Describing Physician Language Fluency

Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 02/2009; 301(4):426-8. DOI: 10.1001/jama.2009.6
Source: PubMed


Language barriers are increasingly important in US health care. Limited English proficiency is associated with poorer health care processes and outcomes.1 Disparities in care for patients with limited English proficiency persist even when socioeconomic and insurance status are considered, suggesting that language and culture also play an important role.2 Accumulating research shows that having a language-concordant physician is associated with improved quality and outcomes.3- 5 Using professional interpreters can also lead to better care for patients with limited English proficiency,6 but physicians and medical trainees underuse professional interpreters, frequently substituting their own limited spoken Spanish during clinical encounters.7


Available from: Lisa C Diamond
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    • "Studies providing these data are likely necessary before Federal regulations are modified to be more specific . The current regulations offer no guidance on the classification of physician lan - guage proficiency ( Diamond and Reuland 2009 ) , resulting in less than ideal approaches , such as that being used by PAMF prior to the policy change to using the ILR scale . "
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    ABSTRACT: To describe the initial impact of an organizational policy change on measurement of physician non-English language proficiency. Multispecialty health care organization in the San Francisco Bay Area. In response to preliminary findings suggesting that the organization's nonvalidated and undefined three-category tool for physician self-report of non-English language proficiency levels was likely inadequate, the organization asked physicians to rate their non-English language proficiency levels using an adapted Interagency Language Roundtable (ILR) scale, a validated measure with five rating levels and descriptors. We then compared the self-reported language proficiency on the original scale and the ILR for those physicians who completed both and used regression analysis to investigate physician characteristics potentially associated with a change in score on the old versus ILR scales. Six months after the ILR scale was implemented throughout the organization, 75 percent (258/342) of physicians had updated their language proficiency ratings. Among clinicians who had previously rated themselves in the "Medical/Conversational" category, there were substantial variations in scores using the ILR scale. Physicians who spoke two or more non-English languages were significantly more likely to lower their self-reported proficiency when updating from the old scale to the ILR scale. The organization was willing to adopt a relatively straightforward change in how data were collected and presented to patients based on the face validity of initial findings. This organizational policy change appeared to improve how self-reported physician language proficiency was characterized.
    Health Services Research 10/2011; 47(1 Pt 2):556-69. DOI:10.1111/j.1475-6773.2011.01338.x · 2.78 Impact Factor
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    • "While this observational study cannot provide evidence for causality, health plans should consider systematically offering the choice of language-concordant primary care physicians to patients with diabetes and LEP. The widespread distribution of patients with LEP throughout the country already renders increasing the linguistic capacity of the current physician workforce a priority.31,60 "
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    ABSTRACT: A significant proportion of US Latinos with diabetes have limited English proficiency (LEP). Whether language barriers in health care contribute to poor glycemic control is unknown. To assess the association between limited English proficiency (LEP) and glycemic control and whether this association is modified by having a language-concordant physician. Cross-sectional, observational study using data from the 2005-2006 Diabetes Study of Northern California (DISTANCE). Patients received care in a managed care setting with interpreter services and self-reported their English language ability and the Spanish language ability of their physician. Outcome was poor glycemic control (glycosylated hemoglobin A1c > 9%). The unadjusted percentage of patients with poor glycemic control was similar among Latino patients with LEP (n = 510) and Latino English-speakers (n = 2,683), and higher in both groups than in whites (n = 3,545) (21% vs 18% vs. 10%, p < 0.005). This relationship differed significantly by patient-provider language concordance (p < 0.01 for interaction). LEP patients with language-discordant physicians (n = 115) were more likely than LEP patients with language-concordant physicians (n = 137) to have poor glycemic control (27.8% vs 16.1% p = 0.02). After controlling for potential demographic and clinical confounders, LEP Latinos with language-concordant physicians had similar odds of poor glycemic control as Latino English speakers (OR 0.89; CI 0.53-1.49), whereas LEP Latinos with language-discordant physicians had greater odds of poor control than Latino English speakers (OR 1.76; CI 1.04-2.97). Among LEP Latinos, having a language discordant physician was associated with significantly poorer glycemic control (OR 1.98; CI 1.03-3.80). Language barriers contribute to health disparities among Latinos with diabetes. Limited English proficiency is an independent predictor for poor glycemic control among insured US Latinos with diabetes, an association not observed when care is provided by language-concordant physicians. Future research should determine if strategies to increase language-concordant care improve glycemic control among US Latinos with LEP.
    Journal of General Internal Medicine 09/2010; 26(2):170-6. DOI:10.1007/s11606-010-1507-6 · 3.42 Impact Factor
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    ABSTRACT: Clinicians should be educated about how language barriers contribute to disparities for patients with limited English proficiency (LEP). However, educators must avoid developing educational interventions that increase health disparities for LEP patients. For example, studies suggest that teaching “Medical Spanish” or related courses may actually contribute to health care disparities if clinicians begin using these non-English language skills inappropriately with patients. We discuss the risks and benefits of teaching specific cultural competence skills and make evidence-based recommendations for the teaching content and methods for educational interventions focused on overcoming language barriers in health care. At minimum, we suggest such interventions include: (1) the role of language barriers in health disparities, (2) means of overcoming language barriers, (3) how to work with interpreters, (4) identifying and fixing problems in interpreted encounters, and (5) appropriate and safe use of one’s own limited non-English language skills. KEY WORDScommunication barriers-doctor-patient relationships-medical education-health disparities
    Journal of General Internal Medicine 05/2010; 25:189-193. DOI:10.1007/s11606-009-1201-8 · 3.45 Impact Factor
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