"There is a gap”: A qualitative study of patient experiences in a linguistically diverse safety-net primary care setting

INTRODUCTION: Conversion to a patient-centered medical home (PCMH) has the potential to improve patient experience and primary care quality. Within an urban safety net Adult Medicine Clinic (AMC), an urban safety-net setting, these desired outcomes are complicated by both the diversity of the patient community and the continuity implications of a residency program. To create a truly patient-centered environment within such a complex healthcare setting, direct engagement with patient voice and experience beyond survey-based satisfaction measures is crucial, though not often done.

METHODS: To more holistically explore the patient experience, the authors initiated a qualitative study, interviewing 19 patients who spoke English, Spanish, or Mien about what makes their experiences in the clinic positive or negative. These three groups represented the most commonly spoken or interpreted languages in the AMC. The authors—a team of physicians, researchers, interpreters, and a patient—collaboratively analyzed the transcripts and notes to identify key themes of patient experience.

FINDINGS: Some themes were identified across language groups. The unique challenges of physician discontinuity due to residency training resulted in frustration with physicians not knowing one’s history, while the expectation of healthcare system failures—a sense that “it’s just [the Hospital]”—was tied to the reality of seeking care at a public facility. Other themes were specific to the non-English speakers. Spanish and Mien speakers both described the potential negative influences of interpreter-filtered conversations on the provider-patient relationship as well as quality of care. As one Spanish-speaking patient said:“The appointments…[are] only fifteen minutes long and then you waste a lot of time when you…are telling the interpreter what the doctor is asking you…you lose some of the natural flow of conversation between a patient and provider.” Mien speakers in particular identified a sense of being forgotten and unable to self-advocate as a result of the language barrier, in part due to speaking a language that is not spoken amongst healthcare providers or staff in the AMC.

DISCUSSION: Findings demonstrate important crosscutting issues to be addressed as well as the added impact of language differences on clinical relationships and healthcare system navigation. The challenges faced by all patients within the AMC are compounded by the realities of seeking care in a different language. Soliciting the perspectives of a diverse community of patients is vital for nuanced considerations of needs and challenges within primary care training clinics to create a medical home for a linguistically diverse patient population.