America
is a country of many races and cultures, and with each passing year,
more health care providers are recognizing the challenge of caring for
patients from diverse linguistic and cultural backgrounds. Health care
professionals and managers must have a basic understanding of the impact
of language and culture on health care delivery in order to efficiently
organize services that meet the needs of both the institution and a
diverse patient population.
Linguistic
and cultural diversity is an inescapable fact of modern American
society. According to the 1990 Census, 31.8 million residents of the
United States -- 14 percent of the total population -- spoke a language
other than English at home. Spanish was the most frequently spoken
language, followed by French or Creole, German, Chinese, and Italian. A
total of 4.5 million Americans spoke an Asian or Pacific Island
language. In some states, the percentages of those speaking a language
other than English at home were significantly higher than the national
average--36 percent in New Mexico, 31 percent in California, and 20
percent each in Arizona, Hawaii, New Jersey, New York, and Texas.
The
challenge of learning a new language is significant. Basic language
proficiency often takes years to achieve, and even then, familiarity
with medical terminology and concepts may still be lacking. There are
typically never enough English-as-a-Second-Language classes to meet
demands, and aspiring candidates often wait months or years to move up
on waiting lists. Lack of basic reading and writing skills in a person's
native language (or speaking a language with no written form) hinders
the ability to learn a new language. Finally, in times of significant
stress or emotional trauma, such as dealing with an illness or injury,
even individuals with years of English experience often revert to the
"mother tongue."
Health
care facilities in almost every large U.S. city and many suburban and
rural areas are serving diverse patient populations. Even though most
health care providers want to offer them the same attention and concern
as to any other patient, limited English proficient (LEP) patients
encounter obstacles at every turn.
They
may delay making an appointment because of the difficulty communicating
over the telephone. Meanwhile, the health problem may become more
severe or advanced requiring more expensive or invasive treatment.
Misunderstandings about the time, date, and location of appointments are
more likely to occur if the patient does not understand English. Even
when patients arrive at the facility on time, they may be late for
appointments because of difficulty communicating with registration
staff. Furthermore, the medical interview and examination present
unlimited possibilities for confusion and potential serious
misunderstanding can occur since complete and accurate medical history
is crucial to an accurate diagnosis. Sophisticated technology and
diagnostic procedures are not substitutes for clear patient-provider
communication. In addition, miscommunication can result in unnecessary
or inaccurate tests. Even when tests are necessary, if patients are not
given instructions in a language they can understand, they may not be
adequately prepared physically or psychologically to undergo these
sometimes painful and frightening procedures. Likewise, if patients are
to comply with a treatment plan, they must have a clear understanding of
what is required of them.
is a country of many races and cultures, and with each passing year,
more health care providers are recognizing the challenge of caring for
patients from diverse linguistic and cultural backgrounds. Health care
professionals and managers must have a basic understanding of the impact
of language and culture on health care delivery in order to efficiently
organize services that meet the needs of both the institution and a
diverse patient population.
Linguistic
and cultural diversity is an inescapable fact of modern American
society. According to the 1990 Census, 31.8 million residents of the
United States -- 14 percent of the total population -- spoke a language
other than English at home. Spanish was the most frequently spoken
language, followed by French or Creole, German, Chinese, and Italian. A
total of 4.5 million Americans spoke an Asian or Pacific Island
language. In some states, the percentages of those speaking a language
other than English at home were significantly higher than the national
average--36 percent in New Mexico, 31 percent in California, and 20
percent each in Arizona, Hawaii, New Jersey, New York, and Texas.
The
challenge of learning a new language is significant. Basic language
proficiency often takes years to achieve, and even then, familiarity
with medical terminology and concepts may still be lacking. There are
typically never enough English-as-a-Second-Language classes to meet
demands, and aspiring candidates often wait months or years to move up
on waiting lists. Lack of basic reading and writing skills in a person's
native language (or speaking a language with no written form) hinders
the ability to learn a new language. Finally, in times of significant
stress or emotional trauma, such as dealing with an illness or injury,
even individuals with years of English experience often revert to the
"mother tongue."
Health
care facilities in almost every large U.S. city and many suburban and
rural areas are serving diverse patient populations. Even though most
health care providers want to offer them the same attention and concern
as to any other patient, limited English proficient (LEP) patients
encounter obstacles at every turn.
They
may delay making an appointment because of the difficulty communicating
over the telephone. Meanwhile, the health problem may become more
severe or advanced requiring more expensive or invasive treatment.
Misunderstandings about the time, date, and location of appointments are
more likely to occur if the patient does not understand English. Even
when patients arrive at the facility on time, they may be late for
appointments because of difficulty communicating with registration
staff. Furthermore, the medical interview and examination present
unlimited possibilities for confusion and potential serious
misunderstanding can occur since complete and accurate medical history
is crucial to an accurate diagnosis. Sophisticated technology and
diagnostic procedures are not substitutes for clear patient-provider
communication. In addition, miscommunication can result in unnecessary
or inaccurate tests. Even when tests are necessary, if patients are not
given instructions in a language they can understand, they may not be
adequately prepared physically or psychologically to undergo these
sometimes painful and frightening procedures. Likewise, if patients are
to comply with a treatment plan, they must have a clear understanding of
what is required of them.
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