Limited English Proficiency ( Lep )

A healthcare disparity is a limitation of healthcare availability, usually among a certain racial or socioeconomic demographic (Black, 2013). However, there are disparities that don’t have a specific demographic and affect the entirety of the United States, which are potentially most detrimental to the overall health of our country. One of those disparities is health literacy, or the exchange of complex information from the healthcare provider to the patient or client (Black, 2013). The lack of health literacy in America poses as a problem, especially with the chronically ill. Without proper knowledge of how to treat their illness and what to do when the disease process worsens or ameliorates can potentially cause millions of unnecessary hospitalizations,

Non-English speaking citizens and immigrants are receiving improper medical care because of the miscommunication. The people who cannot speak English well are misunderstood, when they go to free clinics or hospital emergency rooms and attempt to explain their symptoms and illness or cannot understand the doctors or medical profession that are trying to help them. ” Interpreters are omitting questions about drug allergies. Patients are not telling nurses the correct symptoms. A mother misunderstood by putting oral antibiotic into the ears of the child instead of the mouth. The Puerto Rican word for mumps is not the same in Central America, so a child was mistreated. A doctor mistakenly told a parent to put a steroid crème on entire child instead of just the face” (Yolanda Prtida, 2005). Language barriers in the medical field are dangerous and some times even fatal. There is definitely a need for more translators in hospitals and doctors office. Clear communication is essential for safe quality healthcare. Poor communication can lead to disastrous outcomes, especially for patients with limited or no English ability.

In 2004 my grandmother and I moved from Haiti to United States without a speck of English in our language. After few years living in the states, my grandma started to get ill and she had to seek monthly medical assistance. At the time, my mother was working multiple jobs and I was a full time undergrad student that lived on college campus. Our busy schedule posed a challenge for us to bring grandma to her medical appointments. Most times it was hard for us to find someone to go with her and assist her with language translation. When it was time for her to go by herself, the health providers would have trouble finding a professional translator on the spot to assist my grandma. This became a repetitive problem and my grandma’s case was not getting any better. If she had the ability to communicate with her provider using her own language, she would have been able to be more expressive about her symptoms and the doctors would have assisted her to her needs. Just like my grandma, many people that speaks little to no English, are having trouble interpreting their medical diagnosis and communicating with their healthcare providers.

In the state of Massachusetts the state law states that the emergency department patients with limited English proficiency have the right to a medical interpreter (Ginde, Clark, & Camargo, 2009). Having a medical interpreter for patients that have limited English proficiency will increase the quality of health care they receive; it also increases patient compliance and increases patient satisfaction. The use of professional interpreters is shown to decrease revisiting the emergency department, and increase this population’s use of outpatient clinics for follow up care (Ginde et al., 2009).

Can you imagine the how the healthcare industry would be without language, what seems to be impossible to imagine is the everyday reality of some patients because of their native language. Language is a major contribution to the health disparities that some populations face, because it makes it difficult for some patients to communicate their problems as well as understand the care they provided. Language contributes to the health disparities that some populations face because it creates a barrier between the patient and the care provider, making it difficult for a patient to receive proper care. Language barriers create a communication gap between a patient and a provider, forcing the patient to feel misunderstood and unable to trust his/her provider to properly care for them. I come from a family that speaks more than one language, so I have seen the impact language barriers can have on someone who doesn’t speak fluent English.

Across the country, a steady increase has been noted in the number of patients presenting to emergency departments for psychiatric complaints (Zun, 2014). Patients also attempt to use their primary care doctors to treat their mental illnesses. The mental health care options for these patients are extremely limited, especially for minority populations such as African Americans and Hispanics. One out of four adults in America suffers from some form of mental illness, yet only one out of three of those affected receives treatment (Safran, 2009). Furthermore, patients are routinely misdiagnosed, receive poor quality of care, receive care from providers who have no understanding of their cultures and values, or are not even able to receive care in the first place (Sanchez, 2012).

(2013) discussed the issue of lack of english skills being a primary barrier for patients receiving adequate health care. The article also mentions how studies have shown that Spanish speaking Latinos are less satisfied with the health care that they received in determine whether comparison to their English speaking counterparts. The purpose of the study was to Spanish speaking Latinos have an increased quality of care when provided with an interpreter during their visit. The population for the study was 30 patients in the Washington, DC metropolitan area, whose primary language was spanish. The intervention implied that the use of interpreters will improve the quality of healthcare received by non english speaking patients. The comparison aimed at urging providers to make an effort to provide legally appropriate care to patients who are unable to speak english. The outcome of the study was that miscommunication between healthcare workers can end up causing medical mistakes and liabilities. It was found that when facilities provided patients with interpreter services, the patient perception of quality care was

(1997). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus, and Giroux. Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited english proficiency?

In response to reading this book, I will be utilizing more the services of professional interpreters during the physical therapy session with the patient rather than using ad hoc interpreters such as family, friends, hospital clerks and housekeepers. Professional interpreters improve the quality of clinical care for LEPs to level that for those patients without barriers in language (Gray & Hardt, 2017). Meanwhile, ad hoc interpreters might be bilingual but they have no medical training (Gray & Hardt, 2017).

A big problem today in health care for many people is health literacy. Health literacy is when a person is able to understand and process medical information they are given. Having low health literacy can affect how a person understands, and uses information about their health and health services (Batterham 2016). Low health literacy rates lead to big issues in communication. Limited literacy impacts health behaviors, decisions, and ultimately outcomes. Many people have low health literacy which leads to bad health outcomes. Research shows that low literacy is linked with the lower likelihood of people being able to manage their own health conditions, and less access to health care services which can lead to poor health outcomes. There are many reasons people have low health literacy, A lack of formal education and poor reading ability aren't the only causes of low health literacy. Low health literacy is associated with a number of things like poor engagement in health services, health knowledge, and overall health status. People with low health literacy may feel ashamed and try to hide it from professionals and family members. Most health care professionals are unaware of the level of health literacy their patient has. (Greenhalgh 2015) There is a need to identify individual health literacy needs and address how to work on solutions to benefit them and whole groups of people. Differences in health literacy

Singleton, K., & Krause, E. (2009). Understanding Cultural and Linguistic Barriers to Health Literacy. The Online Journal of Issues in Nursing, 4(3), Retrieved from http://www.nursingworld.org/mainmenucategories/anamarketplace/anaperiodicals/ojin/tableofcontents/vol142009/no3sept09/cultural-and-linguist

Language Line Focus Group was held Monday May 22, 2017. Under Section 1557 it attempts to improve outcomes for limited-English proficient (LEP) patients by setting specific requirements on who can provide health care interpretation. Federal law required health care interpreters to be “competent.”

Jacobs, E. A., Shepard, D. S., Suaya, J. A., Stone, E. (2004). Overcoming language barriers in health care: costs and benefits of interpreter services. American Journal of Public Health, 94 (5), 866-869.

Mental disorders are largely undertreated in America in general by all races and backgrounds and now there is more awareness of this public health need (Kohn-Wood & Hooper, 2014). In the past decade, disparities between whites and non-whites have increased, most notably between whites and Latinos and whites and blacks. There are numerous discussions on the possible explanations for this finding, a few being: limited access in the neighborhoods in which the population lives, socioeconomic status, treatment modality preference, and race/ethnic background of provider (Ault-Brutus & Alexis, 2012). SMIs that go untreated are highly contributed to the development of other serious health concerns like obesity, diabetes, cancer, cardiovascular disease, COPD, and many more (De Hert et al., 2011).

I see many challenges in regards to providing care to patients that do not speak English especially in the healthcare realm. From the very beginning we need to know what is wrong, what happened, how long it has been going for, what medical history they have, allergies, and medication taken. How can we treat what we do not know is wrong? In order to probably do some root cause analysis you need to drill down and see what is going on, which cannot be done if you cannot communicate. Also, you do not know what I making things better. These non-English speaking individuals will have unmet needs because of my inability to