Hira Zaman, Year 2
The gentleman was in his mid 60s,
A dress sense like my grandad which hasn’t shifted since the 70s,
I watched as he nodded blankly to the nurse’s question,
At every contradicting statement I saw the nurse’s brows furrow in frustration,
The gentleman turned to me saying beta,
Is there any way you could help me understand this nurse bethar,
I looked towards the nurse and she welcomed my input,
I turned to the gentleman and he smiled thank you puthr,
I witnessed the creases on his forehead diminish,
He spoke in full sentences from start to finish,
After this encounter I empathised,
I understood why the visits to the doctors were despised,
By my mother, my grandfather and many others,
The struggles many immigrants shared with each other,
The language barrier uncovered.
Glossary:
- Beta and puthr—endearing way of addressing someone younger in Urdu
- Bethar—Urdu for better
I wrote this poem on the way home after an encounter I had during my primary care placement. The practice where I was situated had a good understanding of the cultural barriers present in consultations due to a diverse patient demographic. The diabetic clinic had pamphlets with diabetic-friendly curry recipes, which I found so useful that I slipped one into my bag for my diabetic grandad. They were very aware of which ethnic groups were more at risk of certain conditions. An example I learned was that South Asian men were more likely to have pilonidal cysts. It even took me by surprise when the nurse seemed to understand the common family dynamics of my own culture.
However, I realised that there was an emotional disconnect between the practitioner and the patient through language barriers, which challenged both patient engagement and shared decision making (Suurmond and Seeleman 2006). As healthcare students, we’re taught all these different consultation and communication methods, but we’re rarely taught about how they would need to be adapted when patients have a different first language or when an interpreter is present.
Effective communication is vital as miscommunication can lead to a higher prevalence of adverse events (Shamsi and Almutairi 2020) So, what can we do to break this language barrier? One possibility is to make it compulsory to ask patients if they require an interpreter when they’re booking appointments. This should be done even when the person on the phone speaks fluent English, since a lot of people ask English-speaking family members to book appointments on their behalf—I often book appointments for my mum.
Practices should also try to hire at least one bilingual staff member and offer this clinician to patients who aren’t proficient in English. Patients would be more likely to attend regularly having built an understanding with a clinician within the practice (O’Donnel et al. 2008).
Additionally, practices should encourage healthcare professionals to use diagrams or pictures to explain conditions and instructions. Hospitals regularly have volunteers, ranging from high school students to adults such as porters. I think primary care should also consider volunteers who could interpret for patients when an interpreter isn’t available. Healthcare students would be great for this role, but it would be beneficial to provide volunteers with training beforehand. Alongside these volunteers, the NHS should create a library of short videos made by GPs explaining different conditions or examinations in different languages. These videos could be played during the consultation and would reduce the risk of miscommunication, whilst saving time and improving patient understanding and engagement. It’s important that we encourage interpreters to feel comfortable asking questions and challenging a healthcare providers decision, when they feel that an option hasn’t been explored enough for the patient to form an informed decision.
No patient should ever have to avoid accessing care just because their first language isn’t English. As future healthcare professionals, we need to put our frustrations aside when patients don’t understand us and realise how challenging it must be for a patient to not be understood when their health is compromised. We need to be more innovative—there is so much room for improvement when it comes to reducing the impact of language barriers on the quality of care. On-call online interpreters, System1 updates that include visual and verbal explanations for different conditions in different languages or even pocket translation devices are three simple changes that could do wonders.
Alongside many others, English language proficiency is a major social determinant of health, and that needs to change (Rowlands et al. 2015)
References
Al Shamsi, H., Almutairi, A.G., Al Mashrafi, S. and Al Kalbani, T. 2020. Implications of Language Barriers for Healthcare: A Systematic Review. Oman Medical Journal. 35(2).
O’Donnell, C.A., Higgins, M., Chauhan, R. and Mullen, K. 2008. Asylum seekers’
expectations of and trust in general practice: a qualitative study. The British Journal of
General Practice. 58(557), pp.e1–e11.
Rowlands, G., Shaw, A., Jaswal, S., Smith, S. and Harpham, T. 2015. Health literacy and the
social determinants of health: a qualitative model from adult learners. Health Promotion
International. 32(1), pp.130–138.
Suurmond, J. and Seeleman, C. 2006. Shared decision-making in an intercultural context.Patient Education and Counseling. 60(2), pp.253–259.
THE WORSLEY TIMES 
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