96% of U.S. millennial healthcare providers believe Spanish-speaking patients receive inferior care to English-speaking patients
The stress of the coronavirus widens existing health inequities for Spanish-speaking patients. Even with the aid of interpretation technology, it takes an English-speaking healthcare provider on average 1.5 to 2 times longer to treat a Spanish-speaking patient than an English- speaking one. (1) As a result, building rapport between doctor and patient is nearly impossible, and health outcomes decrease. "A good relationship fosters better communication, which improves diagnosis. It also encourages people to tell their doctors about symptoms they might not otherwise disclose," says Dr. John Kelley, a psychologist at Massachusetts General Hospital. (2) Medical schools and residency programs across America are rising to the challenge to educate healthcare professionals to give more culturally competent care to address this problem, and some healthcare professionals are taking matters into their own hands to learn medical Spanish.
A Widespread and Growing Problem
In a survey of millennial doctors and nurses, 96% thought that Spanish-speaking patients received care inferior to English-speaking patients, with 35% believing COVID-19 had made matters disproportionately worse for Spanish-speaking patients. (1)
Of those responding to the survey, a full 89% had witnessed Spanish-speaking patients receiving inferior care, with the most reported issue being interpreters not being called when needed. More than half (52%) observed practitioners acting without complete information in a life or death situation due to a lack of rapid interpretation services and their inability to communicate with patients in Spanish. In addition, 11% said they have witnessed racist or disrespectful treatment toward Spanish-speaking patients. (1)
A unanimous 100% of the doctors and nurses surveyed wished they were more proficient at Spanish at some point in their career. Over 70% of them have tried or are actively trying to improve their Spanish, but only 11% reported feeling confident using the Spanish they had learned with patients. About a fifth of responding to the survey (19%) felt their learning was somewhat effective in helping them communicate with patients. The majority (56%) reported being unsuccessful in learning Spanish, citing factors such as not having enough time and not seeing results fast enough to keep them motivated. (1)
While the problem grows, it seems as though the medical field’s ability to solve it is decreasing. Less than 6% of non-Hispanic white physicians report being fluent in Spanish compared to 69 to 92% of Latino physicians, and to make matters worse, the percentage of Latino physicians relative to the total physician population has declined over the last 30 years. (3)
Medical Schools Attempt to Solve Health Inequities
Medical schools have taken steps to combat these health inequities by teaching medical Spanish as an elective. A 2015 survey found that 66% of US medical schools offered curricula to develop Spanish-speaking skills, and 62% of these schools incentivized participation with school credit. However, many of these programs did not offer an assessment of oral language proficiency. (3) An overwhelming 93% of doctors and nurses surveyed believe that medical and nursing schools should expand their curriculum to include more education on how to use basic medical Spanish. (1) At a time when the number of Spanish-speaking patients is increasing rapidly -- the Spanish-speaking population in the US is estimated to double over the next 50 years -- teaching Spanish-speaking skills at every medical institution is essential to proper patient care. (3)
The Urban Health Scholars program at the Geisel School of Medicine demonstrates how medical schools are changing their medical Spanish curricula to make it more robust, immersive and integral to medical education. In addition to offering Spanish as an elective, they require service-learning opportunities and additional enrichment activities. Also, the Urban Health Scholars are working with the Migrant Health Interest Group at Geisel to offer clinical service opportunities for students to practice their Spanish skills and participate in the delivery of healthcare to underserved migrant farm worker populations in the area. (4)
The Lawrence Family Medicine Residency is another organization that is training its physicians to give patient-centered care to communities that are underserved, offering 10- to-14 day intensive medical Spanish training residencies. Equipped with the Rassias Method®, a unique approach that speeds language learning and increases language retention, this program is able to get participants speaking and understanding medical Spanish in as little as two weeks. (5)
Dr. Rose Molina, the leader of Harvard Medical School’s Medical Language Department, has made it a clear mission of the department to educate doctors to give more “culturally humble care.” The department’s most advanced Spanish language program, called “Intensive Medical Spanish,” is geared for students with beginner or intermediate knowledge of the language. This speaking-focused, 28-day course is an efficient way to get students on the right path to communicate with patients in Spanish, but without supplemental studying and practice, programs like it will not be enough to sustain a lifetime of interactions with patients in Spanish. (6)
The Future of Medical Spanish Education
While medical schools and residency programs are taking action, some healthcare providers are taking matters into their own hands, using innovative new technology to improve their spoken Spanish. Dr. Jenny O’Brien, an internal medicine resident at Temple University Hospital, treats Spanish-speaking patients daily and uses Beepboop, a speaking-focused medical Spanish language learning app, to help her improve rapport with her patients: “It’s important to me to connect with my patients and their families. While I’ve studied Spanish since high school, I never felt comfortable speaking it until I started using Beepboop. Whenever I have a spare moment after work, I use Beepboop to connect with teachers who guide me through simulated patient experiences in Spanish. I find actually practicing speaking out loud with people is the only thing that helps me overcome my fear of speaking in real life and prepares me the most for treating my patients.”
Launched in September 2019, Beepboop provides free classes, starting every thirty minutes, that allow groups of students to connect live with language instructors to practice speaking medical Spanish. Beepboop was recently awarded a grant by the U.S. Economic Development Administration through Hofstra University’s HECC for its efforts solving health inequities in U.S underserved communities. (7)
The lack of Spanish-speaking healthcare workers across the country is a problem that is looming ever larger, but solutions exist. While many medical schools and residency programs are stepping up with Spanish language programs, healthcare providers are beginning to utilize new technology, such as Beepboop, to help them rapidly improve their medical Spanish in order to deliver more culturally competent care.
- Beepboop (2020). US Healthcare Providers Believe Spanish-Speaking Patients Receive Inferior Care (Working paper). New York City, New York.
- Doctor-patient relationship improves your health. (2014, June). Retrieved November 17, 2020, from https://www.health.harvard.edu/staying-healthy/doctor-patient-relationship-improves-your-health
- Sadanand, A., Ryan, M. H., Cohen, S., & Ryan, M. S. (2018). Development of a Medical Spanish Curriculum for Fourth-Year Medical Students. PRiMER, 2. doi:10.22454/primer.2018.738688 https://journals.stfm.org/media/1807/sadanand-primer2018738688.pdf
- Medical Spanish. Retrieved November 17, 2020, from https://geiselmed.dartmouth.edu/uhs/projects/spanish/
- Spanish Curriculum. (2020, July 23). Retrieved November 17, 2020, from https://glfhc.org/residency/curriculum/spanish-curriculum/
- Medical Language Program. Retrieved November 17, 2020, from https://meded.hms.harvard.edu/medical-languages
- Devon Saliga – Bilingual Communication for Better Health Outcomes. (2020). Retrieved November 17, 2020, from https://www.nasdaq.com/articles/devon-saliga-bilingual-communication-for-better-health-outcomes-2020-10-07