The language of care: Resources for treating patients with limited English proficiency

There are so many things I loved about my residency program. One of my favorite things, though, was its location. Located in the heart of New York City, the family medicine residency program at NewYork-Presbyterian/Columbia University Irving Medical Center (NYP-Columbia) offered me the diverse patient population that I desired in a residency program. As a Spanish major, being able to use my Spanish was important to me. Even though I didn’t speak any additional non-English languages, being able to care for patients with limited English proficiency was important to me.

One day during my intern year on the inpatient service, I counted the number of different languages my patients spoke during our morning rounds. Given that we mainly served patients from Washington Heights, Inwood and the Bronx, most of our patients spoke Spanish. Any time I had a patient who spoke a language other than English or Spanish, the language enthusiast in me would get incredibly excited. That day, there were five primary languages represented on my list: English, Spanish, Russian, Greek and French.

I had come to the hospital a little early that morning so that I could learn how to say good morning to my Russian- and Greek-speaking patients, and I did. However, learning anything more than that in the limited time I had as a resident on inpatient that day was unfortunately pushing it. While every hospital system is legally required to provide interpreters for patients with limited English proficiency/who speak English as a second language (ESL), providing optimal care for patients who are depending on a translation over the phone is challenging.

I ended up searching for and finding additional resources that I could use not only to better communicate with my patients but to provide them with resources as well. This was especially true when some of my patients would decline an interpreter despite a demonstrated language barrier.

Now that I’ve graduated from residency and practice as a family physician, I still use that list of resources. It’s a list I’d like to share with other osteopathic residents and the greater osteopathic medical profession.

Resources for language learning

Duolingo
Duolingo is great for starting a new language or maintaining accountability when you commit to learning a language. I’ve used it for Spanish, French and Italian, and I’m now using it for Arabic. It’s great for accountability because med students, residents and practicing physicians don’t always have time for lengthy lessons. I always worry that once I stop, it will be hard to regain momentum and pick my lessons back up.

With Duolingo, I can at least commit to maintaining my streak, which means that I learn a little each day, even if it’s not as fast as I’d like. Others may breeze through lessons, which are only available in app form. Duolingo has a free version and a paid version that removes ads, and it allows you to join challenges with friends to maintain your streak. I admit, many of us Duolingo users live in fear of losing our streaks.

Rosetta Stone
Rosetta Stone is great for those who can carve out a little more time in their week for more intense language learning. I used it for French before med school and, last year, I started using it for Arabic. Since the platform is available both via app and web on a computer or laptop, I like the versality it provides. It feels more like a traditional language course than Duolingo and requires more of my time and mental effort, but it also does more for my language comprehension and communication skills.

AOA Member Value program
AOA members have exclusive access to a variety of tools and resources, including a discount on the CanopyLearn medical Spanish course. This course is designed to improve patient care through teaching physicians medical Spanish to help them deliver culturally sensitive, patient-centered care. It is available online and can be completed at your own pace.

Resources for communicating

While audio interpretation must be provided to ESL patients, written interpretation doesn’t have to be, and patients are often sent home with discharge instructions they can’t understand. Google Translate works great for Latin languages, but it falls short for non-Latin-based alphabets, because most electronic health systems aren’t equipped to recognize them. When I find myself in these situations, I use an interpreter to guide my patients through writing their discharge instructions in their own words.

Resources to give patients

When I want to provide my patients with resources I can trust they’ll be able to use at home, I look to a few key places. National associations are great for this.

American Heart Association (AHA)
The AHA provides many of its resources for patients in Spanish. I use this website when I want to provide my patients with information on their guidelines for healthy eating and routine, moderate-intensity aerobic exercise. I often just provide patients with the link so that they can browse at their leisure.

American Stroke Association (ASA)
The ASA has a website page for Spanish speakers that explains what a stroke is, how to prevent it and what comes next after a stroke. I’ll also share the link to a specific page on their website based on the counseling I’ve provided my patients with that day.

American Diabetes Association (ADA)
The ADA also has a Spanish version of their website. It’s a great resource for educating patients on what life with diabetes is like and what a healthy diabetic diet looks like.

Centers for Disease Control and Prevention (CDC)
The CDC provides resources in over 26 languages on topics such as healthy living, injury, traveler’s health and certain diseases and conditions. While their resources have changed a lot over the last few months, and I no longer use it as extensively as I once did, I do still find it best for vaccine education, because I can print out information for patients to take home and read about if they’re vaccine hesitant. They also have posters and handouts related to maternal health, including one that helps pregnant women recognize urgent maternal warning signs, and I still find these specific resources helpful.

The National Institutes of Health (NIH) National Library of Medicine
The NIH National Library of Medicine provides resources for patients in 53 languages. It contains resources for dozens of conditions from acne and allergies to cancer and end-of-life issues. I look to this website when I want patients to be able to read information at their leisure at home, so it’s great for topics like advance directives and fall prevention. 

FamilyDoctor.org
This is my specialty’s main resource for patients, so I use it often. The entire website can be accessed in Spanish, so I don’t have to worry about my Spanish-speaking patients’ ability to navigate it. The site is great for providing education on conditions like chronic kidney disease and dementia; general wellness like healthy food choices and weight loss; and family health like pregnancy and childbirth.

In a nutshell

As a family physician and a language major, I always appreciate the opportunity to care for patients who speak non-English languages. When I care for patients who speak ESL, I often engage them in the teach-back method so that I can ensure they understand the resources I’m providing in a language I may not understand myself. It’s a great reminder for me that I can always find ways to engage patients in their own health.

Related reading:

The benefits of learning another language for patient care

Essential apps for health care professionals: Streamlining care, education and wellness