She grasped her chest, struggling for words that eluded her in English. The nurse leaned closer, attempting to make sense of the situation. Her son was absent to translate, and the phone interpreter service was not yet connected. I noticed her distress escalating. Valuable minutes ticked away before we finally understood she was outlining the typical symptoms of a heart attack. That patient survived, but the outcome could have easily been different. And in many instances, it is.

The extent of the issue

In the United States, over 25 million individuals possess limited English proficiency (LEP). In critical situations (heart attacks, strokes, or medication mishaps), time is of the essence. Yet numerous patients encounter delays and misinterpretations due to a lack of understanding of their words.

Studies have consistently proven that patients with LEP endure:
– Increased rates of misdiagnosis
– More medication mistakes
– Extended hospital stays
– Poorer overall health outcomes

For a cardiologist, the implications are starkly evident. If a patient is unable to convey chest pain accurately (or cannot grasp discharge directions about blood thinners), the repercussions can be disastrous.

Why this persists

In spite of regulations mandating interpreter services, hospitals exhibit inconsistencies in their provision. The reasons are frustratingly straightforward:
– **Interpreter shortages:** Few hospitals can provide professional interpreters around the clock.
– **Dependence on family members:** Children or spouses are frequently called upon to translate, jeopardizing confidentiality and leading to clinical errors.
– **Technology shortcomings:** Interpreter phone lines and apps exist, but they are often underutilized, too slow, or unavailable during high-pressure emergencies.

The outcome is that language continues to be a silent obstacle, veiled in plain sight, within some of the most advanced hospitals globally.

The human toll

In cardiology, communication gaps can prove fatal. A patient experiencing chest discomfort might have difficulty articulating the differences between burning, pressure, or stabbing pain, which are vital clues that direct us toward heart attacks, reflux, or alternative diagnoses.

Apart from emergencies, patients who do not fully grasp medication directives are less likely to adhere to them accurately. I’ve witnessed individuals returning with aggravated heart failure because they did not understand that “take one pill daily” means every day, not just when symptoms arose. This issue transcends mere convenience. It is a matter of safety and survival.

What we can improve

Addressing this dilemma requires more than just policy; it necessitates urgency. Some solutions are uncomplicated:
– **Instant interpreter access:** Hospitals need to ensure that professional interpreters are readily accessible, either in person or through secure video options.
– **Cultural competence training:** Language is just one aspect; understanding cultural health beliefs and anxieties enhances communication significantly.
– **Bilingual healthcare providers:** Hiring and empowering multilingual clinicians can foster trust and expedite care.
– **Community engagement:** Health fairs, local clinics, and collaborations with community leaders aid in establishing trust prior to emergencies.

If we can ensure prompt access to cardiac catheterization labs during crises, we must also guarantee immediate access to effective communication.

Final thoughts

The woman I mentioned earlier survived her heart attack. However, her survival was due to luck and perseverance, not because the system functioned as it should. In the realm of medicine, luck should never dictate who lives and who dies. Effective communication is not a luxury; it is as crucial to patient care as oxygen and medication. Until language access is considered a matter of patient safety rather than convenience, too many patients will continue to bear the burden.

Monzur Morshed is a cardiologist. Kaysan Morshed is a medical student.