Conscious and Unconscious Biases in Health Care

Role of Linguistic Competence

Female nurse in hospitalThe literature cites patient-provider communication as a contributing factor to health care disparities including documented differences in the way practitioners communicate with patients based on race, ethnicity, primary language spoken, and other demographic factors. 3,47(p359)-51 Conscious and unconscious biases on the part of practitioners are frequently cited as causal factors in this literature. For example, biases are documented in how health care practitioners interact with patients who have limited English proficiency among language discordant encounters. An interesting finding in this literature is that such biases exist even when there is language concordance among patients and medical staff. Johnson et al., found that African Americans, Hispanics, and Asians were more likely than Whites to agree that medical staff judged them unfairly or treated them with disrespect based on how well they speak English.52

“The finding in this study that African Americans believe they are treated unfairly and with disrespect in the health care system based on the way they speak English lends support to the assertion that cultural differences between African Americans and their predominantly white physicians exist, regardless of language concordance.”52(p108) Embedding linguistically competent approaches in your practice can address both conscious and unconscious biases for the population of patients who have limited English proficiency, those with low health literacy, individuals with disabilities, and those who are deaf or hard of hearing.

Data from the U.S. Census reveal a high degree of linguistic diversity, with more than 59 million residents speaking a language other than English at home.53 Among these, a total of 25.2 million live in linguistic isolation, a termed coined by the U.S. Census Bureau where no one in a household over 14 years of age speaks English at least very well. There is a well-documented body of evidence that describes the adverse impact on patients with limited English proficiency when interpretation and translation services are not provided in health care settings including, but not limited to:

  • Poor communication;
  • Incomplete and inaccurate health history;
  • Misdiagnoses of health and mental health conditions;
  • Misuse of medications;
  • Patients’ lack of understanding of their health condition and recommended treatment;
  • Repeat visits to physician offices or emergency room; and
  • Lack of informed consent.

Linguistic Competence

Linguistic competence is the capacity of an organization and its personnel to: (1) convey information in a manner that is easily understood by diverse groups including persons of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabilities, and those who are deaf or hard of hearing; and (2) respond effectively to the health and mental health literacy needs of populations served. The organization must have policy, structures, practices, procedures, and dedicated resources to support this capacity.54

Now let us hear from Dr. Glenn Flores, a nationally recognized clinician, researcher, and educator in reducing racial, ethnic, and linguistic disparities in health and health care about why health care professionals may not utilize interpretation services.

Dr. Flores also shares advice about how to encourage health care professionals to overcome these barriers.