Bridging the language gap: For patients with limited English skills

A new patient comes to your office for the first time. You want to do what comes naturally: Talk. Take a history. Find out what's wrong. But in this case, it isn't so simple. The patient doesn't speak English well.

A flurry of questions pop into mind. What products and services are out there to help you communicate? What is the safest choice going to be for your patient? Who's going to pay for it? What are your legal obligations?

This scenario is not at all uncommon, and it's going to become even more frequent.

The United States is becoming more diverse. The U.S. Census reported that more than 21 million people -- about 7% of the population -- have limited English skills. That figure is expected to exceed 28 million people -- 10% of the population -- by 2010. So if they haven't already, doctors need to find out how to handle patients with limited English proficiency.

To help them, the American Medical Association recently released a Web-streaming video program that highlights the issues doctors and patients face when they don't speak the same language. The AMA also has published a free brochure, "The Office Guide to Limited English Proficiency Patient Care." It is available by e-mailing a request ([email protected]" target="_blank">link).

The free seven-minute video, "Optimal Strategies for Addressing Language Barriers Between Physicians and Patients," is the second installment in a monthly series called "Educating Physicians on Controversies in Health."

The first tackled health disparities. The next one, which will be released this month, deals with sexually transmitted infection vaccines for adolescents.

The language program provides a primer on the types of translation services needed in clinical interactions to ensure quality of care and patient safety. It also gets at the issue of whether it is appropriate to let a patient's family member to serve as an interpreter.

The video explains the legal obligations involved as well. Since 2000, the federal government has required all physicians accepting payment from public programs, such as Medicare, Medicaid and the State Children's Health Insurance Program, to provide interpreter services to all patients who need help with English. The Dept. of Health and Human Services Office of Civil Rights in 2003 softened the requirements, so that, for example, a small physician practice would not be expected to offer the same level of service as, say, a big inner-city hospital.

But the changes didn't address one of the biggest problems with the federal rules -- the requirement that a physician must pay for the interpreter services. This unfunded mandate continues to put financial pressure on physician practices struggling with high liability insurance premiums and the prospect of Medicare payment cuts.

The lack of reimbursement is a reality doctors must face in all but the 10 states that pay for interpreter services. To solve this problem, AMA policy calls for federal funding for interpreters and for health plans to cover language services.

The issues go beyond the practical -- what services are out there and how do I afford them -- and into the personal. Communication is the crux of the patient-physician relationship.

In addition, studies show that language barriers have an adverse impact on both health care and health outcomes. Patients who have limited English skills are less likely to have a medical home, and they take fewer prescribed medications than their English-speaking counterparts.

Doctors truly want what's best for all patients. For doctors who want to make sure they're providing the best care for their patients with poor English skills, this video will give them the background they need to understand the issues involved.