Treating in Tongues

Over the summer, I had the opportunity to sit in on a new summer Spanish program at Harvard Medical School which addressed a fundamental need in healthcare: the ability to communicate with patients. Run by AES World Languages and Cultures Institute (where I was interning), the classes were tailored to the medical field, so vocabulary was health-related and grammar exercises featured hospital vocabulary. The goal was to teach doctors to hold basic, health-related conversations in Spanish with patients directly, without relying on an interpreter. I came to realize that teaching languages in medical schools is an important piece of providing widespread access to healthcare, and one that could act as a vital supplement to the policies already in place regarding medical interpreting.

Medical interpreting is undoubtedly most vital in emergency situations: The need for medical care is urgent, time is vital, and the lack of communication could be fatal. The U.S. has legislation in place to address this need—healthcare providers that receive federal funding are required to provide interpreters so that a language barrier won’t get in the way of basic medical treatment.

A few weeks ago I experienced firsthand what an emergency situation feels like with a language barrier. My mother fell down the stairs while we were in Germany and (we found out later) fractured a vertebra in her neck. I suddenly realized I didn’t know how to call an ambulance and wouldn’t be able to say more than our address if I could somehow get someone on the phone. We were incredibly fortunate that my aunt (whom we were visiting) lives nearby and has an extensive medical vocabulary in German. Even so, the inability to communicate in a high-stress, high-stakes situation renders you stricken and powerless in a unique and terrifying way. Language service in emergency situations is invaluable, and the U.S. is right to focus its attention first and foremost on interpreting in a hospital setting.

However, the need for language services in healthcare does not stop with trips to the ER. Over 20 percent of Americans speak a language other than English at home, and 8.7 percent speak English “less than well,” according to the 2011 U.S. Census Bureau survey. There is a wide variety of medical services one is likely to need, and with a shortage of interpreters and a broad mix of languages spoken there is ample opportunity for non-native speakers to fall through the cracks. Often, even if a patient speaks enough English not to require an interpreter, having one could still help because of the nuances in language on both ends: Doctors need detailed descriptions of symptoms, and patients need to understand diagnoses and follow medical advice exactly. I have seen non-native English speakers I know leave the doctor’s office confused about their diagnosis, or come home from physical therapy in a great deal of pain because they couldn’t adequately communicate what was wrong.

There is also the matter of insurance coverage—many people struggle with instructions on forms or have difficulty making themselves understood to representatives over the phone. Dealing with medical records and paperwork can be complicated, and miscommunications can cause serious problems down the line.  Some states have instituted policies that make this process easier. For example, California requires insurance companies to provide patients with translations of important paperwork, and some states have instituted a mechanism that allows federal aid to pay for language services. These policies make a huge impact on the accessibility of healthcare and will hopefully spread to a larger number of states.

Legislative steps, however, often take time to implement and have logistical complications with altering a system that is already in place. As of now, most states do not have these measures, so acquiring translated documents and getting funding for interpreting are not options for the majority of Americans. Training doctors in foreign languages directly—even if it is conversational and health-related rather than terminology-oriented—cuts out the middle man and makes a non-native English speaker’s experience slightly easier (and less costly).

Learning languages is a sound business strategy for doctors, as well. In the setting of a private practice where patients choose whom to see, it is a good way to make your services useful to a larger number of people. If there is only one doctor in a given town who speaks Haitian Creole, he is very likely to get referrals from within the Haitian community. I know that in my hometown, for example, the Russian-speaking community is fairly close-knit, and most Russian speakers I know could recommend a Russian-speaking person for just about any service, be it a haircut or SAT prep. Doctors with experience in a foreign language are able to expand their practices and better meet the needs of their communities.

Teaching medical students the basics of languages with large communities of speakers is a relatively simple proposition. It doesn’t require a large-scale system overhaul, and it can be implemented at the local level in languages that are regionally important. By simply instituting a language requirement in medical schools (or offering courses run by outside organizations, as with AES), we can increase patient trust, improve the quality of care, and play a role in integrating immigrant communities that are often isolated by a removable language barrier.

Lauren E. Goff ’16 is a Crimson editorial writer in Currier House.