What does being a surgical patient with limited English proficiency in the U.S. look like?

04 Mar 2023

By Gabriela Brandão, MD

Have you imagined yourself under the surgeon’s knife? It might be a terrifying circumstance even for us, right? Now, can you imagine yourself under the surgeon’s knife but in a place where nobody speaks your language? You would have no idea what’s happening with your health in that room… It would probably be an intense fear of death. That scenario is not just a fictional horror movie story, unfortunately. According to the U.S. Census Bureau, over 25 million people in the United States speak English “less than very well.” Many of them have very limited or no understanding of English. We have already faced or will definitely meet those patients throughout our surgical careers. We seek to provide the highest quality of care possible for all of our patients. Addressing language barriers in health, medicine, and surgery is urgently needed.

Let’s think together about their main barriers and how to address them:

In the outpatient scenario:

          The very first difficulty might be reaching the first surgeon appointment. There are many barriers here, including scheduling, transportation, entering the hospital or clinic, finding the right place, and more.

          With a lot of help or a lot of struggles, the patient is face-to-face with the surgeon. What now? The patient might already be stressed and anxious and have to explain their symptoms. Many other factors might play a role here, including the level of literacy and cultural background. Let’s consider that the patient was able to explain clearly and in detail enough for the surgeon to make the proper diagnosis.

          Now, it is the surgeon’s responsibility to ensure the patient completely understands the explanation of the diagnosis, the surgical procedure, and all the risks involved in both decisions to be operated on or not and to give all the necessary preoperative instructions, medications, labs, imaging, etc. Now, what are the chances, under so many barriers, the patient has had a complete understanding to make an individual choice reasonably? It’s not for nothing that patients with limited English proficiency (LEP) have shown to have more LOS, chances of complication, late presentation of disease, and many other disparate outcomes.

In the inpatient scenario:

          During hospitalization, the challenges are magnified. There are many encounters requiring communication, from the nursing staff to the residents and attendings. That miscommunication can generate a lack of trust and compliance with the treatment, directly impacting the outcomes.

          In a busy surgical schedule, those patients, because they require more resources or time, usually do not receive the same unbiased, effortless care as other patients. They are more likely to have a faster visit, receive ad hoc translator assistance, or even gestures-only communication. This receipt of negligence. For those who like financial consequences, think about where those medical errors can lead as well.

In non-exhaustive ways, we can start doing better by using professional interpreters (not family members, friends, or hospital working staff), providing translated and visual materials, addressing the cultural barriers that might be playing a role, and using the plainest vocabulary possible.

Besides patient contact, you can also indirectly support them by advocating for their proper care in your local institution, advocating for their proper care when caring for them in your team, and supporting or partnering with people and groups that have research and education initiatives focused on improving their care and addressing those disparities in surgery.

I hope to have made you at least thoughtful about the matter. I am Latina, an aspiring surgeon, and I hope to be part of the change for that population as much as Association of Women Surgeons has been for women and minorities



Gabriela Brandão is a Brazilian medical doctor who aspires to become an Academic Surgeon in the United States. She is preparing to apply for the general surgery residency MATCH in the near future. Additionally, she serves as the founding president of the AWS UFCSPA Chapter and is scheduled to commence her tenure as a research fellow at the Beth Israel Deaconess Medical Center in Boston. Gabriela is a member of several esteemed organizations, including the Association of Women Surgeons, Latino Surgical Society, and Association for Academic Surgeons. Her research interests primarily focus on addressing disparities in surgery, surgical oncology, and promoting gender equity. Twitter: @BrandaoGR 

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