Doctor not helping patient

By Malcolm Herman and Mayan Herman LCSW

At the best of times, there are frequent breakdowns in communication between doctors and their patients. There are many reasons for this problem, ranging from simple misunderstandings to a complete lack of physician care. The problem is so pervasive that we spend whole sessions in U.S. Pain Foundation support groups discussing how to communicate with your doctor. 

But what happens when the doctor and the patient literally do not speak the same language?

A study in 2012, “‘Does This Doctor Speak My Language?’ Improving the Characterization of Physician Non-English Language Skills” concluded that although federal regulations require health care organizations to assure the competency of language services being offered by bilingual staff, including clinicians, there is very little guidance on what this means in practice. It is usually left to the physicians to determine whether it is appropriate for them to treat individual patients in spite of language differences and many physicians seriously overestimate their language skills. In the absence of a national standard, the system appears to be largely a matter of chance.

Recently, Dr. Mimi Zheng, a physician in Downey, California, who is affiliated with Kaiser Permanente Downey Medical Center, wrote an excellent article in the Los Angeles Times entitled “Does your doctor speak your language?” Dr. Zheng describes how Kaiser Permanente used the Clinician Cultural and Linguistic Assessment to test her ability to communicate medical information in Spanish and Mandarin. She passed.  

At Kaiser Permanente, only doctors who pass this exam in a particular language may communicate directly with patients in that language without using an interpreter. However, many medical institutions do not require language proficiency testing and leave it to physicians to assess their own competence. The result is that a substantial proportion of non-English speakers are receiving substandard medical care.

When doctors have poor language skills, they are reinforcing the barriers that non-English speakers face every day. In particular, they are less likely to identify mental health needs. 

It is now recognized that people with chronic pain are significantly more likely to experience anxiety, depression, and suicidal thoughts and that for treatment to succeed these psychosocial issues must be addressed. Even without language difficulties, most people are afraid to raise the subject with their physician because of the stigma attached to it, but without adequate comprehension, this problem is greatly exacerbated. Doctors and nurses are less likely to identify mental health needs and make appropriate referrals because of this failure in basic communication. 

This creates a highly counterproductive and medically dangerous feedback loop. The overestimation of language skills leads to failure of communication which in turn leads to inadequate medical care. In addition, language barriers create tension and anxiety, which in turn exacerbates “white coat syndrome” (white coat syndrome describes how blood pressure naturally rises in the doctor’s office causing hypertension).

The conclusion, therefore, is that the lack of clear language guidelines is an unacceptable barrier to health care and should be addressed at the federal level. Mandating that patients be matched with a provider who speaks their preferred (non-English) language will improve treatment outcomes—federal policy should be amended to reflect this. 

In the meantime, there are several corporations that specialize in language credentialing, so there is no excuse for healthcare providers to ignore this vital element in the provision of efficient and satisfactory medical services.

U.S. Pain Foundation offers a chronic pain support group for Spanish-speaking family members and caregivers. Click here to learn more.

About the Authors

Malcolm Herman worked as an attorney in Maryland for 25 years. After his wife, Gwenn, was injured in an automobile accident, Malcolm became active in the chronic pain community and assisted Gwenn as she created Pain Connection, a nonprofit in Maryland, which is now part of U.S. Pain Foundation.

Malcolm previously served as a director of Pain Connection and is now director of the National Coalition of Chronic Pain Providers and Professionals (NCCPPP), a program of U.S. Pain Foundation. He and Jennine Watson moderate a specialized support group for caregivers and care partners through Pain Connection.

Mayan Herman is a licensed clinical social worker who lives in Austin, Texas and works for a nonprofit community clinic as a bilingual mental health expert. The clinic serves as a safety net for Austin’s uninsured and medically underserved populations. Mayan is a graduate of the University of Pittsburgh and subsequently obtained her MSW from the University of Michigan. 

Her career has spanned a wide range of fields, including mental health disorders, addictions, immigration issues, and child welfare. She has worked in school settings, county agencies, and rehabilitation centers. Mayan also has considerable experience in the psychosocial aspects of chronic pain and has participated in Pain Connection’s chronic pain support group leadership training. To relax, Mayan plays the piano, guitar, writes and composes music as well as writing short stories, poetry and articles.