‘Communication Gap’ Can Have Dangerous Health Consequences
While there are no official tallies of every patient's race, ethnicity or language ability, "those on the front lines of patient care do not doubt a communication gap exists," the Los Angeles Times reports. Thomas Perez, director of HHS' Office for Civil Rights, said, "Regrettably, the problem is prevalent across the country. ... It didn't matter if I was in Seattle, San Francisco, Atlanta or Chicago. I heard story after story of immigrants and others who couldn't access critical services." Often foreign-language speakers delay care until "things reach an emergency," and once in a hospital or clinic, "they're likely to get lesser-quality care because they can't make their needs known -- and can't give meaningful consent to treatment," the Times reports. Julia Puebla Fortier, director of Silver Spring, Md.-based Resources for Cross Cultural Health Care, added, "If the patient can't describe their symptoms, then the doctor is going to be forced to use more complicated and invasive diagnostic tools." In turn, doctors and parties paying for the care "face higher costs generated by wrong diagnoses, ineffective prescriptions and mistakes," the Times reports.
Although the Civil Rights Act of 1964 requires any doctor, hospital or clinic to provide interpreters if they serve non-English-speaking patients through federally funded programs such as Medicare, Medicaid or CHIP, many doctors "balk at the financial burden" of providing interpreting services. According to the California Medical Association, the cost of complying with the requirement "is onerous," particularly for doctors in smaller practices. Furthermore, the CMA contends, doctors "are not reimbursed enough to cover the cost of care plus language experts." Despite those contentions, some hospitals, doctors and insurers have begun addressing the situation. After "being hit with 16 civil rights complaints and several lawsuits over language assistance," Washington has since become a "model state for interpretation," using a combination of state and federal monies to cover the cost of interpreters and translated materials for medical, mental health, disability and social services. Many hospitals and doctors' offices employ bilingual doctors, nurses and receptionists, while some larger hospitals have established interpreting departments. In addition, Kaiser Permanente "makes note of" the languages its customers speak. Each time those customers call for an appointment, the doctors' office asks whether they need interpretation services. Other options include tapping community organizations that provide interpretation services and telephone language lines, which charge between $2 and $3 per minute.
While community-based solutions are a cost-friendly approach to closing the communication gap, "inadequate interpretation can have dire consequences," the Times reports. Cindy Roat, co-chair of the National Council on Interpretation in Health Care, said, "Research has shown that untrained interpreters are extremely inaccurate, which means whatever the doctor says, the message gets edited, people put in their own ideas, they editorialize." For instance, interpreters might translate "glaucoma" into an "eye infection." Good interpretation also "requires knowledge of cultural backgrounds," the Times reports. But as the "recognition of the communication gap grows, so too is the realization that interpreters play a crucial role in patient care." And Perez says that providers' attention to this role will make them realize that the "short-term cost of adhering to the federal law is in their best interests financially" (Allen, Los Angeles Times, 11/6).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.