Non-English Speaking

Caring for Non-English Speakers

Authors: Colline Wong, Christopher Steele MD MPH

 

Introduction

Including noncitizen residents, 66 million U.S. residents ages 5 and older speak a language other than English at home.1 This represents about 21.6% of the U.S. population. Furthermore, 14 million Americans do not speak English well.2 Language affects the way that these patients receive healthcare. Given that finding a doctor, booking an appointment, arriving at an appointment, and understanding what happens in a physician visit all require the use of language, non-English speakers need to overcome significant barriers to access healthcare. Currently, non-English speaking patients receive fewer preventative services and have less access to healthcare than English speaking patients. Despite these disparities, research shows that physicians perceived spending more time with the patient while using an interpreter, when the visit was actually the same amount of time.2 This adds to bias in appointment booking, expectations, and care given at each appointment. In order to provide appropriate care to these communities, we need more bilingual healthcare providers, better interpreter services, and improved cultural awareness.  This module describes the disparities in health care of non-English speakers in the United States, and discusses ways we can address these vulnerabilities to help non-English speaking patients. 

 

Learning Objectives

By the end of the session, learners will be able to:

  • Describe the current demographics of non-English speakers in the US.
  • List and describe disparities in health care access and the clinical consequences of language barriers experienced by non-English speakers.
  • Describe strategies for communicating with non-English speakers in the clinical setting. 
  • Describe the different types of medical interpreters and how to get certified as a medical interpreter. 
  • Summarize strategies to address language barriers in the clinical setting, including medication management.

 

Required Assignments

  1. Wong C. Introduction to Care for Non-English Speakers: https://www.youtube.com/watch?v=JHGe_fdTDeY
  2. Flores, G. (2006). Language Barriers to Health Care in the United States. New England Journal of Medicine, 355(3), 229-231. doi:10.1056/nejmp058316 https://drive.google.com/file/d/1RCPEHx5TavM_WawwF7brx-QC8075RhUt/view?usp=sharing

 

Optional Assignments

 

Works Cited

  1. Ingraham, C. (2018, May 21). Analysis | Millions of U.S. citizens don't speak English to one another. That's not a problem. Retrieved July 26, 2020, from https://www.washingtonpost.com/news/wonk/wp/2018/05/21/millions-of-u-s-citizens-dont-speak-english-to-each-other-thats-not-a-problem/
  2. Taira, D. (1999, May). Improving the health and health care of non-English-speaking patients. Retrieved July 26, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496581/

 


Application Exercise

Medication management is an important part of a patient’s care. There are many reasons why a patient is not adherent to their medication regimen. Lack of understanding of the medication's proper use, reason for taking medication, and adverse side effects in conjunction with complicated instructions of use can all lead to suboptimal medication adherence. Other times, a patient takes many medications and may leave out a particular one by accident. One way to help patients manage their medications is by providing a pill card with pictorial aids. 

Instructions

Using the Pictorial Aid for Medication Management document and the Blank Pill Card template provided, please make a pill card for the following patient:

Mr Y. is a 56 year old male who speaks Spanish as his primary language and has limited English proficiency. Mr. Y has hypertension, hypothyroidism, hyperlipidemia, and allergic rhinitis/seasonal allergies. He reports difficulties taking his medications, stating that he has so many medications to take and the instructions are often too complicated. After going through the medications proper use, reason for taking the medications, and possible side effects with Mr. Y using a medical interpreter, you decide it’s best to send him home with a pill card to help manage his medications. Mr. Y’s medicine regimen is currently:

  • Lisinopril 20mg once a day PO
  • Metoprolol tartrate 25mg twice a day PO
  • Atorvastatin 10mg once a day PO at bedtime
  • Aspirin 81mg once a day PO
  • Levothyroxine 100 mcg every morning PO
  • Fluticasone propionate 2 sprays in each nostril once a day

Reference

Katz MG, Kripalani S, Weiss BD. Use of pictorial aids in medication instructions: a review of the literature. Am J Health Syst Pharm. 2006 Dec 1;63(23):2391-7. doi: 10.2146/ajhp060162. PMID: 17106013.