Spanish Medicine in the United States

© Francisco Marcos-Marin, PhD, 2019 RIUSS Translation from Spanish Language Source: 

Treating a Hispanic at a U.S. medical center can cost 60 times more than treating an Anglo who has the same disease. The reason is primarily linguistic: Hispanics go to the hospital and begin treatment much later, when the disease is very advanced and treatment is much more expensive. Why? Simply because they are ashamed (they are “embarrassed” as the Mexicans say) to go to the doctor because of their poor knowledge of English and because they do not perceive that there is communication between them and the professionals who treat them. It is true that the legislation protects citizens and residents who speak other languages. Any institution receiving federal aid has an obligation to provide an interpreter. 

The solution is not so simple. Interpreting requires technical knowledge that is not readily available. Families often turn to the youngest of their members, who go to school and are, in theory, bilingual. Exactly the same as Arabic-speaking families in Spain or other European countries. This means throwing on a girl’s back (it is more frequent that girls are in charge of this task) the responsibility of understanding medical concepts that surpass her level of knowledge of the world and its corresponding linguistic expression. A ten-year-old Hispanic girl, although she speaks English at her school level just like her Anglo classmates, is not capable of understanding the medical-hospital lexicon and can make serious mistakes, with the best intention in the world. Her experience of life and illness is insufficient. 

To this must be added the complexity of hospital institutions and services. The size of the hospital, for example, is already a psychological barrier that dissuades many from going to the doctor. Moving around inside the building is not easy either. There are patients who have never seen an elevator, for example, except in the cinema or on television, and the same is true of escalators. These devices sometimes produce a fearful rejection and sometimes, especially in the youngest children, an attraction that makes them go up and down several times, like a game. 

There is a growing concern to train doctors and nurses, many of whom are of Hispanic origin and have a greater or lesser knowledge of the Spanish language; but this implies an additional responsibility that requires a type of control to ensure effective communication. 

When communication does not take place, it is useless to prepare instructions for patients to follow their treatment, because, by not understanding them and colliding with traditional uses and different ways of understanding the medical culture, those instructions will not be followed or will be followed badly and the patient will get worse, with the consequent increase in costs. Written explanations are incomprehensible to many and oral explanations, although they may give another impression, are not understood either, when patients do not have the lexical and conceptual level that allows them to assimilate and comply with what they are being told in Spanish. In addition, the Spanish of health personnel may include terms of variants of Spanish that are not familiar to the patient and vice versa. 

Institutions and health care staff are aware that this situation can only be improved through training in Spanish as part of medical-health care studies, for anyone who wishes to be able to practice bilingual medicine. In order to do so, it is necessary to work towards the normalization or standardization of medical Spanish in the United States. 

In March 2018, the National Hispanic Health Foundation and the School of Medicine of the University of Illinois (Chicago) convened an interdisciplinary panel in Maryland, near Washington DF, to establish the paths that would define this standard and recommend the pertinent educational measures. For climatic reasons (a great snowstorm that prevented other colleagues from reaching) I became the only representative of RIUSS, the Research Institute of United States Spanish, thus I was present at all meetings and activities that allowed me to have a clear vision of the problems and proposed solutions. The situation, as can be imagined, is complex; but the number of people involved, more than fifty thousand medical doctors, justifies all the efforts. 

The Medical Spanish Taskforce was created to define educational standards. In this line it is evident from the beginning that a consensus must be reached among the many and varied institutions that offer medical Spanish courses, in order to guarantee a complete and balanced training. Related to this is the problem of examinations and certifications. It is necessary to achieve homogeneous solutions and for this it is necessary to unify the criteria that define the core competencies. The educational programs that are becoming increasingly necessary will be built on this core. Medical schools that offer medical Spanish courses must be based on a strong strategy of medical education in which other professionals must participate, because the Spanish-speaking population is growing and must be given the necessary health care. 

The study of the linguistic needs of medicine in Spanish requires coordination, the relevant research, with financial support from the federal and state governments, must achieve standardization with homogeneous curricula, homogeneous learning strategies and research aimed at an understanding of the linguistic needs for medicine in Spanish. The information coming from the doctor-patient relationship must correspond to a normalized pattern. The purpose of all this effort is health: the improvement of the health conditions of the Spanish-speaking population in the United States. The medical aspect must take precedence over the linguistic one: it is not a question of imposing a supposedly normalized or academic terminology. It is a matter of extracting linguistic information from the doctor-patient relationship and applying it so that resources and health efforts are fully exploited, thanks to a significant improvement in communication. It is essential that there be a consensus and that the Medical Spanish Taskforce advance along the path of basic linguistic research applied to medicine and, most specifically, to educational programs, their outcomes and certifications. It should not be forgotten that what is important is not the linguistic study, a means to achieve the end, but the improvement and standardization of educational programs that lead to effective communication with patients. 

People interested in Spanish in the United States are often surprised by the dance of numbers, which often does not match reality, but to the interests of the institutions that handle them. That is why sometimes partial considerations are more representative, not the global sum. Between 1990 and 2015, according to the American Community Survey, Spanish-speaking residents grew by 131.2%. 17.2 million of them are monolingual Spanish speakers. From the point of view of the care of the population, this is a very considerable figure, which requires all efforts to ensure their welfare and this can only be achieved 

with improved communication between patient and health personnel. It seems more important to ensure medical care for Spanish speakers in North America than to discuss which country has the highest number of Spanish speakers in the world. In addition, the economic repercussion is enormous, the greater the linguistic attention, with a substantial improvement in communication, the greater the savings in health expenditure. These savings will undoubtedly be greater than the cost of research and educational programs. The support of the National Hispanic Health Foundation and U.S. health professionals offers every guarantee.