Removing the Multilingual Barrier to Improve Patient Outcomes

By Susan Kreimer
June 5, 2018

For physician leaders, understanding the scope of the problem is a step toward addressing concerns of communication and compliance.  

Catering to the community’s ethnic diversity, Henry Ford Health System in Detroit, Michigan, opted to post short videos on its website of physicians speaking their native languages — Arabic, Chinese and Hindi, to name a few.

“It’s basically about their care philosophy, a bit little bit about themselves, what they like to do,” explains Diane George, DO, chief medical officer of the system’s primary care department.

diane george

Diane George

The reason these personal details matter is: “We have seen improvement in patient satisfaction when the physicians’ and patients’ languages are congruent,” she says.

But when there are disparities between the second languages of physicians and their patients, it may affect communication and compliance with recommended tests and treatments. Ultimately, this could have a negative impact on outcomes.

“The patients may not fully understand, and so they may be less likely to follow instructions,” says Christopher Whaley, PhD, an assistant adjunct professor at the University of California at Berkeley’s School of Public Health and lead author of an October 2017 report,  “Language Barriers in U.S. Health Care,” undertaken by Doximity, a social network for physicians and advanced practice clinicians.


The survey of 60,000+ physicians analyzed the languages (other than English) they speak across the largest U.S. 50 metropolitan areas. Some findings:.


Patients with limited English proficiency in these areas are most likely to have challenges finding physicians who speak their language.

  1. Washington, D.C.
  2. Louisville, Kentucky
  3. Minneapolis, Minnesota
  4. Baltimore, Maryland
  5. Seattle, Washington
  6. Detroit, Michigan
  7. Boston, Massachusetts
  8. Pittsburgh, Pennsylvania
  9. Nashville, Tennessee.
  10. Jacksonville, Florida


Patients who speak these languages, which proportionally fewer physicians speak, will likely have a more difficult time finding a doctor who speaks their language.

  1. Swahili / Sub-Saharan African
  2. Hamitic / Near East Arabic;
  3. Polynesian;
  4. Burmese / Southeast Asian
  5. Filipino
  6. Korean
  7. Indonesian
  8. Vietnamese
  9. Thai
  10. Japanese


  1. Spanish: 36.2%
  2. Hindi: 13.8%
  3. French: 8.8%
  4. Persian/Farsi: 7.6%
  5. Chinese: 5.2%
  6. Arabic: 4.1%
  7. German: 3.7%
  8. Russian: 3.0%
  9. Italian: 2.7%
  10. Hebrew: 1.9%

Source: Doximity

A wide gap exists between the languages most commonly spoken by physicians and patient populations across the country’s 50 largest metropolitan areas, according to the report, which compared its findings against U.S. Census data. It was based on a national sample of more than 60,000 physician respondents.

Physicians, native- and foreign-born, who are conversant in second languages often care for patients who lack English proficiency. Nearly half, or 44.7 percent, of U.S. physicians who speak a language other than English completed medical school in another country, the report notes, while highlighting that many foreign graduates contribute important communication skills to clinical settings.

To narrow the gap, provider groups and hospitals “can make an effort to hire physicians who speak the under-represented languages,” Whaley says.

Utilizing certified medical interpreters could be another solution.

At Baptist Health Medical Group, a Kentucky network with about 1,100 providers, patient requests for physicians who speak a second language are sometimes made to referral services, says Isaac J. Myers II, MD, the group’s president and chief health integration officer for the parent company, Baptist Health.

In the Louisville area, where Baptist Health is headquartered, 8 percent of residents speak a language other than English. Of that number, 3.8 percent are in Spanish-speaking households. Next in order of the most commonly spoken are African languages, French, Vietnamese, German, Chinese and Serbo-Croatian.

Recruiting and retaining physicians who mirror the languages of patient populations enhance the health care experience. Integrating cultural sensitivity and breaking down communication barriers forges stronger connections, says Myers, who trained in family medicine.

“A lot of patient satisfaction is based on service and how service is delivered,” he says. “It’s how they are treated that’s important.”

Henry Ford Health System created a language-access clinic for Spanish-speaking patients in the Detroit area, George says. It hired bilingual physicians and medical assistants for the federally qualified health center to better support this population.

Meanwhile, in suburban locations with native speakers of Arabic, “we also attract a lot of doctors who have that often as their first or their second language,” she says. For Bengali, however, it is much harder to recruit a native speaker.

“We try to be kind of opportunistic about these things,” George says, “so we may not recruit on purpose, but if we find somebody who applies for a particular position, we might say, ‘Oh, you’d be great for this other position, partly based on languages spoken.’ ”

Susan Kreimer is a freelance health care journalist based in New York.

Topics: Leadership

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