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Archive Diversity in Surgery 2019

9 Tips for Negotiating Language Barriers

For moral, legal and financial reasons, we must do better. Here's advice on how.

Allison Squires

Allison Squires, PhD, RN



A 4-year-old boy breaks his elbow and the trauma results in a blocked artery. The Spanish-speaking family sees an English-speaking orthopod who sets the fracture, but complications ensue, resulting in the removal of some of the arm's muscle tissue. An investigation determines that for all the surgical procedures, the surgeon provided an informed consent in English only and failed to use an interpreter. The case settles for $650,000.

A hospital radiology department finds a mass on a Spanish-speaking patient's left kidney, but the surgeon misreads the reports and proffers an informed consent in English for the right kidney instead. No interpreter is summoned, the patient loses both kidneys and ends up on dialysis for the rest of his life. The case settles for an undisclosed sum.

A 59-year-old Egyptian woman who speaks no English undergoes a urologic procedure. The surgeon removes her kidney, but blood loss leads to hemorrhagic shock, heart failure and death. An investigation determines that hospital employees had been unable to identify the patient's language, so they presented the Conditions of Admission in English without translation or a translator. The informed consent they presented, also in English, failed to mention the possibility of nephrectomy. The case settles for just under $100,000.1

Every day, miscommunications occur between healthcare providers and patients who don't speak English well or at all. Many patients suffer and some even die as a result. Miscommunication is also expensive to facilities and providers. Patients with limited English proficiency (LEP) have longer lengths of stay than English-speaking patients, no matter their socioeconomic status.(2-4) They also have a significantly higher risk of 30-day readmission. When they encounter facilities that are not accommodating, they are likely to rate their satisfaction as low. And they may even sue. According to one study, 1 in 40 malpractice cases is directly related to poor or non-existent interpretation services.1

The challenge of language barriers is of increasing concern. One in five U.S. residents speaks a language other than English at home and 40% of that group does not speak English well enough to effectively communicate with a healthcare provider.

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