Overcoming patient-doctor communication barrier: a prospective observational study
INTRODUCTION
More than 25 million Americans speak English ‘less than very well,’ according to the U.S Census Bureau.1 Hispanics account for over 60% of the U.S. population growth and 25% speak little-to-no English.2 This population might have a language barrier in accessing healthcare and consequently, is at a higher risk of adverse outcomes related to understanding the proposed diagnostic tests and treatment options. Patient safety and satisfaction could be negatively affected as well. The aim of this study was to compare various modes of communication in patient-physician encounters among Spanish speaking, Limited English Proficiency (LEP) patients in a tertiary health care emergency room setting.
METHODOLOGY
This was a prospective observational study. Study protocol was approved by the Texas Tech University Institutional Review Board (IRB) and other appropriate authorities. Self-reported surveys were used to collect information from the patients and physicians after initial medical encounters in the Emergency Room (ER). Independent observers also completed a checklist after each encounter. The patient population consisted of UMC hospital Emergency Room (ER) Spanish speaking LEP patients who confirmed at triage that they preferred to receive medical care in Spanish due to poor English proficiency. The patient-physician encounters were categorized into three groups based on mode of communication: use of professional medical interpretation, ad hoc medical interpretation, and bilingual physician interaction. One-way analysis of variance (ANOVA) was used to test for between-group differences in patient satisfaction, physician satisfaction, time to complete initial patient evaluation, time-to-start of patient-physician interaction, and patient comprehension of physician instructions.
RESULTS
Interim analysis results consist of 64 patient-physician encounters. Ad hoc medical interpretation, professional medical interpretation, and bilingual physician interaction comprised 38%, 11% and 51% of these encounters, respectively. Majority of the patients were Hispanic (93%), female (66.67%), with a mean age of 54.41 years (±17.16). The physicians were primarily Emergency Medicine resident physicians. There was no significant difference between the groups with regard to patient satisfaction with medical care received and patient understanding of physician instruction as well as time for physician to complete initial evaluation between the groups. However there was a significant difference in physician satisfaction between groups and time-to-start of patient-physician interaction. Among the three groups, physicians in the professional medical interpretation group were least satisfied with the patient-physician encounter and this group also had the longest time-to-start.
CONCLUSION
Verbal communication is an invaluable component of an effective clinical encounter. From the above study, although professional medical interpretation is largely underutilized, there is no difference in patient satisfaction and patient understanding of instructions in this group vs the other groups. Interestingly, physicians were less satisfied with this mode of communication vs other modes.
References
1. Juckett G, Unger K. Appropriate use of medical interpreters. Am Fam Physician. 2014;90:476-480.
2. Dunlap JL, Jaramillo JD, Koppolu R, Wright R, Mendoza F, Bruzoni M. The effects of language concordant care on patient satisfaction and clinical understanding for Hispanic pediatric surgery patients. J Pediatr Surg. 2015;50:1586-1589.
