The fierce urgency of addressing language, literacy care barriers

Kevin B. O'Reilly , News Editor

In the absence of a qualified interpreter, patients with limited English proficiency (LEP) can have trouble conveying critical information about symptoms and experiences. Offering reliable access to quality language and interpretive services is one strategy for improving cross-cultural communication in health care organizations. This is one pathway to quality care and shared decision-making, which some argue is not only an urgent priority, but also a clinical, legal and ethical obligation.

This month’s AMA Journal of Ethics® features numerous perspectives on how physicians can address the linguistic and cultural barriers that may impede high-quality care. It also covers the broader question of language and hierarchy in medicine, including topics such as when and how clinicians can share health-record details with patients who have a mental illness and the role of illness narratives in medical education.

Take a moment to consider this question: When is it acceptable for a clinician to ask a child to translate for a parent with limited English proficiency?

  • Always.
  • Never.
  • Only when no medical interpreter can be located.
  • Only if the child consents to translate.

Give your answer and find responses to this question in the March issue of the AMA Journal of Ethics, which explores the obligations physicians and health care organizations have to provide medical interpreters for patients with LEP.

Articles include:

Clinicians’ Obligations to Use Qualified Medical Interpreters When Caring for Patients with Limited English Proficiency.” Access to language services is a required and foundational component of care for patients with LEP. In the vignette, the attending physician infringes upon the patient’s right to appropriate language services and renders unethical care. Clinicians are obliged to create systems and a culture that ensure quality care for patients with LEP.

The Role of Universal Health Literacy Precautions in Minimizing ‘Medspeak’ and Promoting Shared Decision Making.” Shared decision-making (SDM), a collaborative process whereby patients and professionals make health care decisions together, is a cornerstone of ethical patient care. The patient-clinician communication necessary to achieve SDM depends on many factors, not the least of which is a shared language—sometimes with the aid of a medical interpreter. However, even when a patient and clinician are speaking the same mother tongue, the use of medical jargon can pose a large and unnecessary barrier.

Strategies for Acing the Fundamentals and Mitigating Legal and Ethical Consequences of Poor Physician-Patient Communication.” This article explores how the absence of effective verbal and nonverbal communication in the physician-patient encounter can lead to poor outcomes for patients and physicians alike. There are legal and ethical factors physicians should consider during a medical encounter; the article provides educational and practical suggestions for improving communication between physicians and their patients.

How Medicine May Save the Life of U.S. Immigration Policy: From Clinical and Educational Encounters to Ethical Public Policy.” Our nation has been unable to move forward with meaningful immigration reform because many citizens seem to assume that immigrants are in the U.S. to access benefits to which they are not entitled. When the health care system is amended to be inclusive, immigrants become contributors to the systems that they access. This thesis is illustrated by examining the issues of forced medical repatriation, access to health insurance and the access of undocumented students to medical education. One AMA PRA Category 1 Credit™ is available for completing continuing medical education activity associated with this article.

The March issue of the journal also features opinions from the revised AMA Code of Medical Ethics related to language and hierarchy in medicine. The Code of Medical Ethics recently underwent a comprehensive modernization, resulting in greater relevance, clarity and consistency.

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. The journal invites original submissions for peer review on 13 themes that will be explored in 2017–2018 issues, including the ethics of correctional health care, clean water access and the roles of clinicians, and the ethics of collaborative health systems design. Submit a manuscript for publication here. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

Upcoming issues of the AMA Journal of Ethics will focus on moral psychology and "difficult" patient-clinician dyads, mental health and oncology, and moral distress. Sign up to receive email alerts when new issues are published.