The aim of this essay is to understand the
language barriers and miscommunication that may occur in a healthcare setting between
patients and healthcare practitioners, especially where at least one of the
speakers is using a second (weaker) language.
The world we live in requires effective
communication in order to continue developing, and for any form of
communication to be effective, it is important that a clear and mutual
understanding between both parties is achieved. This is why language
becomes an important factor, as if one individual is unable to speak the
particular language in question or the listener is unable to understand the
language, then communication, let alone effective communication, cannot take
It is critical that healthcare
professionals understand that the key to good holistic care is communication,
particularly since patients require information and reassurance regarding their
care. Communication is something we do every day, it is the process of receiving
and sending messages between multiple people. It is not just talking to
each other that defines communication, but it is how we respond to each other
in many different ways (Langs,1983).
There are many varied examples of
communication such as reading, singing, talking, writing and body
language. In order for communication to be effective, it first needs to
be established as well as maintained. In terms of a healthcare setting, this
can be done during the assessment stage when a patient arrives at the practice.
Stuart and Sundeen (1995), state that communication can create barriers, and
this is the case as it is argued that communication barriers can prevent
effective and appropriate care being provided to patients. Additionally, Stuart
and Sundeen also debate that communication may aid in the development of a
In some instances, by simply observing an
individual, many problems which can hinder communication are able to be
discovered. If the patient has any visual impairments, physical
disability or illness, observation can be used to determine which language is
being used or the way the patient is able to communicate with the healthcare
professional, as any of the issues stated could control the way the individual
is able to communicate.
Within our general practices, persons of
all nationalities deserve the best care possible. However, language
barriers and the misunderstanding between individuals proposes puts a restraint
on patient care. Miscommunication in any instance could lead to potential
issues but within the health care sector miscommunication may also result in
lower patient satisfaction scores, illnesses or could even be life-threatening
when streaks of communication are crossed. Hence, one of the most important
tools that we use to provide outstanding patient care as well as improve
patient satisfaction is communication.
Around 9 out of 100 individuals have
limited English proficiency. It is believed that there are approximately
6000 languages spoken in the world. When wandering around in modern
Britain, the South East to be precise, most of these languages are apparent.
More so when you walk into any large NHS Trust in the city we reside in.
There are many challenges that the multicultural and multilingual world brings.
The question is, if we struggle to make sense of each other’s worlds, how do we
work together as well as support each other?
Many people from different cultures and
backgrounds walk through the doors of general practices in London every
day. I am currently training in a busy North London practice, and whilst
on placement I observed many encounters where language barriers became an
obstacle. The English language barrier in comparison to other native languages
has made it difficult for healthcare professionals, nurses in particular, to
perform their roles to their fullest potential. This subsequently leads to
unnecessary mistakes in the practice due to miscommunications because of the
differences in language.
But how can we optimize the care and
information they receive?
Language and cultural differences are the
main communication barriers in which I have observed within the general
practice I am currently training at, where patients and healthcare
professionals not speaking the same language is something that has now become
an occurrence. This is despite effective as communication with patients in
primary care being an essential part of the planning and delivery of
appropriate high-quality and safe patient care.
Overtime there has been an increase in
not only the number of migrant patients but also in the staff who are
foreign-trained. Consequently, the likelihood of communication errors rises as
English may be a second language in which some still aren’t proficient in and
when either the healthcare practitioner or patient attempt to communicate with
each other on this basis, there is likely to be misinterpretations or confusion
in what they are trying to put across. Unfortunately, there is limited research
that addresses this issue.
There is a rise in number of
foreign-trained members of staff and patients, which means that errors in
communication between patients and healthcare staff when a second language is
spoken between one or both are increasingly likely. Hiring an interpreter who
can speak the patient’s language as well as aid the healthcare professional in
making the appropriate choices towards making the individual better, can help
prevent fatal mistakes from occurring. As simple as this solution may sound,
many general practices have no access to an interpreter and healthcare
professionals have little training in dealing with people of a different
language. On the other hand, a problem which arises with the use of
interpreters is that patients tend to have a concern with indirect
communication with the health professional. Vital information that could
significantly affect the diagnosis may be omitted as the patient does not feel
comfortable disclosing this with the interpreter. Even with an interpreter,
there is still a large chance that there could be misinformation between the
healthcare professional and patient, missing key information that could
endanger the life of the patient.
The use of a non-professional
interpreter, such as friends, bilingual member of staff or even a family member
can erupt a few ethical issues, the issue with using untrained interpreters for
issues relating to health or care discussions can usually raise legal and
professional challenges for nurses, as well as patient disclosure implications.
The NMC (2008) states that patients are entitled to their confidentiality and
this must be respected by the nurse. Gerrish (2004) suggests that a means of
addressing language barriers may be the use of friends and family. On the other
hand, McGee and Johnson (2008) expresses that even though friends and families
are seen as the patients chosen advocates, they are not suitable.
Health Scotland (2008) advises that it is
not recommended for children to be substituted as interpreters, as they may
become distressed, may lack the understanding and maturity of what is being
communicated and also the patient be may be reluctant to disclose certain
information to a younger person. Nurses cannot be entirely sure if the
information that is being translated to the patient is correct (Black, 2008). (NMC,
2008) requires nurses to disclose health and treatment information if it has
been requested by the patient.
For patients suffering from anxiety
related illnesses there will be miscommunication from the initial stage. In
result of this psychological stress from the patient, it will become apparent
as well as medical discrepancies possibly displayed from the healthcare
professional. In a scenario where a patient and a healthcare professional are
communicating in different languages, it is important that patients fully take
in the advice of the nurse in a medical context. Nevertheless, because there is
a mismatch in languages, patients are more likely to fail in adhering to the
nurses’ directions and in some cases saving their life. This is why it is
essential that there is a clear understanding between the nurse and the patient.
In the instance that the patients’ fluent
language is conflicting with wider community and the nurse, it will distort the
health related risks from the patient to the nurse and prevents resolutions to
be accurately and appropriately conveyed. In a sector where a vast number of
cultural groups is involved, specific feelings including distress and pain can
be portrayed differently, which complicate matters even further. Even though in some cases glimpses of the
English language are shown; metaphors, culturally-specific terms or expressions
can be challenging to navigate.
Furthermore, when interpreters are unavailable and clinicians lack the
cultural and linguistic skills required, patients have no choice but to rely on
bilingual medically inexperienced relatives or non-medical staff. This
heightens the chance of worsening health outcomes and the quality of care for
the minority communities.
Within a language-discrepant medical
communication setting, there are at least three theoretical approaches to
understanding why communication problems arise. The first approach called
the Psycholinguistic Approach concentrates on the way in which the speaker
directs the attention of focus of the other individual to key elements of their
message. Meuter et al (2015) debates this is done by using syntactic and semantic
features of the language to properly package the message.