SAN DIEGO — Nearly two-thirds of internists provide care for patients with limited English proficiency, according to a national survey conducted by the American College of Physicians.
That language barrier can create challenges for patients and physicians, because patients who are not proficient in English tend to have a worse understanding of basic health information, have difficulty asking questions of clinical and administrative staff, and may not follow through on treatment recommendations, the survey showed.
ACP officials conducted the survey of 4,000 of its members in fall 2006 and received responses from 2,022 internists. The analysis was based on the 1,261 respondents who work at least 20 hours weekly.
The results were released at the annual meeting of the ACP in conjunction with the organization's new position paper on language services for patients with limited English proficiency (LEP).
In its position paper, the ACP called for language services to be available to improve health services for patients with LEP, and recommended that Medicare directly reimburse physicians for the added expense of language services and the extra time involved in providing care for patients with LEP.
The ACP is also pushing for the establishment of a national clearinghouse to provide translated documents and patient education materials.
“If we're unable to communicate with our patients—either understand what they are telling us or help them to understand how best to take care of themselves—we certainly aren't practicing patient-centered care,” Dr. Lynne Kirk, ACP immediate past president, said at a press briefing.
Internists who care for limited English proficiency patients estimated that these patients make up an average of about 12% of their practice.
Physicians often devote additional time to their limited English proficiency patients, said Dr. William Golden, immediate past chair of the ACP board of regents.
For example, 51% of physicians who see LEP patients in their practice said they devote an average of 5–15 minutes of additional time during a visit with an LEP patient.
Another 26% report spending an extra 16–30 minutes on average, according to the survey of ACP members.
“That is time that is sometimes difficult to carve out, and at the same time [is] often unreimbursed,” Dr. Golden said.
Spanish topped the list of most frequently encountered languages, but physicians reported seeing patients who spoke nearly 80 different languages or dialects, from Chinese to German. (See box.)
About 52% of respondents said they thought their practices could determine the top three languages spoken by their LEP patients, whereas 48% could not or were uncertain.
Many practices do not have processes in place for obtaining information about a patient's primary language, the survey of ACP members found.
About 28% of physicians said their practice recorded the patient's primary language in the medical record, whereas others cited informal monitoring or data provided on check-in or patient registration forms.
About 64% of survey respondents said they provide some type of language services to their LEP patients.
Those language services are usually provided by a bilingual health care provider, bilingual staff, or ad hoc interpreters.
Of those physicians who reported providing language services to their limited English proficiency patients, about 64% also provided translated documents or forms to patients.
Medical practices vary in the cost they assign to providing language services to limited English proficiency patients, with cost estimates ranging from zero to $25,000 annually.
Physicians absorb most of the costs, with 75% of respondents saying they received no direct reimbursement, 24% reporting they were uncertain, and 1% reporting direct reimbursement for language services provided.
Providing payment either to physicians or translators for language services for limited English proficiency patients eventually could save a significant amount of money in direct medical costs, Dr. Golden commented.
The provision of adequate language services can lower medical costs by helping to avoid medical errors and unnecessary tests and hospitalizations.
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