|Articles|August 5, 2015

Patient language barriers: Why physicians are responsible

Hospitals, physicians and other healthcare providers receiving financial assistance from the U.S. Department of Health and Human Services (HHS) must be mindful of their obligation not to discriminate against patients having a limited ability to communicate in English. That’s why your practice needs to develop protocols and procedures to find what works best.

Language barriers may undermine a patient’s “meaningful access” to federally funded healthcare services, because these barriers may prevent patients from understanding medical treatment and advice received from providers. Therefore, HHS mandates that providers take reasonable steps to overcome language barriers and ensure that Limited English Proficient (LEP) patients have timely and meaningful access to healthcare services.

The HHS Office for Civil Rights (OCR) is responsible for enforcing this mandate. A patient who feels that a provider has discriminated by denying access to language services may file a civil rights complaint with OCR, which has the authority to investigate complaints and to conduct “compliance reviews” to determine if providers’ policies, procedures and actions are consistent with the law.

Providers should arrange for oral and/or written language assistance services to communicate effectively with LEP patients concerning the delivery of healthcare services. HHS allows a provider some flexibility in determining the appropriate mix of language assistance services to facilitate communications depending upon:

the percentage of LEP individuals served

the frequency of services provided to LEP individuals

whether the services provided are important or emergent and

the resources available to the provider.

However, while a provider has a range of choices regarding which language assistance services are appropriate, the services the provider chooses must actually work to ensure effective communication. Below are best practices.

Language preferences

Ask the patient about his or her primary oral language and preferred written language. A provider can even use language identification cards that help the patient inform staff of language needs (i.e. “I speak Spanish.”)

Don’t assume understanding

Determine if the patient requires an interpreter. Note that it is important for providers not to assume that a multilingual patient understands them. Though it is not required by law, as a best practice a provider may check for patients’ understanding by requesting him or her to repeat back both treatment and discharge instructions in the patient’s own words.

Inform patients about their rights

Inform the patient of his or her right to a competent interpreter free of charge. Providers may provide notice regarding how to access language assistance services by posting signs, translated into the most common languages encountered, in intake areas. The Social Security Administration provides such notices at: www.ssa.gov/multilanguage/langlist1.htm.

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