The Unheard Voice: When Language Barriers Limit Patient Care

I never had to think when I switched between speaking Tamil and English, it was second nature to me. I spoke Tamil at home and English at school, sometimes mixing the two without realising it. I had never given much thought to the role of an interpreter. I had always translated for my parents during appointments and considered it normal. It wasn’t until I began observing GP appointments as a student that I realised how many details were overlooked.

There is one appointment I remember clearly. A woman in her thirties walked in with her son, who volunteered to translate for her as the scheduled interpreter was not available. They both spoke Tamil, and without meaning to, I understood every word they said. At first, everything seemed to go well; the GP asked general details about the abdominal pain the woman was experiencing, and her son translated clearly everything she said. The GP continued, asking more personal questions about her menstrual cycle; I could sense a shift in both the mother and son. The mother took her time before speaking, giving very short and rushed answers. The son started to hesitate before translating, missing out details and mumbling his words. It felt very uneasy seeing the awkwardness and discomfort between the two.

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I quietly caught the GP’s attention and told him I was fluent in Tamil. With the consent of the patient, her son waited outside while we finished the appointment. I spoke very gently in Tamil, trying to make her feel at ease. Her answers started to be longer, more specific, and the relief was evident on her face. The GP continued to ask direct questions, which helped him gain a clearer picture of what was going on. At the end of the appointment, the woman and her son thanked me. In that moment, I realised how differently the appointment could have ended and the value of a professional interpreter.

I am writing this piece as a current medical student, whose understanding of language barriers has been shaped by both my personal and professional experiences. From translating for my parents as a child to observing GP consultations as a student, I have seen firsthand how communication gaps can affect patient care. This has motivated me to reflect on the impact of language barriers and the urgent need to address them.

Language Barriers in UK Primary Care

The UK is very linguistically diverse, with more than three-hundred different languages spoken. In fact, over 20% of primary school children speak English as an additional language. Nonetheless, patients with limited proficiency in English face significant language barriers in healthcare, resulting in a higher risk of adverse events, misdiagnosis and unplanned readmissions.

The UK’s Equality Act 2010 places a legal duty on the National Health Service (NHS) to reduce inequalities between patients with respect to their ability to access health services. The guidance for primary care states that ‘patients should be able to access primary care services in a way that ensures their language and communication requirements do not prevent them receiving the same quality of healthcare as others.’ However, there has been little progress in implementing this guideline, with large gaps between the policy and the reality that many patients experience. 

Non-English-speaking patients face multiple barriers when accessing healthcare, including struggling to communicate their symptoms clearly, understanding medical information, booking an appointment, and even requesting the needed language support. For example, a pilot study exploring the experience in South Asian communities with limited English proficiency reported that lack of confidence in the system, difficulty in requesting language support, and fear of being a burden impacted the experience of care in this population. 

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Communication barriers are also experienced by healthcare professionals. A nationwide study of 599 primary care physicians in Switzerland found that 90% experienced language barriers at least once a year, with 30% encountering them weekly. While no large-scale nationwide survey exists in the UK, qualitative research and numerous reports consistently highlight clinicians’ concerns regarding language barriers.

Lack of Adequate Support for HealthCare Professionals

What is even more striking is that healthcare professionals do not have access to adequate tools to overcome these barriers. Although professional interpreter services are considered the gold standard for addressing language barriers in primary care, they are often unavailable and, as such, replaced by ad hoc translation by patients’ family members or friends. In fact, the study cited above reported that while 88% of clinicians expressed a desire to access professional interpreting services, over 60% had never done so. This led over 60% of clinicians to rely on patients’ relatives and friends, including 23% who depended on minors.

While translation by relatives and friends is often the most practical solution, it is not the most optimal. As illustrated by the earlier example of the woman presenting with abdominal pain, relying on her son to translate created discomfort and reduced the amount of information shared, which in turn limited the clinician’s understanding of her medical needs.  Indeed, research has shown that translation by relatives or friends is associated with higher rates of errors, ethical and confidentiality concerns, as well as lower satisfaction for both patients and clinicians.

So, What is the Way Forward?

To address this issue, alternatives to professional interpreting services have been explored. At present, the most promising solution involves using digital translation tools and remote interpreting devices. A systematic review assessing different research studies exploring the performance of ChatGPT-4 and Google Translate in translating text and instructions found that translation accuracy was above 90% in both tools. However, it is important to note that up to 6% of instruction sets were translated incorrectly, which was deemed clinically concerning. As such, the study concluded that currently these tools are suited for low-stakes situations, as they lack accountability and clinical validation. Despite these limitations, digital translation tools represent a key area for future research and hold potential to help mitigate language barriers for both patients and clinicians.

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Beyond professional interpreting services, education is another area for addressing language barriers in healthcare. There are many educational initiatives aimed at helping healthcare professionals develop the skills and awareness needed to recognise communication challenges and work with the services effectively. For example, the Interpret2Improve initiative was an educational programme designed for healthcare students to focus on collaborating with interpreters. Out of the 22 participants, 14 reported increased awareness in addressing language barriers after the programme. This suggests that education can improve clinicians’ confidence in interacting with interpreter services; however, it cannot alone resolve the wider systemic issue. Nonetheless, these programmes still remain valuable in teaching clinicians to advocate for their patients’ rights, particularly when access to professional interpreting services is required.  

Educational programmes should also focus on improving awareness of non-verbal cues — such as tone, facial expressions, pauses, and body language — and on the ability to read between the words to recognise subtle signals from patients. This is especially important when language directly limits what can be verbally expressed.

Everything discussed in this article highlights that no single solution is sufficient to address language barriers in healthcare; rather, a combination of strategies is required. The need to address these issues is undeniable, and we must continue to advocate for change. Equitable care means providing patients with a space where they feel comfortable enough to express themselves and have their voices heard. As a future doctor, this is the kind of care that I aspire to deliver.