Journal of General Internal Medicine

, Volume 27, Issue 1, pp 117–123

The Use of Spanish Language Skills by Physicians and Nurses: Policy Implications for Teaching and Testing

  • Lisa C. Diamond
  • Delphine S. Tuot
  • Leah S. Karliner
Original Research

ABSTRACT

BACKGROUND

Language barriers present a substantial communication challenge in the hospital setting.

OBJECTIVE

To describe how clinicians with various levels of Spanish language proficiency work with interpreters or their own Spanish skills in common clinical scenarios.

DESIGN & PARTICIPANTS

Survey of physicians and nurses who report ever speaking Spanish with patients on a general medicine hospital floor.

MEASUREMENTS

Spanish proficiency rated on a 5-point scale, self-reported use of specific strategies (own Spanish skills, professional or ad-hoc interpreters) to overcome the language barrier.

RESULTS

Sixty-eight physicians and 65 nurses participated. Physicians with low-level Spanish proficiency reported frequent use of ad-hoc interpreters for all information-based scenarios, except pre-rounding in the morning when most reported using their own Spanish skills. For difficult conversations and procedural consent, most used professional interpreters. Comparatively, physicians with medium proficiency reported higher rates of using their own Spanish skills for information-based scenarios, lower rates of professional interpreter use, and little use of ad-hoc interpreters. They rarely used their own Spanish skills or ad-hoc interpreters for difficult conversations. Physicians with high-level Spanish proficiency almost uniformly reported using their own Spanish skills. The majority (82%) of nurses had low-level Spanish proficiency, and frequently worked with professional interpreters for educating patients, but more often used ad hoc interpreters and their own Spanish skills for information-based scenarios, including medication administration.

CONCLUSIONS

Physicians and nurses with limited Spanish proficiency use these skills, even in important clinical circumstances in the hospital. Health-care organizations should evaluate clinicians’ non-English language proficiency and set policies about use of language skills in clinical care.

KEY WORDS

physician-patient communication interpreter language barriers nurses inpatients 

REFERENCES

  1. 1.
    Shin HB, Kominski RA. Language Use in the United States: 2007. US Census; 2010 [cited 2011 May 20]; Available from: http://www.census.gov/hhes/socdemo/language/data/acs/ACS-12.pdf.
  2. 2.
    Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J, Task Force on Community Preventive S, et al. Culturally competent healthcare systems. A systematic review. Am J Prev Med. 2003;24(3 Suppl):68–79.PubMedCrossRefGoogle Scholar
  3. 3.
    DuBard C, Gizlice Z. Access to care, and receipt of preventive services among US Hispanics. Am J Public Health. 2008;98(11):2021–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Fernandez A, Schillinger D, Warton EM, Adler N, Moffet HH, Schenker Y, et al. Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: The Diabetes Study of Northern California (DISTANCE). J Gen Intern Med. 2011;26(2):170–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Phelan M, Parkman S. How to work with an interpreter. BMJ. 1995;311(7004):555–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Pippins JR, Alegria M, Haas JS, Pippins JR, Alegria M, Haas JS. Association between language proficiency and the quality of primary care among a national sample of insured Latinos. Med Care. 2007;45(11):1020–5.CrossRefGoogle Scholar
  7. 7.
    Woloshin S, Bickell NA, Schwartz LM, Gany F, Welch HG. Language barriers in medicine in the United States. JAMA. 1995;273(9):724–8.PubMedCrossRefGoogle Scholar
  8. 8.
    John-Baptiste A, Naglie G, Tomlinson G, Alibhai SMH, Etchells E, Cheung A, et al. The effect of English language proficiency on length of stay and in-hospital mortality. J Gen Intern Med. 2004;19(3):221–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Karliner LS, Kim SE, Meltzer DO, Auerbach AD. Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med. 2010;5(5):276–82.PubMedCrossRefGoogle Scholar
  10. 10.
    Atchison KA, Black EE, Leathers R, Belin TR, Abrego M, Gironda MW, et al. A qualitative report of patient problems and postoperative instructions. J Oral Maxillofac Surg. 2005;63(4):449–56.PubMedCrossRefGoogle Scholar
  11. 11.
    Wilson E, Chen AHM, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20(9):800–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Wisnivesky JP, Kattan M, Evans D, Leventhal H, Musumeci-Szabo TJ, McGinn T, et al. Assessing the relationship between language proficiency and asthma morbidity among inner-city asthmatics. Med Care. 2009;47(2):243–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Flores G, Laws MB, Mayo SJ, Zuckerman B, Abreu M, Medina L, et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111(1):6–14.PubMedCrossRefGoogle Scholar
  14. 14.
    Jacobs EA, Lauderdale DS, Meltzer D, Shorey JM, Levinson W, Thisted RA. Impact of interpreter services on delivery of health care to limited-English-proficient patients. J Gen Intern Med. 2001;16(7):468–74.PubMedCrossRefGoogle Scholar
  15. 15.
    Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–54.PubMedCrossRefGoogle Scholar
  16. 16.
    Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275(10):783–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Burbano O'Leary SC, Federico S, Hampers LC. The truth about language barriers: one residency program's experience. Pediatrics. 2003;111(5 Pt 1):e569–73.PubMedCrossRefGoogle Scholar
  18. 18.
    Diamond LC, Schenker Y, Bradley EH, Curry L, Fernandez A. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2009;24(2):256–62.PubMedCrossRefGoogle Scholar
  19. 19.
    Schenker Y, Wang F, Selig SJ, Ng R, Fernandez A. The impact of language barriers on documentation of informed consent at a hospital with on-site interpreter services. J Gen Intern Med. 2007;22(S2):294–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Yawman D, McIntosh S, Fernandez D, Auinger P, Allan M, Weitzman M. The use of Spanish by medical students and residents at one university hospital. Acad Med. 2006;81(5):468–73.PubMedCrossRefGoogle Scholar
  21. 21.
    Karliner LS, Perez-Stable EJ, Gildengorin G. The language divide. The importance of training in the use of interpreters for outpatient practice. J Gen Intern Med. 2004;19(2):175–83.PubMedCrossRefGoogle Scholar
  22. 22.
    Lee KC, Winickoff JP, Kim MK, Campbell EG, Betancourt JR, Park ER, et al. Resident physicians' use of professional and nonprofessional interpreters: a national survey. JAMA. 2006;296(9):1050–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Green AR, Ngo-Metzger Q, Legedza AT, Massagli MP, Phillips RS, Iezzoni LI. Interpreter services, language concordance, and health care quality. Experiences of Asian Americans with limited English proficiency. J Gen Intern Med. 2005;20(11):1050–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Ngo-Metzger Q, Sorkin D, Phillips R, Greenfield S, Massagli M, Glarridge B, et al. Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use. J Gen Intern Med. 2007;22(Suppl 2):324–30.PubMedCrossRefGoogle Scholar
  25. 25.
    Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care. 1988;26(12):1119–28.PubMedCrossRefGoogle Scholar
  26. 26.
    Perez-Stable EJ, Napoles-Springer A, Miramontes JM. The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes. Med Care. 1997;35(12):1212–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Fernandez A, Schillinger D, Grumbach K, Rosenthal A, Stewart AL, Wang F, et al. Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients. J Gen Intern Med. 2004;19(2):167–74.PubMedCrossRefGoogle Scholar
  28. 28.
    Eamranond PP, Davis RB, Phillips RS, Wee CC. Patient-physician language concordance and lifestyle counseling among Spanish-speaking patients. J Immigr Minor Health. 2009;11(6):494–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Carter-Pokras O, O'Neill MJ, Cheanvechai V, Menis M, Fan T, Solera A, et al. Providing linguistically appropriate services to persons with limited English proficiency: a needs and resources investigation. Am J Manag Care. 2004;10:SP29–36.PubMedGoogle Scholar
  30. 30.
    Jacobs E, Sadowski L, Rathouz P. The impact of an enhanced interpreter service intervention on hospital costs and patient satisfaction. J Gen Intern Med. 2007;22(Suppl 2):306–11.PubMedCrossRefGoogle Scholar
  31. 31.
    Wirthlin Worldwide. Research Report-Hablamos Juntos: We Speak Together. 2008 [cited 2011 May 20]; Available from: http://www.hablamosjuntos.org/pdf_files/wirthlin_report.pdf.
  32. 32.
    Tuot DS, Lopez M, Miller C, Karliner LS. The Impact of an Easy Access Telephonic Interpreter Program in the Acute Care Setting: an Evaluation of a Quality Improvement Intervention. Joint Commission Journal on Quality and Patient Safety. 2010; In Press.Google Scholar
  33. 33.
    Karliner LS, Hwang ES, Nichleach D, Kaplan CP. Language Barriers and Patient-Centered Breast Cancer Care. Patient Education and Counseling. 2010 Aug 2; ePub ahead of print.Google Scholar
  34. 34.
    National Council on Interpreting in Health Care. The Terminology of Health Care Interpreting: A Glossary of Terms. 2001 [cited 2011 May 20], Available from: http://www.linguisticainternational.com/files/TheTerminologyofHealthCareInterpreting.pdf.
  35. 35.
    U.S. Department of Justice, Civil Rights Division. Title VI of the Civil Rights Act. 1964 [cited 2011 May 20], Available from: www.justice.gov/crt/grants_statutes/titlevi.txt.
  36. 36.
    Chen AH, Youdelman MK, Brooks J. The legal framework for language access in healthcare settings: Title VI and beyond. J Gen Intern Med. 2007;22(Suppl 2):362–7.CrossRefGoogle Scholar
  37. 37.
    US Department of Health and Human Services, Office of Minority Health. National Standards for Culturally and Linguistically Appropriate Services in Health Care. US Department of Health and Human Services-Office of Minority Health; 2001 [updated 2001; cited 2011 May 20]; Available from: http://www.omhrc.gov/assets/pdf/checked/executive.pdf.
  38. 38.
    Schenker Y, Lo B, Ettinger K, Fernandez A. Navigating language barriers under difficult circumstances. Ann Intern Med. 2008;149(4):264–9.PubMedGoogle Scholar
  39. 39.
    Mazor S, Hampers L, Chande V, Krug S. Teaching Spanish to pediatric emergency physicians: effects on patient satisfaction. Arch Pediatr Adolesc Med. 2002;156(7):693–5.PubMedGoogle Scholar
  40. 40.
    Nora L, Daugherty S, Mattis-Peterson A, Stevenson L, Goodman LJ. Improving crosscultural skills of medical students through medical school-community partnerships. West J Med. 1994;161:144–7.PubMedGoogle Scholar
  41. 41.
    Prince D, Nelson M. Teaching Spanish to emergency medicine residents. Acad Emerg Med. 1995;2(1):32–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Reuland D, Frasier P, Olson M, Slatt L, Aleman M, Fernandez A. Accuracy of self-assessed Spanish fluency in medical students. Teach Learn Med. 2009;21(4):305–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Diamond LC, Jacobs EA. Let’s not contribute to disparities: the best methods for teaching clinicians how to overcome language barriers to health care. J Gen Intern Med. 2010;25(Suppl 2):189–93.CrossRefGoogle Scholar
  44. 44.
    Diamond LC, Reuland DS. Describing physician language fluency: deconstructing medical Spanish. JAMA. 2009;301(4):426–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Certification Commission for Healthcare Interpreters. 2011 [cited 2011 May 20]; Available from: http://www.healthcareinterpretercertification.org/index.html.
  46. 46.
    Moreno M, Otero-Sabogal R, Newman J. Assessing dual-role staff-interpreter linguistic competency in an integrated healthcare system. J Gen Intern Med. 2007;22(Suppl 2):331–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Tang G, Lanza O, Rodriguez FM, Chang A. The Kaiser Permanente Clinician Cultural and Linguistic Assessment Initiative: research and development in patient-provider language concordance. Am J Public Health. 2011;101:205–208.PubMedCrossRefGoogle Scholar
  48. 48.
    Tidwell L. Kaiser Permanente-Southern California Physicians Language Concordance Program: Meeting the Needs of LEP Patients. Health Care Interpreter Network. Oakland, CA: From Ad-Hoc to Best Practices in Healthcare Interpreting; 2009. July 16–17.Google Scholar
  49. 49.
    Interagency Language Roundtable. Interagency Language Roundtable. 2009 [updated 2009; cited 2011 May 20]; Available from: http://www.govtilr.org.

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Lisa C. Diamond
    • 1
  • Delphine S. Tuot
    • 2
    • 3
  • Leah S. Karliner
    • 3
    • 4
  1. 1.Memorial Sloan-Kettering Cancer CenterCenter for Immigrant Health and Cancer Disparities, Department of Psychiatry and Behavioral HealthNew YorkUSA
  2. 2.Division of NephrologyUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  4. 4.Medical Effectiveness Research Center for Diverse Populations, Division of General Internal MedicineUniversity of California, San FranciscoSan FranciscoUSA

Personalised recommendations