Language Barriers with Surgical Patients
In 2020, about 25 million Americans did not speak English [1], posing difficulties for a healthcare system in a country where most physicians do not know any other languages [2]. This language barrier is particularly troublesome for surgery, where the risks posed by lack of comprehension and misunderstandings are high. Consider, for instance, the need for fluent communication in acquiring a patient’s informed consent, explaining outpatient procedures, and presenting medical results. This article will explore the various problems that language barriers present for surgical patients before providing suggestions for bridging that gap.
Consent is an essential aspect of surgery. At all US-based medical institutions, medical providers must obtain informed consent before moving forward with invasive procedures [3]. Language barriers may prevent a patient from giving informed consent to an operation. This phenomenon was the subject of a study by Clark et al., which measured patients’ comprehension of the complications associated with the laparoscopic cholecystectomies they were scheduled to undergo [3]. Compared to US natives, non-US-born patients had a 17% worse response rate, demonstrating how important it is for medical teams to develop alternative ways of communicating with patients who do not speak English fluently [3].
Surgical outcomes may also be worse as a result of language barriers between patients and providers. Gupta and colleagues conducted a meta-analytical study to determine how such barriers affected patients in need of coronary revascularization [4]. They found that patients with difficulties speaking English were less likely to receive revascularization procedures when needed [4]. However, results were mixed as to whether there was an association between language barrier and mortality [4]. Inagaki et al. also studied surgical outcomes for patients undergoing non-emergent infrainguinal bypass for ischemic rest pain, tissue loss, and claudication [5]. They did not identify a difference in adverse graft events, readmissions, and wound infection between English-speaking and non-English-speaking patients, perhaps indicating that language barriers did not have a large impact on surgical outcomes [5].
Nevertheless, language barriers do appear to influence how well hospital discharge goes. A 2012 study by Karliner et al. found that patients with limited English proficiency were less likely to understand information relating to the medication category they were supposed to take, medication type and purpose together, and follow-up appointment type [6]. These observations indicate that patients with limited English proficiency could suffer from impaired surgical recovery [6].
To address these issues, researchers pose several suggestions. Of course, using language concordant care —meaning finding a way for patients and providers to communicate in the same language— is optimal [7, 8]. Patients who can communicate with their health team in their primary language report greater satisfaction, and the aforementioned studies suggest that they may also receive better care [7]. Where a facility lacks personnel with the necessary language experience, translation software can be helpful; however, providers should be wary of the possibility that apps are inaccurate and not HIPAA-compliant [9]. Providers should also avoid relying on patients’ family members as their interpreters, barring exceptional circumstances [9]. Telephone or live video interpretation may thus be a good alternative to untrustworthy software [9].
While bridging language barriers may be costly and time-effective for medical facilities, it is important to ensure that surgical patients fully understand their risks and provide consent and that recovery is seamless. Therefore, medical providers must take steps to facilitate clear communication with the people that they treat.
References
[1] “25 Million Americans Don’t Speak English: Translators and Interpreters Essential in Pandemic,” The ATA Compass, Updated May 22, 2020. [Online]. Available: https://www.atanet.org/client-assistance/25-million-americans-dont-speak-english-translators-and-interpreters-essential-in-pandemic/.
[2] “First-Ever National Study to Examine Different Languages Spoken by U.S. Doctors,” Doximity, Updated October 17, 2017. [Online]. Available: https://press.doximity.com/articles/first-ever-national-study-to-examine-different-languages-spoken-by-us-doctors;
[3] S. Clark et al., “The Informed Consent: A Study of the Efficacy of Informed Consents and the Associated Role of Language Barriers,” Journal of Surgical Education, vol. 68, no. 2, pp. 143-147, March-April 2011. [Online]. Available: https://doi.org/10.1016/j.jsurg.2010.09.009.
[4] A. K. Gupta et al., “Lost in translation: The impact of language barriers on the outcomes of patients receiving coronary artery revascularization,” Cardiovascular Revascularization Medicine, pp. 1-5, March 2023. [Online]. Available: https://doi.org/10.1016/j.carrev.2023.03.016.
[5] E. Inagaki et al., “Role of language discordance in complication and readmission rate after infrainguinal bypass,” Journal of Vascular Surgery, vol. 66, no. 5, pp. 1473-1478, June 2017. [Online]. Available: https://www.jvascsurg.org/article/S0741-5214(17)31247-8/pdf.
[6] L. S. Karliner et al., “Language Barriers and Understanding of Hospital Discharge Instructions,” Medical Care, vol. 50, no. 4, pp. 283-289, April 2012. [Online]. Available: https://doi.org/10.1097%2FMLR.0b013e318249c949.
[7] J. L. Dunlap et al., “The effects of language concordant care on patient satisfaction and clinical understanding for Hispanic pediatric surgery patients,” Journal of Pediatric Surgery, vol. 50, no. 9, pp. 1586-1589, September 2015. [Online]. Available: https://doi.org/10.1016/j.jpedsurg.2014.12.020.
[8] L. Hsueh et al., “Patient–Provider Language Concordance and Health Outcomes: A Systematic Review, Evidence Map, and Research Agenda,” Journal of Vascular Surgery, vol. 78, no. 1, pp. 3-23, July 2019. [Online]. Available: https://doi.org/10.1177/1077558719860708.
[9] A. Squires, “Strategies for overcoming language barriers in healthcare,” Nursing Management, vol. 49, no. 4, pp. 20-27, December 2021. [Online]. Available: https://doi.org/10.1097%2F01.NUMA.0000531166.24481.15.