- There is a significant language gap between patients and providers, making it hard for patients with limited English proficiency to have meaningful patient-provider communications, according to a recent survey assessment from Doximity.
The survey administrators compared results of a survey of over 60,000 clinicians to the most recent data from the US Census Bureau. This analysis revealed gaps in non-English language proficiency between patients and providers.
Clinicians must prove they are English language proficient in order to receive board certification, the survey authors noted. However, many clinicians, just like their patients, may speak another language in addition to English. The study did not indicate the total number of clinicians who speak another language besides English.
Of clinicians who do speak another language besides English, nearly 45 percent attended medical school outside of the United States and are immigrants whose unique skill sets have found a niche in the country’s medical industry.
The 10 most common second languages clinicians speak nationally include:
- Spanish (36.2 percent)
- Hindi (13.8 percent)
- French (8.8 percent)
- Persian/Farsi (7.6 percent)
- Chinese (5.2 percent)
- Arabic (4.1 percent)
- German (3.7 percent)
- Russian (3.0 percent)
- Italian (2.7 percent)
- Hebrew (1.9 percent)
Spanish is the most commonly spoken non-English language amongst both patients and providers, showing one area of opportunity for non-English speaking patients to communicate with providers during encounters. Other than Spanish, there is very little overlap between patient and clinician second languages, the survey showed.
Common languages amongst patients include Filipino, Vietnamese, Korean, and Swahili or Sub-Saharan African. Doctors, on the other hand, are more likely to speak Persian/Farsi, German, Italian, and Hebrew.
The biggest disparities are in the following languages:
- Swahili and Sub-Saharan African
- Hamitic and Near East Arabic
- Burmese and Southeast Asian
Nearly all large urban areas had limited patient and provider language overlap, the survey showed. However, Washington, D.C., Louisville, Minneapolis, Baltimore, Seattle, Detroit, Boston, Pittsburgh, Nashville, and Jacksonville, had the biggest disparities.
Understanding language gaps is key to ensuring patients can engage in meaningful conversations with their providers, according to lead author and adjunct professor at the University of California, Berkeley School of Public Health Christopher Whaley, PhD.
"Previous research has not determined which non-English languages are most commonly spoken by physicians, or how those languages compare to patient populations," Whaley said in a statement. "Understanding the scope of this problem is the first step to creating solutions for people with limited English proficiency."
Patient-provider communication is key for a meaningful patient encounter, and contributes to both care outcomes and patient satisfaction. Communications are seriously hindered or even impossible when patients and providers do not speak the same language.
"The most important conversations we have as physicians are with our patients," said Doximity Co-founder Nate Gross, MD. "A growing body of research has shown patients achieve better health outcomes when they can communicate with their caregivers in the same language. Understanding imbalances between languages can help address communication challenges across our health care system."
Language proficiency is a key social determinant of health, healthcare experts say. Patients cannot meaningfully engage with their providers, understand their diagnoses and care management plans, or interact with the healthcare industry at large if they do not understand the language.
Many patients do face significant language barriers, research shows. Data from CMS complements the Doximity survey, revealing language proficiency lapses across the country.
Eight percent of the 52 million Medicare beneficiaries across the country have limited English language proficiency, the data reveals. Patients living in urban areas are four times more likely to have limited English proficiency compared to their rural-dwelling counterparts.
Overwhelmingly, the most commonly spoken language outside of English is Spanish, with 52 percent of Medicare beneficiaries reporting Spanish as a comfortable language.
Patients also face communication barriers when they are deaf or hard of hearing, CMS said in the May 2017 report. These patients, along with those with limited English language proficiency, would benefit from providers who can speak a second language or who are proficient in sign language. When patients cannot access a doctor with those skills, healthcare organizations can lean on third-parties for help.
“Persons with limited English proficiency and those who are deaf or hard of hearing may need an interpreter to communicate effectively, and persons who are blind or who have low vision may need materials or signage presented in alternative formats during their receipt of health care,” CMS suggested.
“Evidence suggests that access to communication and language assistance for patients and consumers is important to the delivery of high-quality care for all populations,” the agency concluded.