs MD, MPP
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Correspondence to Lisa C. Diamond MD, MPH.

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Diamond, L.C., Jacobs, E.A. Let’s Not Contribute to Disparities: The Best Methods for Teaching Clinicians How to Overcome Language Barriers to Health Care. J GEN INTERN MED 25 (Suppl 2), 189–193 (2010). https://doi.org/10.1007/s11606-009-1201-8

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  • DOI: https://doi.org/10.1007/s11606-009-1201-8

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