Caring for Patients with Limited English Proficiency: The Perspectives of Small Group Practitioners

BACKGROUND: Language barriers in medical care are a large and growing problem in the United States. Most research has focused on how language barriers affect patients. Less is known of the physician perspective and the efforts they are making to overcome these barriers. OBJECTIVE: To learn about current approaches to communicating with limited English-proficient (LEP) patients and the associated financial and nonfinancial constraints that private practice physicians and managers perceive in providing these services. DESIGN: Computer-assisted telephone focus groups with open-ended discussion guide. SETTING: Small private practices in geographic areas that have experienced recent dramatic increases in LEP populations. PARTICIPANTS: Primary care physicians, specialists, and practice managers. APPROACH: Focus group transcripts were systematically coded using grounded theory analysis. The research team then identified common themes that arose across the groups. RESULTS: Citing the cost, inaccessibility, and inconvenience of using professional interpreters, physicians commonly used family and friends as interpreters. Few recalled any actual experience with professional interpreters or were well-informed about the cost of their services. Physicians and office managers voiced uniform concern about how language barriers impede quality and safety of patient care and increased malpractice risk. CONCLUSIONS: Health care providers in private practice recognize the importance of overcoming language barriers. However, perceived barriers to implementing cost-effective strategies to these barriers are high. Physicians in private practice would benefit from information about how to best overcome language barriers in their practices efficiently and affordably.