Improving Language-Concordant Care From Medical School to Clinical Practice

As medical students, we were drawn to the field for numerous meaningful reasons; with the medical curriculum placing greater emphasis on improving health equity than ever, we anticipate that innovations will continue to expand on language-concordant care for both the safety and the quality of relationships and interactions with our future patients.

In the Annals article “Lost in Translation,” Mark Saxena (1) reflects on his journey with medical Spanish and his subsequent interactions with Spanish-speaking patients. He homes in on an imperative truth—trust forged through direct communication with interpreter services cannot match the rapport and relationship fostered by language-specific tone and candor. With an ever-growing population with a non–English-language preference (NELP) in America, it is crucial to consider implementing resources to offer higher-quality language-concordant care at a structural level. From our student perspective, we believe improvements could target the medical education level and continue through clinic-regulated hospital resources. In this opinion piece, we discuss the resources explored in Schenker and colleagues’ “Navigating Language Barriers Under Difficult Circumstances” (2) while also further delving into Saxena’s path to medical language competence.

In medical school, students are exposed to a range of interest groups, research opportunities, and volunteer connections, all of which foster participation in our future careers and communities. However, established medical language curricula or resources and funding for students to pursue language courses are often lacking. For students who are passionate about serving their community, curricula that reflect their local language needs as well as methods that adequately assess language proficiency would increase their connection to their community and decrease the false sense of language security. On top of improved communication, learning another language solidifies nonverbal cues, customs, and expressions that give further insight into our patients’ perceptions of disease and their care, a core part of Saxena’s interactions while forging trust and deepened relationships when communicating in his patient’s preferred languages.

As noted by Schenker and colleagues (2), the only type of interpreter associated with overall improvement of care is professional interpreters. To best care for our patients with NELP, we need to understand our limits when it comes to language competency; this includes knowing when to have a professional interpreter to step in to assist, especially when we’re at an impasse with our skills. Such training between providers and professional interpreters, including how to conduct effective interactions, can begin at the medical school level, such as through workshops and mock patient encounters; with so many of these encounters surrounding topics such as heart failure or diabetes, we feel that there is a need to learn how to effectively interact with patients requiring interpreters in this setting as well. As future providers, it would be transformational if, at the beginning of our education, we learned how to advocate the appropriate use of professional interpreters and resources for our patients with NELP. We can follow role models with proficiency in this area to provide accurate and clear information to the patient in a digestible format, and as Saxena experienced, as future providers we hope to see and understand the patient holistically; we feel that can be most fruitful when communication is as close to a dialogue shared within the same language as possible.

Thus, as current medical students, we call for the incorporation of sustainable access to medical language opportunities. If language competencies cannot be fully met, training students from their first years to appropriately gauge the use and practice of professional interpreter services as part of their curriculum and implementing stringent regulations to ensure effective communication and flow can collectively fortify the trust and quality of care within our diverse patient–provider relationships and honor the core principles of our medical profession.

References

1. Saxena M. Lost in translation. Ann Intern Med. 2009;150:419-20. [PMID: 19293076]
2. Schenker Y, Lo B, Ettinger KM, et al. Navigating language barriers under difficult circumstances. Ann Intern Med. 2008;149:264-9. [PMID: 18711157]

Mariam B. Farhat, BS

Mariam is a third-year Doctor of Medicine candidate at the Washington State University Elson S. Floyd College of Medicine in Spokane, Washington. She is from Federal Way, Washington, and obtained her undergraduate degree in cellular, molecular, and developmental biology from the University of Washington. Mariam is interested in internal medicine and gastroenterology, and is passionate about global health, cultural humility, and increasing language accessibility within healthcare.

Michelle Yan, B.Kin

Michelle is a third-year Doctor of Medicine candidate at the Washington State University Elson S. Floyd College of Medicine in Spokane, Washington. She grew up in Olympia, Washington, and studied kinesiology and health science at the University of British Columbia in Vancouver, BC. Michelle is passionate about a career in internal medicine and health equity, bridging the two fields together for greater patient advocacy.