One of the responsibilities of a healthcare professional is communication with a patient, especially when it comes to making health decisions with a lasting impact. Among other things, having meaningful conversations with a patient helps to gain informed consent, which is the foundation of ethical medical practice. However, transmitting information is not always possible when a healthcare professional interacts with non-English speakers and their families. The inability to gain consent from such patients compromises the principle of autonomy. This essay will discuss the issue of medical consent in non-English speakers and measures that medical facilities might undertake such as hiring professional interpreters.
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Factors Influencing Care in Non-English Speakers and Their Families
Some worldwide tendencies account for the pressing issue of language discordance at medical facilities – fast-paced globalization, increasing rates of migration, and travel. As a result, medical practitioners have to work with a growing number of non-English speaking patients, with little to no training on how to deal with such situations. A study by Parsons, Baker, Smith-Gorvie, and Hudak (2014) showed that physicians in Toronto had to choose between “getting by” and “getting help” – as in doing their best or delegating communication to an interpreter (e004613). They based their choice on time constraints, the gravity of the issue, and availability of facilitating services.
Language barriers are not only disruptive to communication but also reasonably frustrating for each party involved. In a survey conducted in the US, half of the respondents reported a poor understanding of treatment goals and test results (Raynor, 2015). There is evidence that communication barriers had the potential of leading to adverse health outcomes and insufficient compliance with treatment plans (Lee et al., 2017). Thus, language discordance may also be dangerous in perspective, especially in regards to the inability to fully consent due to misunderstanding.
Interpretation as Workable Solution
Hiring a professional who is fluent in two or more languages and knowledgeable of medical terminology may help significantly with dealing with non-English speakers. In their study, Lee et al. (2017) advocated for providing rapid access to bedside phones for translation. The findings of their research showed that interpretation over the phone improved consent for patients with limited language proficiency. After phone interpreter implementation, a larger share of patients reported a full understanding of the reasons why a procedure was necessary and risk awareness. All in all, the authors concluded that their consent was genuine and well-informed (Lee et al., 2017).
Challenges of Implementing Medical Interpretation
According to statistics, in the United States, more than 25 million people have limited English proficiency (LEP) (Zong & Batalova, 2015). The government prescribes the use of specialized interpreters for patients with LEP; however, this mandate is unfunded, and the guidelines are barely followed (The U.S. National Archives and Records Administration, 2016). Due to the shortage of medical interpreters, hospitals are not always capable of facilitating encounters with non-English speakers. Even the largest medical facilities struggle with hiring a sufficient number of professionals.
For instance, in Texas, St. Luke’s hospital has only ten Spanish-English interpreters at its disposal whereas the Hispanic population number that it serves amounts to 40,000 (Diño, 2017, para. 8). Working conditions do not help the situation – interpreters are overloaded and work long shifts, which may lead to high turnover rates.
Through communication, a medical practitioner aims at explaining the particularities of a chosen procedure, outlining possible implications, and gathering feedback. Language barriers may disrupt medical communication and compromise the validity of gained consent. Poor understanding of the nature of prescribed medical procedures was linked to adverse health outcomes and lesser adherence to treatment plans. Medical practitioners are often forced to choose between trying to understand their patients and asking for help, with the latter not always being an option. In the United States, there is an observable shortage of medical interpreters, which may be explained by insufficient funding and harsh working conditions.
Diño, G. (2017). Demand in the US for Legal and Healthcare Interpreters Gets Increasing Media Attention. Slator. Web.
Lee, J. S., Pérez-Stable, E. J., Gregorich, S. E., Crawford, M. H., Green, A., Livaudais-Toman, J., & Karliner, L. S. (2017). Increased access to professional interpreters in the hospital improves informed consent for patients with limited english proficiency. Journal of General Internal Medicine, 32(8), 863-870.
Parsons, J. A., Baker, N. A., Smith-Gorvie, T., & Hudak, P. L. (2014). To ‘get by’ or ‘get help’? A qualitative study of physicians’ challenges and dilemmas when patients have limited English proficiency. BMJ Open, 4(6), e004613.
Raynor, E. M. (2016). Factors affecting care in non-English-speaking patients and families. Clinical Pediatrics, 55(2), 145-149.
The U.S. National Archives and Records Administration. (2016). Title VI prohibition against national origin discrimination as it affects persons with limited English proficiency. Web.
Zong, J., & Batalova, J. (2015). The limited English proficient population in the United States. Migration Policy Institute. Web.