The aim of this essay is to understand
language barriers and miscommunication that may occur in a healthcare setting
between patients and healthcare practitioners, especially where at least one of
the speakers is using a second (weaker) language.

It is important that healthcare professionals
understand that the key to good holistic care is communication, particularly
since patients require information and reassurance regarding their care. 
Communication is something we do every day, it is the process of receiving and
sending messages between two or more people.  It is not just talking to
each other that defines communication, but it is how we respond to each other
in many different ways (Langs,1983).  There are many varied examples of
communication, such as, reading, singing, talking, writing and body
language.  In order for communication to be effective, it first needs to
be established as well as maintained. In terms of a healthcare setting, this
can be done during an assessment when a patient arrives at the practice. Stuart
and Sundeen (1995), state that communication can either create barriers and
this is the case as it is argued that  communication barriers can prevent
effective and appropriate care being provided to patients however they also
debate that it may aid in the development of a therapeutic relationship.

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In some instances, by simply observing an
individual, many problems which can hinder communication are able to be
discovered.  If the patient has any visual impairments, physical
disability or illness, observation can be used to determine which language is
being used or the way the patient is able to communicate with the healthcare
professional, as any of the issues stated could control the way the individual
is able to communicate.

Within our general practices, individuals of
all nationalities deserve the best care possible.  However, language
barriers and the misunderstanding between individuals it proposes puts a
restraint on patient care. Miscommunication in any instance could lead to
potential issues however within the health care sector miscommunication may
result in lower patient satisfaction scores, illnesses or could even be
life-threatening when streaks of communication are crossed. Hence, one of the
most important tools that we use to provide outstanding patient care as well as
improve patient satisfaction is communication.


Around 9 out of 100 individuals have limited
English proficiency.  It is believed that there are approximately 6000
languages spoken in the world.  When wandering around in modern Britain,
the South East to be precise, most of these languages are apparent. More so
when you walk into any large NHS Trust in the city we reside in.  There
are many challenges that the multicultural and multilingual world brings. The
question is, if we struggle to make sense of each other’s worlds, how do we
work together as well as support each other.

Many people from different cultures and
backgrounds walk through the doors of general practices in London every
day.  I am currently training in a busy North London practice, and whilst
on placement I observed many encounters where language barriers became an
obstacle.  The English language barrier in comparison to other native
languages has made it difficult for healthcare professionals to perform their
job to their fullest potential. This subsequently leads to unnecessary mistakes
in the Practice of Medicine due to miscommunications because of the differences
in language.

But how can we optimize the care and
information they receive?

Language and cultural differences are the
main communication barriers in which I have observed within General Practices,
where patients and healthcare professionals not speaking the same language is
something that has now become an occurrence. This is despite effective
communication with patients in primary care being an essential part of the
planning and delivery of appropriate high-quality and safe patient care.

Overtime there has been an increase in not
only the number of migrant patients however also in the staff who are
foreign-trained. Consequently, the likelihood of communication errors rises as
English may be a second language in which some still aren’t proficient in and
when either the healthcare practitioner or patient attempt to communicate with
each other on this basis, there is likely to be misinterpretations or confusion
in what they are trying to put across. In addition, methodically there is
limited research into this that addresses this issue.

There is a rise in number of foreign-trained members
of staff and patients, which means that errors in communication between
patients and healthcare staff when a second language is spoken between one or
both are increasingly likely. Hiring an interpreter who can speak the patient’s
language as well as aid the healthcare professional in making the appropriate
choices towards making the individual better, can help prevent fatal mistakes
from occurring.  As simple as this solution may sound, many general
practices have no access to an interpreter and healthcare professionals have
little training in dealing with people of a different language. On the other
hand, a problem which arises with the use of interpreters is that patients tend
to have a concern with indirect communication with the health professional.

Vital information that could significantly affect the diagnosis may be omitted
as the patient does not feel comfortable disclosing this with the interpreter.

Even with an interpreter, there is still a large chance that there could be
misinformation between the healthcare professional and patient, missing key
information that could endanger the life of the patient.


The use of a non-professional interpreter,
such as friends, bilingual member of staff or even a family member can erupt a
few ethical issues, the issue with using untrained interpreters for issues
relating to health or care discussions can usually raise legal and professional
challenges for nurses, as well as patient disclosure implications The NMC
(2008) states that patients are entitled to their confidentiality and this must
be respected by the nurse. 

Health Scotland (2008) advises that it is not
recommended for children to be substituted as interpreters, as they may become
distressed, may lack the understanding and maturity of what is being
communicated and also the patient be may be reluctant to disclose certain
information to a younger person. Nurses cannot be entirely sure if the
information that is being translated to the patient is correct (Black, 2008). (NMC,
2008) requires nurses to disclose health and treatment information if it has
been requested.

patients suffering from anxiety related illnesses there will be miscommunication
from the initial stage. In result of this psychological stress from the patient
will become apparent as well as medical discrepancies possibly displayed from
the healthcare professional. In the scenario of a patient and a healthcare
professional are communicating in different languages, it is important that
patients fully take in the advice the practitioner in a medical context. Nevertheless,
because there is a mismatch in languages, patients are more likely to fail in adhering
to the professional’s directions and in some cases saving their life. This is
why it’s essential that there is a clear understanding between the doctor and

In the instance
that the patient’s fluent language is conflicting with wider community and the
practitioner, it will distort the health related risks from the patient to the
practioner and prevents resolutions to be accurately and appropriately
conveyed. In a sector where a vast number of cultural groups is involved,
specific feelings including distress and pain can be portrayed differently , which
complicate matters even further.  Even
though in some cases, glimpses of the English language is shown; Metaphors, culturally-specific
terms or expressions can be challenging to navigate.  Furthermore, when interpreters are
unavailable and clinicians lack the cultural and linguistic skills required. Patients
have no choice but to rely on bilingual medically inexperienced relatives or
non-medical staff. This heightens the chance of worsening health outcomes and
the quality of care for the minority communities.