Patients with Language Barriers: Getting the Message Across

by Lubna Kousa Pharm.D., PGY1 Community Pharmacy Practice Resident, Johns Hopkins Home Care Group

The United States is notorious for its diversity. Over the past several decades the use of a language other than English at home has increased by 148 percent.¹  The number of non-English speakers increased from 23.1 million in the 1980’s to 57.1 million in 2009.  This rapid change can be seen throughout the country, whether it’s a Chinese language television station or a road sign in Spanish, the linguistic diversity continues to evolve.

Language barriers are becoming progressively more challenging for the delivery of health care services. Given the heterogeneity of ethnic origins and the primary languages among these groups, individuals who have limited English proficiency have significant challenges when communicating with health care providers. Patients with poor communication skills have difficulty accessing care and conveying their health concerns to practitioners.  In many health care settings, there is a lack of interpreters. This often results in misdiagnosis, inappropriate treatments, and the delivery of suboptimal care.²  Moreover, patients with limited English proficiency report being less satisfied, less likely to understand medication instructions, and more likely to have problems adhering to their medication regimens.

But why should this be? It shouldn’t. We invest billions of dollars in systems and programs for providing medical care and finding cures for diseases.  Why can’t we invest resources in systems and programs for patients with language barriers?

As pharmacists, we are responsible for providing excellent care in order to achieve optimal outcomes for our patients and enhance their quality of care.  It is our mission to provide our patients with a level of comfort and an opportunity to be understood.  And we should communicate clearly with our patients so that we can arrive at the best decisions together.  Being a pharmacist isn’t about filling prescriptions for our patients, but creating a bond that enables us to ensure a positive outcome, regardless of any barriers. Whether the patient is in a hospital, outpatient clinic, or a community pharmacy, this process requires excellent communication between the patient and the pharmacist to ensure the quality and safety of drug therapy.³  Patients who don’t fully understand their treatments are less likely to follow-up, which in turn puts them at greater risk of being hospitalized or experiencing drug complications.  For example, patients with asthma are at greater risk of intubation if they fail to properly use their treatments.⁴

Using visual methods can help. Going to the drawing board, showing pictures, and drawing examples can paint a clearer picture for our patients.  If nothing else, it demonstrates the effort put forth to help them. Using plain language and avoiding technical jargon is a strategy for making written and oral information easier to understand.  Written materials can be referred to at a later time.  Printed instructions for patients that contain pictographs and photographs that demonstrate medication-use techniques can be very useful in this patient population.² However, a better long-term solution to this problem is for our healthcare system to invest in a powerful interpreter service that is consistently available in order to facilitate optimal communication between providers and patients.  This will, in turn, improve patient satisfaction and safety.^5,6

Despite ongoing efforts to increase awareness of communication difficulties in patients with limited English proficiency, health disparities continue to exist.  Our challenge as pharmacists involved in the direct care of patients is not only to provide medications, but create a welcoming environment that encourages them to seek care even when language barriers exist.  Our job is to build a system that can mitigate communicate problems and deliver the best possible care to diverse patient populations.

References

1.    Ortman JM. Language Projections: 2010 to 2020. Population Division, U.S. Census Bureau.  Accessed on January 28, 2013.

2.    Diamond LC and Jacobs EA. Let's not contribute to disparities: the best methods for teaching clinicians how to overcome language barriers to health care. J Gen Intern Med 2010;25 Suppl 2:S189-93. Accessed on January 28, 2013.

3.    Bubalo J, Clark R, Jiing S et al. Medication adherence:Pharmacist perspective.  J Am Pharm Assoc 2010;50: 394-406.  Accessed on January 30, 2013.

4.    Flores G, Laws MB, Mayo SJ, et al. Errors in medicalinterpretation and their potential clinical consequences in pediatric encounters. Pediatrics 2003;111:6-14.  Accessed on January 30, 2013.

5.    Flores G. Language Barriers toHealth Care in the United States. N Engl J Med 2006; 355:229-231. Accessed on January 30, 2013.

6.    Phokeo V and Hyman I. Provision of pharmaceutical care to patientswith limited English proficiency. Am J Health-Syst Pharm 2007; 64: 423-429.  Accessed on January 30, 2013.