Barriers in Healthcare: A Focus on Language

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We live in a society filled with a diverse set of cultures and languages. The US especially has been known to have one of the largest immigrant populations. However, despite advances in language assistance and advocacy, many patients still do not have access to the healthcare that they deserve and need.

Some of the limitations to healthcare access are not necessarily language-based—for example, lack of insurance, high cost of care, or distance and inability to travel to healthcare centers. That said, lack of knowledge and language barriers are prominent factors in accessing adequate care, leading to disparities and inequalities in healthcare for Latinos and many other immigrants.

Another barrier that has added to these disparities is the COVID-19 pandemic—many patients have failed to follow up with or maintain preventive care due to anxiety of getting COVID-19. I recently saw a patient who checked nearly all of these boxes for healthcare barriers: She is an elderly, Spanish-speaking woman from a rural community about 5 hours away from my clinic. She had felt a lump in her breast in the summer of 2020, but failed to seek care due to the pandemic. The patient then felt that the lesion was getting bigger and painful; she told her family, who sought care for her almost 16 months after the lump was initially felt. Due to delay in seeking care and the patient's lack of knowledge about the risks of delaying evaluation, she now has locally advanced breast cancer and is consequently very anxious about her future.

The patient and her family were first seen by a local oncologist who spoke very little Spanish; the patient's daughter served as the interpreter as best as she could. Sadly, they had recently lost the patriarch of the family to lung cancer; he had received a few cycles of chemotherapy and they blamed the medicine for their father's death. When they were offered chemotherapy for the mother, they were very hesitant and confused about the whole process. They believed that if the mother received chemotherapy, she too would die, and they were considering not proceeding with treatment. I was the first Spanish-speaking provider that they saw, and I was able to speak to them with proper medical Spanish terminology and with a vocabulary that they were able to understand. After a long conversation and education about the disease and chemotherapy, the family agreed to proceed with treatment. The patient did, in fact, end up changing oncologists to a Spanish-speaking provider, as they didn't feel comfortable with the original oncologist given the language barrier.

It is important for clinical providers to be able to communicate with their patients in their preferred language—whether that be through a certified interpreter or their own competencies in the language—so that patients can feel safe, comfortable, and educated by their provider. I am a strong advocate for medical Spanish courses and encourage all my peers to expand their comfort levels in communicating in a non-native language so that we can help as many patients as possible and expand quality healthcare access to all communities.


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Filed under: Miscellaneous , Practice Management/Career

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