A female patient from Somalia who does not speak much English hesitates to explain symptoms of her suspected rheumatologic disease.
A Spanish-speaking patient with fibromyalgia brings along her young son to help translate.
A hospital translator stumbles to explain the intricacies of lupus to a patient.
These are just some of the common scenarios that rheumatologists encounter when treating patients who are limited English proficient (LEP). As challenging as these situations may be, the quest for solutions to better reach these patients is key, because 37 million Americans are foreign born, according to the Joint Commission. Additionally, 54 million speak a language other than English at home; slightly less than half of this population is considered LEP.
Federal law requires hospitals to provide reasonable language access services for patients who are LEP or who are deaf or hard of hearing. In some states, interpreters and specific language resources must be available at hospitals for LEP patients.
English-language barriers can make an already time-strapped medical staff struggle a little more. “Whenever there’s an intermediary [like a translator], it takes more time,” says rheumatologist Eric S. Schned, MD, a rheumatologist at Park Nicollet Clinic in Minneapolis.
On the other end, the patients, often already nervous about their medical symptoms, may feel limited by their loss for words in English. “When you speak, you feel vulnerable,” says Maria Conceicao, a Spanish and Portuguese interpreter based in the Washington, D.C., area.
The specialty of rheumatology is hit particularly hard when language barriers arise. “A lot of the concepts are complicated,” says Karen Onel, MD, director of the rheumatology training program at the University of Chicago/La Rabida Children’s Hospital. Also, rheumatology doesn’t always have the “fame” of other health conditions. “A lot of people have heard about heart attacks. Not as many people have heard of osteoarthritis,” Dr. Onel adds.
“Think of how complicated it is to explain an autoimmune disease to a patient. Now translate it into a different language. Unless you are a native speaker and understand the culture the patient comes from, you will have a difficult time explaining the disorders and potential treatment options,” says Alfonso E. Bello, MD, clinical associate professor of medicine at the University of Illinois College of Medicine at Chicago, Illinois Bone and Joint Institute, LLC.
The Pros and Cons of Translation
The natural solution when working with LEP patients in rheumatology or any medical specialty is to obtain help from translators or a translation service. This option has both advantages and disadvantages, many say.