Case Presentation: A 70-year-old Spanish speaking female was admitted to the hospital with unstable angina. Chart review confirmed that the patient was followed in the cardiology clinic for months for unstable angina and found to have elevated coronary calcium score. Cardiac catheterization was not offered to the patient due to concerns around compliance with dual antiplatelet therapy. Medical documentation repeatedly characterized the patient as having poor health literacy and possible noncompliance with her current medication regimen. The patient was scheduled for a follow up in 3 months with a Spanish speaking provider in the cardiology clinic. Subsequently, when communicating through the in-person Spanish interpreter on admission, the patient demonstrated excellent understanding of her complex medication regimen which included multiple twice and thrice daily dosing and indication for the medications. During the hospitalization, cardiology was consulted and ultimately pursued cardiac catheterization and a stent placement for nearly complete occlusion of the left anterior descending artery.
Discussion: This case illustrates a common disparity faced by many limited English proficiency, LEP, patients in accessing equitable healthcare. The discrepancies in health outcomes for non-English speaking patients as compared to native speakers are well documented and studied. Patients are often unable to thoroughly advocate for themselves, and even with the use of phone interpreter services, miscommunications are common. These barriers can have severe consequences including delays in care, deferment of appropriate treatment, or incorrect treatment. In the case of our patient, the decision to delay cardiac catheterization in a high-risk patient could have led to devastating acute coronary syndrome, or even death. Multiple providers had recorded misconceptions and biases in her chart that were passed along to subsequent clinic visits. As hospitalists, we must utilize data from clinics and other providers, while remaining unbiased in order to provide satisfactory care for our diverse patients. Our patient’s situation demonstrates the essential role that proper communication plays in dictating care provided and ultimately the outcomes. Limited English proficiency patients face many systemic challenges to navigating the healthcare system. As hospitalists, we have the privilege to care for a diverse population, which comes with the responsibility of communicating effectively with all patients. Interpreter services, both virtual and in person, are offered at many hospitals and should be utilized for all LEP patients, while recruitment of more multilingual providers can also assist in decreasing misunderstandings.
Conclusions: As the diversity of the patient population is expanding in our hospitals, so does the potential for inequitable care provided to limited English proficiency patients. With proven data for higher rates of readmission, worse patient satisfaction, and higher risks of morbidity, actions must be taken by all hospitals to overcome this problem. Some possible ways to mitigate this issue include recruitment of a more diverse medical workforce, use of more in person interpreters to facilitate medical conversations, bias training for providers, and extended appointment lengths for LEP patients.