For Limited English Speakers, Communication Can Get in the Way of Health Care

It can be hard enough to understand everything doctors tell you, even when they speak your language. For limited or non-English speakers, language can be a barrier to good care.

Federal and State laws require translation or some accommodation for limited English speakers. But people have uneven experiences communicating with health care providers.

Jaime Pena-Urina gets cognitive and physical therapy at UC Davis Medical Center in Sacramento. He’s still recovering from head trauma from a bike accident more than a month ago. With his Spanish translator in the room his care becomes a team effort.

"Estoy cansado," says Pena-Urina in Spanish, when a physical therapist says she is going to work with him on his balance. 

“I’m tired,” his interpreter translates, so his physical therapist can understand. 

Pena-Urina’s wife Felicitas says she’s happy with the services and the medical translation at the hospital.

"They come and explain what the doctors need to tell me,” she says. “The service is really good."

Hospitals and health insurers are required under state law to make interpretation available. Federal and California laws require limited English speakers to have "meaningful access" at doctors’ offices. But the experience of Spanish speakers at health facilities in California is not uniform.

At the Mexican Consulate in Sacramento, Isabel Flores runs the Ventanilla de Salud, a program that refers about a hundred people a month to regional health care.

"Sometimes just making the initial appointment can be a challenge," says Flores.

She says the clinics to which she refers people have Spanish speakers. But when she checks back in with patients after a doctor’s visit, it’s hard to tell how much they’ve comprehended.

"Partially [the lack of comprehension] could be a language barrier, and the other part could be medical terminology," Flores says.

"We go to the doctors and we say, 'What does this mean exactly?' We know how to ask those questions. Sometimes, [non-English speakers] could be intimidated. They don’t know that they can ask those questions, or they’re blanking out on the spot.”

Twenty-year old Maria Medina says sometimes people at clinics speak Spanish, sometimes they don’t. She translates for her husband and that can be uncomfortable. 

"There’s certain things that a woman shouldn’t know about a man. It’s really complicated trying to translate those stuff," says Medina.

But her husband Ruben Solis says he doesn’t mind.

"We’re a couple, so I’m not embarrassed," says Solis in Spanish. "She’s my wife. If it were another person, maybe I would be."

Blanca Valdez is outside the Ventanilla De Salud in the Mexican Consulate, looking at brochures. She has been in the country for about 11 years. She says she hasn’t had any luck getting Spanish-speaking providers.

"It would great if the doctors spoke Spanish, but I know that in the United States English is the language," says Valdez in Spanish. “So I can’t say ‘Oh, why don’t they speak my language?’”

Valdez sometimes has her kids translate for her. But she says the doctor may explain a lot, and her kids will only tell her two or three things. 

Using relatives to interpret, although not ideal, can sometimes help people get care more quickly, according to Dr. David Hayes-Bautista, Director of the Center for Latino Health and Culture at UCLA’s School of Medicine.

"An interpreter is better than none, but the best is language concordance," says Hayes-Bautista.

Hayes-Bautista says lack of resources can limit patient access. Sometimes, a Spanish-speaking clinic worker may be pulled into translate, but won't have medical training. Or, a translator might be brought in by phone. Neither solution serves the patient well. 

"It increases the chances for medical error, for the patient not understanding things, for the provider not understanding things," he says. "It restricts the flow of information."

He says the larger problem is a shortage of Latino physicians in California. Some things can be done about that – training more Latino or Spanish speaking medical students or bringing in more Mexican or Latin American doctors.