Trying to keep up with medical terminology and acronyms during a doctor’s visit can be tricky for anyone. Imagine if you and your doctor didn’t speak the same language.
Language issues in the hospital can be disastrous. In one high-profile case, decades ago in Florida, a teenager named Willy Ramirez was taken to a hospital in a coma. In describing what they thought happened, family members used the word “intoxicado,” which usually means intoxicated in English.
They meant something entirely different. Ramirez wasn’t on drugs; he had a brain aneurysm. The miscommunication led to a misdiagnosis and ultimately left him quadriplegic.
Equal care for everyone
Tucked into a room in the back of Dallas’ Parkland hospital, dozens of medical interpreters are hard at work making sure language isn’t a barrier to medical care. They’re explaining diagnoses, giving instructions for surgery, comforting friends and family. It’s something they do hundreds of thousands of times each year.
“We are the largest program in the country, and this is basically our brain center,” says Meredith Stegall, director of Language Services at Parkland.
Standing among the cubicles in the language center, Stegall says nurses and doctors request interpretations hundreds of times a day, 24/7. She says in-person interpretations are provided within 15 minutes of the request, and video and phone interpretations are also available.
“We’ve created an environment for our nurses, physicians, dieticians, social workers, etc. that they know that they are expected to use a medical interpreter, but not just that they’re expected to [but also] that it’s the right thing and it’s the law,” she says.
Health care providers that receive federal funding like Medicare and Medicaid are required to offer language services free of charge. And about 40 percent of Parkland’s patients speak a language other than English. The vast majority speak Spanish. After that, the top five are Vietnamese, Amharic, Arabic, Nepali and French.
The challenge is providing the same quality of care for everyone. Stegall says medical interpreters aren’t just people who happen to speak two languages; they’re bilingual people who have gone through intensive cultural and medical training throughout the hospital system.
Shared and unshared languages
In an ideal world, Stegall says, the nurses and the physicians would speak the same language as the patients. But most physicians aren’t multilingual. And even if they are, the second language they speak is often different from that of the patient they’re treating.
A national study of multilingual physicians released by Doximity, a social network for health care providers, shows there is a language gap between the different languages spoken by physicians and the patients and populations that they serve.
Joel Davis, vice president of strategic analytics at Doximity, says in Dallas, Spanish and Hindi are the most common languages spoken by physicians, which matches well with the top languages of patients. But there are significant language disparities.
“Within the Dallas area, Sub-Saharan and Swahili are the languages where there’s the greatest gap between what physicians speak and patients,” Davis says.
Doctors who speak Vietnamese are also underrepresented. At Parkland, Stegall says they turn to a network of vendors who provide remote interpreters for some rarer languages, like Kinyarwanda, the official language of Rwanda, or Rohinga, a language spoken in Myanmar.
“A few months ago we had a patient who spoke K’iche, which is a fairly rare language from South America,” Stegall says. “I called about 20 vendors, and I finally I found one in Chicago who was a qualified medical interpreter in K’iche.”
She says sometimes, it can take 30 minutes to a few hours to find an interpreter.
“We all know that if a woman is in labor, you have to have an interpreter for her,” Stegall says. “You cannot have someone in a situation where there is no one that speaks her language. And so there is a sense of urgency that this is a human being that we need to be able to communicate and comfort.”
In the U.S., there are about 7,000 nationally certified medical interpreters and translators. There are about 25 million people in the U.S. who are limited English proficient, according to census data.
Stegall says long term, medical schools will have to recruit more students who speak multiple languages. She’s also encouraging medical interpreters at Parkland to become physician assistants. So far, a dozen are pursuing nursing school.