Practicing Medicine in the Melting Pot

Elyas Bakhtiari, for HealthLeaders Media, January 8, 2009

Physicians have a hard time communicating effectively with patients in general—whether because of confusion over medical jargon, not enough time to spend with a patient, or just poor communication skills. Add in a language barrier and miscommunication problems can become much more problematic, even dangerous.

But that's an obstacle many physicians increasingly face as a nation historically known for its diversity continues to accept immigrants from around the world. The number of Americans with limited English proficiency grew by 53% in the 1990s to more than 22 million, according to the last U.S. Census.

For physicians, that means having to practice around language and cultural barriers that can lead to decreased access to preventive services, poor understanding of instructions for medications, longer hospital stays and an increased risk of medical errors, and misdiagnoses.

Yet many physicians, particularly residents, don't use readily available interpreters, according to a recent study by the Yale School of Public Health. Instead they rely on their own foreign language skills or a patient's friend or family member.

Is that enough? Not according to legislators in California, who this week enacted a law requiring patients with limited English proficiency to have access to an interpreter. The state is understandably at the forefront of the issue considering nearly one in five residents have limited English proficiency.

The concern, as with almost any effort to improve healthcare, is the cost, which is estimated to be about $25 million.

Where the California law differs from other guidelines about interpreters, including those handed down from the Department of Health and Human Services, is the cost doesn't fall solely on physicians. HMOs are primarily footing the bill and responsible for coordinating interpreter services.

That's a better formula for effectively improving the use of interpreters.

Physicians are responsible for preventing communication breakdowns with patients, and cultural and language barriers need more attention from practicing physicians and medical schools. But it is ultimately a public health issue, and unfunded mandates that place the entire cost burden on physician practices are not only unfair, they aren't very effective.

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at
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