— MEDICAL SCHOOL —
University of Mississippi,
School of Medicine
— GRADUATING CLASS —
Ms. Martin was the type of patient you looked forward to seeing on daily rounds. She was warm, pleasant, and always grateful for her caretakers. As a third-year medical student on call for hospital admissions, I first encountered Ms. Martin in the ED: I arrived to find a young and anxious woman, hunched over in bed crying out in pain. Shortly after introducing myself, I realized that she was Spanish-speaking and excused myself from her room to ask my resident how to get an interpreter. After walking to the other side of the ED to get the virtual interpreter cart, we were in the room for over 30 minutes going back and forth between languages until we had a mutual understanding of the situation. In retrospect, I felt confused and even perturbed that we had to take these extra steps and time to help an already distressed and hurting patient.
For context, Ms. Martin's chief complaint was severe abdominal pain and lower extremity weakness. With an extremely long differential and no known leads, I had a feeling that Ms. Martin was in for an unsettling and confusing hospital stay. During her admission, consulting teams included neurology, interventional radiology, physical and occupational therapy, pain management, and social work. As those in medicine know, this equates to many new faces and people in her room every day, usually discussing her case in front of her, performing multiple physical exams, and taking countless blood sampless.
As her primary team, we strived to give her a complete understanding of our plan each day; however, the complexities in providing care for a non-English-speaking patient remained daunting. Despite the use of proper translation, there remained undeniable cultural and language barriers that produced misperceptions regarding Ms. Martin's medical history and current symptoms. I found myself spending double the amount of time in her room to obtain an accurate history and to ensure that Ms. Martin was comfortable and informed about her health.
Two weeks later, we unfortunately had yet to cure her pain or provide her with a confident diagnosis. From my perspective, we had done her a disservice. She had endured countless needlesticks, imaging tests, and two lumbar punctures, and spent weeks away from her family in a hospital where she could barely communicate. It was difficult to understand why Ms. Martin was so grateful for our care despite our inability to provide her with a diagnosis.
Stories like Ms. Martin's are unique in that, although we as providers failed to isolate a definite solution for her pain, we met her needs in terms of comfort and communication. Regardless of language or cultural barriers, it is necessary to note that patients recognize whether we are invested in their care. It is also crucial to remember that others' perceptions of illness and health care may vary considerably from our own perspective. Sometimes it takes substantial effort to fully empathize with people of such different backgrounds; however, patients like Ms. Martin highlight how much of an impact your efforts can have.
From the perspective of a provider, we can only begin to imagine enduring the uncertainty of language barriers alongside the burden of illness. It is well established that limited English proficiency (LEP) results in increased hospitalization rates and duration, increased health care costs, and decreased health knowledge (1-3). I now see the significance of spending adequate time to combat the disparities that patients with LEP face in the hospital and primary care setting. As internal medicine physicians, we have the choice-and honor-of giving our inherently disadvantaged patients not only a better health outcome, but also a feeling of comfort and understanding while in a foreign setting.
- Yeheskel A, Rawal S. Exploring the ‘Patient Experience’ of Individuals with Limited English Proficiency: A Scoping Review. Journal of Immigrant and Minority Health. 2019;21:853-878. 10.1007/s10903-018-0816-4 .
- 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 May-Jun;5(5):276-82. doi: 10.1002/jhm.658. PMID: 20533573.
- Berdahl, TA, Kirby JB. Patient-Provider Communication Disparities by Limited English Proficiency (LEP): Trends from the US Medical Expenditure Panel Survey, 2006–2015. J Gen Intern Med. 2019 Aug; 34(8): 1434–1440. Published online 2018 Dec 3. doi:10.1007/s11606-018-4757-3.