At its core, the medical profession is founded on human connections. Long before the advent of modern medicine, let alone a relative understanding of science and the human body, care revolved around relationships, trust and human touch.
After all, the ritual of care always begins with a conversation and human connection. But what if this most basic tenet of care was restricted by an inability to communicate with patients? How does the barrier to communicate limit adequate care and hinder the building of strong physician-patient relationships? And how do we reconcile the need for foreign language proficiency and our current model of medical education?
The social and cultural demographics of the United States are shifting rapidly. This is especially true of the Hispanic population, a group that includes those who link their heritage to Mexico and Spain as well as the Spanish-speaking countries of Central and South America. According to the United States Census Bureau, there are around 56 million people of Hispanic origin in the country — 17.6% of the total population — and it is expected that by 2060 this will expand to roughly 119 million.
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This makes Hispanics the largest minority group in the United States, and Spanish the second most spoken language. Logically, this has and will continue to have broad implications on health care and the way that medical professionals adapt to address this diverse patient population.
Presently, having even a low proficiency in Spanish is becoming more and more important in today’s medical profession. It is not uncommon for health professionals to encounter Hispanic patients with little to no proficiency in English.
Naturally, this barrier creates a series of obstacles for both the patient and the physician, including difficulty with collecting reliable patient history, determining between life-threatening or benign symptoms, sharing vital information about medications, and establishing necessary follow-up care.
As expected, this problem translates into inadequate patient outcomes and the propagation of health disparities that predispose Hispanics to diabetes, heart disease, cancer and the development of multiple mental health disorders.
Beyond the protocols of treatment and the quality of care, the inability to communicate with patients makes it difficult to personally connect and establish trust. This is worrisome because it deters the formation of strong physician-patient relationships and reinforces skepticism towards medical professionals.
Studies show that Hispanic patients are more comfortable, open, and compliant with health care professionals who communicate with them in their native language, even if both parties are fluent in English. Intuitively, this makes sense. When we are sick and vulnerable, we are more likely to gravitate towards that which makes us comfortable. For Hispanic patients — many who have left their home countries for safety and opportunity — comfort is often rooted in their culture and native language.
Taking all these factors into consideration, it is clear that Spanish proficiency can be an invaluable tool in the medical setting and can even play an auxiliary role in addressing health inequity. With improved communication, physicians can more effectively address health concerns and patients can receive better treatment.
Improved care can also reduce the risk of medical errors. This in turn, besides clearly benefiting patients, can also decrease costs for care, increase physician wellbeing, and prevent potential malpractice lawsuits. Ultimately, the development of better communication and relationships with non-English speakers leads to positive outcomes for both patients and physicians.
Now, let us address the elephant in the room: Does this mean that physicians need to know Spanish to be competent? Of course not! Despite the clear advantages, there are incredible non-Spanish speaking physicians all over the country that serve Hispanic populations and provide excellent, culturally conscious care. Nonetheless, Spanish continues to be an increasingly useful tool.
The more pertinent problem is that it is inherently difficult to learn a new language while completing the rigors of medical training. Thankfully, there are things that aspiring physicians can do throughout college and medical school to develop a proficiency in Spanish.
The best time to learn Spanish is during the pre-medical years. While this time is vital for acceptance into medical school, it also allows for the most flexibility. Thus, pre-medical students should consider a variety of options to increase their Spanish language aptitude.
Students can take Spanish language courses to “cushion” their heavy-science workload and begin learning basic terminology and grammar. They can also volunteer with Hispanic migrants in their community and the organizations that address their needs.
In parallel, they can seek out opportunities to study abroad or volunteer in Spanish-speaking countries; this allows for a more immersive experience. As students begin to shadow medical professionals, they can reach out to Spanish-speaking physicians that serve Hispanic populations to gain greater exposure to the language and the subtleties of serving non-English speakers.
Early exposure to Spanish and continued interest throughout the pre-medical years will prepare students to better serve this growing population.
As a medical student, it may be difficult to find time to learn Spanish while learning the already demanding language of medicine. There are however medical schools that offer coursework in medical Spanish and provide opportunities that expose students to the language. In their first year — arguably the most flexible time in medical school — students should seek out opportunities to serve Hispanic patients in their community.
Students can also reach out to peers and faculty fluent in the language to Medical Spanish interest groups at their school. As the first year ends, students should inquire about immersion programs and/or global health initiatives provided by their school during the summer break before the second year.
During rotations in the third and fourth years, medical students can continue to work with Hispanic patients, under professional supervision, to hone their skills. This is also an excellent time to become acquainted with the work of professional medical interpreters and their vital role in interdisciplinary healthcare teams.
These nationally certified professionals have seen a rise in employment in recent years and the results have had a significant impact on improved care. A study by the American College of Emergency Physicians found a significant decrease in medical error rates when using certified professional interpreters over non-professionals; 12% and 22% error rate, respectively.
These findings support previous research stating that “... trained professional interpreters and bilingual health care providers positively affect LEP (limited in English proficiency) patients' satisfaction, quality of care, and outcomes.”
Thus, understanding how to work with these professionals while training will allow medical students to better integrate interpreting services to patient care in the future. All in all, taking time during medical school to interact with Spanish speakers, as well as seeking opportunities to assist diverse patients locally and abroad, will ultimately serve medical students well as they prepare to enter the wards.
The growing presence of professional medical interpreters may conjure the following question: if these professionals exist and their work has been shown to lead to positive patient outcomes, why should physicians need Spanish in the clinic?
After all, the interpreter will probably have a stronger grasp of Spanish and its cultural nuances than non-fluent physicians with limited Spanish proficiency. While this may be true, being able to communicate with Spanish-speaking patients, even in a limited way, can have deeper implications on the patient-physician relationship.
Starting simple conversations in Spanish can show patients that physicians are genuine in their care, and it demonstrates empathy and cultural sensitivity. Patients will recognize this as a conscious effort by the physician to comfort and connect resulting in greater compliance and trust. In this way, physicians can form a relationship with their patients and still utilize the expertise of professional interpreters to address more intricate matters.
To end we must again address this fact: success as a medical student and future physician are not dependent on the ability to speak Spanish! As stated previously, there are amazing non-Spanish speaking physicians effectively serving non-English speakers all over the country.
However, future physicians must begin to adapt to the needs of a growing Spanish-speaking population and acknowledge the power of serving patients in their native language. Dr. Benjamin Brown, a gynecologist at University of Chicago Medical Center, recalls his experience as a bilingual physician in an article published in the Annals of Family Medicine titled "Interpreting Medicine: Lessons From a Spanish-Language Clinic:"
"Working with a predominantly Spanish-speaking population, both as a medical student and now as a resident, reminds me of the importance of understanding patients. I mean this not only in the literal sense of being able to understand the patient’s language but in the broader sense of having the courage to ask about the patient’s struggles and to invest effort in helping him or her overcome them."
In that spirit, we return to the humanistic foundations of the medical profession and consider the importance of being able to form strong relationships with patients. In the end, having proficiency in Spanish will allows us to better communicate and care for Spanish-speaking patients.
More importantly, however, showing compassion, empathy and understanding will allow us to become better healers for those under our care. After all, it is this humanism that defines the universal language of medicine.
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