Language access and health care have myriad interrelationships, often of the life-saving and life preserving variety. One of the most integral realities of interpreting health care information and advice is navigating through the complexities of medical jargon, the terms, phrases, and descriptions that are part of medicine and medical care.
But medical jargon is not easily understandable to many people, English speakers and people who are limited English proficient. Medical professionals’ reliance upon and use of such jargon when communicating vital health care information has long been a problem, according to Dr. Michael Wolf, Northwestern University Feinberg School of Medicine professor who studies the ways health communication can go wrong.
Medical Jargon gets in the Way
In a recent report by National Public Radio, Dr. Wolf said:
“Confusion over what a health provider or website is trying to convey can actually lead to misinformation and mistrust of the very things people need to protect themselves…
Drug names are typically multisyllabic and difficult to pronounce. Drugs like acetaminophen often get confused with other drugs, such as amoxicillin, which can make it hard for people to remember which drug they are taking or took previously, when giving a medical history.
Another common problem is ‘vague instructions on prescription vials.’ How should one interpret ‘twice or three times daily’ when taking a medicine? Is that over a 12-hour day, or over 24 hours? And how much in each dose?”
Translate the Jargon – It’s the Law
So, what do health care providers do about translating jargon into more understandable terminology? The first step is recognizing that federal law provides an answer. Both Section 1557 of the Affordable Care Act and Title VI of the Civil Rights Act of 1964 require federally subsidized health care providers and organizations to give people who speak and write little or no English “meaningful access” to health care services.
Health care information must be accurately interpreted and translated for LEP people so they have access to medicine, medical care, and health care information.
In the health care setting, legally compliant language assistance must include utilizing trained interpreters and translators with knowledge of and fluency with relevant health care terminology, including all that jargon. Personnel who provide language assistance must “…have knowledge … of any specialized [health care] terms or concepts peculiar to the entity’s program or activity and of any particularized vocabulary and phraseology used by the LEP person”
Department of Justice Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons (67 Federal Register 41464 et seq).
Similarly, the US Department of Health and Human Services’ National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards) similarly require health care providers to translate medically vital information and to utilize trained people who are familiar with and who can accurately convert medical jargon from English to another language.
To be fully and effectively “bilingual” in the health care environment, medical personnel who communicate directly in language with LEP persons must demonstrate proficiency in the target language and have knowledge in English and the target language of any specialized terms or concepts (jargon) peculiar to the provider’s program or activity and of any particularized vocabulary and phraseology used by the LEP person.
Providers should also ensure that all bilingual or contracted personnel who serve as translators understand the expected reading level of the audience and, where appropriate, have fundamental knowledge about the target language group’s vocabulary and phraseology. See: U.S. Department of Justice Technical Assistance & Guidance for Federally Conducted & Federally Assisted Programs
As I and others have written in multiple blogs and other media, the COVID-19 pandemic has revealed myriad health care disparities and inequities. One such example is not explaining medical jargon to LEP people in ways that they can understand and that fulfill the “meaningful access” requirement of federal law.
NPR Recounts How Jargon Impacts Health Care
As NPR reports:
When cases of COVID-19 began rising in Boston last spring, Pooja Chandrashekar, then a first year student at Harvard Medical School, worried that easy-to-understand information about the pandemic might not be available in the many languages spoken by clients of the Family Van, the health services and health literacy program where she was working at the time.
So Chandrashekar recruited more than 175 multilingual health profession students from around the U.S. to start the COVID-19 Health Literacy Project. Its aim: Create clear, understandable information about the virus in more than 40 languages, including English. The group’s COVID-19 fact sheets, vetted for accuracy and readability by faculty members who speak and read those languages (the first Urdu effort was deemed too formal), were shared with community organizations around the world. They’ve been downloaded more 250,000 times so far in over 150 countries.
Each sentence of the fact sheets must be carefully crafted, the volunteers have found, because there is so much room for misunderstanding. Take for example, the common medical guidance that anyone who thinks they might have COVID-19 should call a doctor. “Translated incorrectly, Chandrashekar says, this could be interpreted as ‘Don’t go to the emergency room until you call your doctor — even if you have symptoms of severe illness.” And that could, in some cases, be a fatal mistake.
The sudden global appearance in 2020 of COVID-19, a new and often lethal viral illness, has meant the scientific evidence on what to do to prevent and treat the virus has been changing rapidly. Simply keeping up with the latest understanding and guidance has been especially challenging for a number of groups in the U.S. — people who speak little or no English, many older adults, people with limited education or cognitive skills and really anyone who finds the often-opaque language of health care too difficult to understand…
The U.S. Department of Health and Human Services defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” By that definition, about 14% of Americans are deemed to have “below basic” health literacy, according to Joseph Dexter, a science data fellow at Harvard University…
Health literacy initiatives have become even more important in 2021, experts say, with millions of people still unvaccinated against COVID-19, often because they don’t understand the information offered or don’t know where or how to get the shots.
Dr. Alicia Fernandez, director of the Latinx Center of Excellence at the University of California, San Francisco, says she noticed when the vaccine rollout began that many health systems were reaching out to patients via the online portals of their electronic health systems, and that tendency left a lot of people out.
‘Health care systems are not set up to be as useful for patients with low health literacy, and the pandemic has exposed that,’ Fernandez says. ‘In the last decade, or so, health care systems have relied more and more on patients doing things for themselves — like filling out forms online and accessing test results online rather than getting a call from the doctor…’
We can expect more health literacy projects aimed at easing the pandemic. HHS recently announced $250 million in funding to go to health literacy programs aimed at COVID-19 safety and vaccinations as part of the American Rescue Plan.”
Language Access is Power
It is axiomatic and common sense that information is power, according to HHS Acting Assistant Secretary for Health Dr. Felicia Collins. But such power can only be effectively wielded when its underlying information is linguistically understandable. During a deadly pandemic that has killed millions of people worldwide, life preserving and life-saving pandemic information must be given in languages people understand so they can use the information to empower and save their lives and the lives of their families, friends, and communities.
© Bruce L. Adelson 2021. All Rights Reserved The material herein is educational and informational only. No legal advice is intended or conveyed.
Bruce L. Adelson, Esq., is nationally recognized for his compliance expertise. Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Trial Attorney. Mr. Adelson is a faculty member at the Georgetown University School of Medicine and University of Pittsburgh School of Law where he teaches organizational culture, implicit bias, cultural and civil rights awareness.
Mr. Adelson’s blogs are a Bromberg exclusive