What is good... LANGUAGE

Language and culture - within a nation.

"America is a country of many races and cultures, and with each passing year, more health care providers are recognizing the challenge of caring for patients from diverse linguistic and cultural backgrounds. Health care professionals and managers must have a basic understanding of the impact of language and culture on health care delivery in order to efficiently organize services that meet the needs of both the institution and a diverse patient population.

Linguistic and cultural diversity is an inescapable fact of modern American society. According to the 1990 Census, 31.8 million residents of the United States -- 14 percent of the total population -- spoke a language other than English at home. Spanish was the most frequently spoken language, followed by French or Creole, German, Chinese, and Italian. A total of 4.5 million Americans spoke an Asian or Pacific Island language. In some states, the percentages of those speaking a language other than English at home were significantly higher than the national average--36 percent in New Mexico, 31 percent in California, and 20 percent each in Arizona, Hawaii, New Jersey, New York, and Texas.

The challenge of learning a new language is significant. Basic language proficiency often takes years to achieve, and even then, familiarity with medical terminology and concepts may still be lacking. There are typically never enough English-as-a-Second-Language classes to meet demands, and aspiring candidates often wait months or years to move up on waiting lists. Lack of basic reading and writing skills in a person's native language (or speaking a language with no written form) hinders the ability to learn a new language. Finally, in times of significant stress or emotional trauma, such as dealing with an illness or injury, even individuals with years of English experience often revert to the "mother tongue."

Health care facilities in almost every large U.S. city and many suburban and rural areas are serving diverse patient populations. Even though most health care providers want to offer them the same attention and concern as to any other patient, limited English proficient (LEP) patients encounter obstacles at every turn.

They may delay making an appointment because of the difficulty communicating over the telephone. Meanwhile, the health problem may become more severe or advanced requiring more expensive or invasive treatment. Misunderstandings about the time, date, and location of appointments are more likely to occur if the patient does not understand English. Even when patients arrive at the facility on time, they may be late for appointments because of difficulty communicating with registration staff. Furthermore, the medical interview and examination present unlimited possibilities for confusion and potential serious misunderstanding can occur since complete and accurate medical history is crucial to an accurate diagnosis. Sophisticated technology and diagnostic procedures are not substitutes for clear patient-provider communication. In addition, miscommunication can result in unnecessary or inaccurate tests. Even when tests are necessary, if patients are not given instructions in a language they can understand, they may not be adequately prepared physically or psychologically to undergo these sometimes painful and frightening procedures. Likewise, if patients are to comply with a treatment plan, they must have a clear understanding of what is required of them"