Lost in translation: Physicians' perspective on how language barriers affect diabetes outcomes among Latino patients with limited English proficiency

Language barriers are one major cause of ineffective diabetes care and poor outcomes among US minority populations. Because at least 21 million of US Latino patients, the largest and fastest growing minority population in the US, have limited English proficiency (LEP) and are disproportionately affected by diabetes, Latinos are at high risk of experiencing poor diabetes outcomes as a result of language barriers.  Use of professional interpreters can substantially improve the quality of care, yet may not be sufficient to eliminate disparities in diabetes outcomes for LEP patients.  Moreover, clinicians must decide when the use of interpreters is appropriate and even necessary.  Therefore, research comparing the clinical effectiveness in communication modalities (bilingual primary care provider vs. interpreter-mediated care) is needed.  Prior research from our team exploring the experience of patients across language divide suggests that patient self blame may obscure language and other structural barriers to diabetes care among low-income, LEP Latino patients. In this study, we examine the experience of language discordant care from the perspective of physicians providing care to these patients.  Using interpretive phenomenology as a theoretical framework, we interviewed a convenience sample of 15 clinicians (about one third of them bilingual and two thirds of them needing interpreter services) at a major, urban public hospital in northern California that counts with award-winning interpreter services.  We analyzed key themes pertaining to how language barriers influence clinical recommendations and providers’ clinical decision making in risk factor control (e.g. clinical inertia). We present preliminary results of our investigation.