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Patient Care Vignette

Mrs. Obayemi is a 78-year-old female who you’ve been caring for in your intensive care unit. Her hospital course has been complicated and her health is slowly deteriorating. Mrs. Obayemi came to the United States from Nigeria last year, initially to visit her adult children, but after realizing that many of her chronic medical issues had not been controlled, she now permanently lives with her children.

She initially presented after a fall, sustaining a severe traumatic brain injury, but her course has been complicated by the incidental discovery of ovarian cancer and subsequently underwent a placement of a tracheostomy and a feeding tube. Mrs. Obayemi is non-English speaking and was born and lived all her life in a small village in northern Nigeria. She speaks an uncommon dialect of Yoruba and because of that, all of your communication with her has been accomplished with her children as intermediaries. Using her children as de facto interpreters has led to misunderstanding and miscommunication about her prognosis and ultimately the goals of her care.

For the majority of US residents, English is the only language spoken in the home. However, the composition of the United States makes it clear that we are represented by residents who speak many different languages and dialects. Indeed, 21.6% of US residents report that they speak a language other than English at home and the proportion of non-English-speaking and limited English proficient (LEP) people is rapidly growing. This presents a challenging issue for healthcare systems and clinicians in the coming decades as communication regarding treatments, options, informed consent, and goals of care may require skilled interpretation to achieve with fidelity. Our task will be to trying to deliver standardized, patient-centered care to an increasingly diverse population. Over the last 30 years, the largest group of migrants into the United States have been individuals who are primarily—or exclusively—Spanish speaking. By 2060, this population is expected to reach 111 million, making up close to 30% of the country’s population by that time. Yet, Hispanics are among the least represented within the healthcare industry, creating additional need for medical interpreters as that role cannot be borne by a native, Spanish-speaking healthcare professional. This specific stressor is magnified by the breadth of languages spoken by US residents, and the lack of competence in unique dialects among medical interpretation professionals.

The impact of language barriers on patient outcome has been recently receiving greater attention. There is evidence to support that adverse outcomes that affect LEP patients are most frequently attributed to errors in communication and are more likely to result in serious harm compared to harms related to communication in English-fluent patients. An avoidable 3-day increase in length of stay when an interpreter isn’t used at admission or discharge increases the risk of falls and nosocomial infection in LEP patients. Also, future care is affected as there is a decreased chance of preventive screening for ...

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