Commentary: Transcending Language Barriers in Obstetrics and Gynecology

Accumulating evidence suggests language discordance between patients and their healthcare teams yields worse patient experience, quality of care, outcomes, and cost. A recent commentary in Obstetrics & Gynecology proposes a framework to address language-related inequities at the clinician, healthcare system, and societal levels.

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The authors are Samantha Truong, MD, diversity, equity, and inclusion (DEI) chief resident in the Departments of Obstetrics and Gynecology at Brigham and Women's Hospital and Massachusetts General Hospital, Adeline A. Boatin, MD, MPH, co-director of Global OB/GYN in the Department of Obstetrics and Gynecology at Massachusetts General Hospital, Caroline M. Mitchell, MD, MPH, chair of the Mass General OB/GYN Department's DEI committee, Allison S. Bryant, MD, MPH, maternal–fetal medicine specialist and associate chief health equity officer at Mass General Brigham, and colleagues.

Clinician Level

Despite institutional and societal constraints, clinicians can play important roles in advancing care for patients with language barriers:

• Confirm and document each patient's preferred spoken and written language(s) for receiving medical information and revisit them regularly
• Have a basic understanding of regional variations in languages (e.g., Portuguese and Arabic) that can affect clinical communication if the wrong interpreter is requested
• Communicating informally in the patient's language to build rapport is encouraged, but a clinician who lacks professional proficiency in the language should rely on qualified bilingual staff or medical interpreters and document their assistance
• When working with an interpreter, address the patient directly, allow time for interpretation, avoid idioms and jargon and ascertain comprehension by asking the patient to repeat what they understood
• Use of ad hoc interpreters (e.g., family members) has been shown to increase communication errors, but in situations involving an imminent threat to the patient's safety or welfare, U.S. Department of Health and Human Services guidelines allow their use
• The patient may insist on having a family member interpret for them, but clinicians have the right to a medical interpreter to ensure their communication is complete and accurate. When preferences are discordant between patient and clinician, a shared decision-making approach is best and should be documented

Healthcare System Level

Healthcare systems that aim to improve care for patients experiencing language barriers should:

• Implement and incentivize processes for healthcare staff to obtain qualified bilingual staff certification
• Develop approaches to recruit and retain a multilingual clinician workforce and build a robust workforce of certified medical interpreters—an opportunity to engage international medical graduates and newly arrived immigrants
• Add community-based doulas or patient navigators to healthcare teams to mediate cultural and linguistic differences between patients and clinicians
• Include patients experiencing language barriers in all research studies and make language-concordant care a reportable quality measure (e.g., measure how often outpatient care is provided in a patient's preferred language)

Societal Level

At the societal level, a complex interplay of xenophobia, discrimination and racism influences health outcomes for patients experiencing language barriers. Healthcare professionals' training curricula should include discussion of historical and contemporary policies and practices in the healthcare system that exclude immigrants and people who speak languages other than English. Redesigning reimbursement structures and health care policy to prioritize language-related outcomes would create opportunities for language access.

The American College of Obstetricians and Gynecologists recommends asking all patients about social determinants of health, referring to social services when indicated, building partnerships with community-based organizations and advocating for policies that contribute to societal change.

The authors also discuss the need for more uniform implementation of federal and state language-access policies, suggest how to improve reimbursement for language-access services, and remind their colleagues that the Affordable Care Act—among other legislation and regulations—gives patients access to language services.

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