Chapter 1: Breaking Down Language Barriers

INTRODUCTION

According to the U.S. Census Bureau, as of mid-2007, Latinos make up over 15% of the U.S. population, and remain not only the country’s largest minority group, but also the fastest growing, with a 29% increase between 2000 and 2007.¹ Many Latinos are limited in English language proficiency, with a limited ability to read, write, speak, or understand English. In fact, according to a 2000 U.S. Census Survey, 45% of all Spanish speakers self-reported that they spoke English “not well” or “not at all.”²

These language barriers in the Latino population may adversely affect their use of health care services. It is well documented that Latinos as a group, and Spanish-speaking individuals specifically, often experience a lower quality if health care in the United States compared to English-speaking individuals. Studies show that Spanish-speaking patients experience longer wait times, less help from office staff, and difficulties with provider communication.^3,4 Without interpreter or translator services, these language barriers and cultural differences can lead to a reluctance to seek medical care, resulting in suboptimal health care overall.

In order for clinicians to provide quality health care to Spanish-speaking patients, they must be able to communicate effectively. To care for the increasing Spanish-speaking patient populations across the country, there is a strong push in all healthcare areas to create a more ethnically diverse nursing work force. In addition, healthcare employers in hospitals and clinics are making extra efforts and providing incentives to recruit bilingual nurses and clinicians.

While there is a growing trend in the United States among health professions’ training programs to provide medical Spanish, it still remains the exception rather than a required component of the curriculum. Among the U.S. Physician Assistant programs surveyed in 2005, only 31% offered any type of medical Spanish training, with only 12.9% of those as a formal class.⁵

The idea for this book came during a night course in medical Spanish, when we—the teacher (a physician educator) and the student (a clinically practicing physician assistant)—realized a need for a new approach to a handbook of clinical medical Spanish. It was obvious early on in the course that, to communicate effectively with Spanish-speaking patients, a non-Spanish-speaking clinician would need more expertise than a semester of night courses could provide. As a non-Spanish-speaking clinician, the challenge is not in learning how to ask questions in Spanish; rather the more daunting task is comprehension of the verbal reply in Spanish. Medical Spanish textbooks currently available are designed to teach open-ended questions. While open-ended questions are considered optimal for obtaining medical histories, they are impractical if the history taker is not fluent in the language. The reply is frequently lost in translation, if not misunderstood altogether.

Dissatisfied with the currently available medical Spanish textbooks, we designed this book to provide the reader with specific sets of directed questions intended to ...