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Do Your Patients Understand Their Written Discharge Instructions?

— All patients should have access to medical information in their native language

Ƶ MedicalToday
A photo of medical discharge forms.
Kao is an in-patient hospitalist.

As King Charles and Princess of Wales Kate Middleton undergo cancer treatment, no doubt they each have a team of physicians and employees paying careful attention to every instruction their care team offers.

Unfortunately, in the U.S., the majority of patients in hospitals who do not have English proficiency do not share in this experience. They are often unable to receive care in their native language or take home specific discharge instructions tailored specifically to their hospital stay, written in a language they understand.

As a hospital-based physician, I see this problem firsthand with my patients' take-home instructions, as well as with my very own parents.

I FaceTime into my father's medical appointments across the country as much as my schedule allows. At 88, he is still physically robust, but his challenges with vision and hearing, as well as memory, make it hard for him to navigate the medical system.

My mother is still a stalwart of energy, and while both of their English skills are quite proficient, having lived and worked for over 50 years in the U.S. from their native Taiwan and China, it's not their native tongue. Their healthcare provider speaks Mandarin as well as English, and can conduct some of their interviews and instructions in Mandarin, which is quite comforting to them.

Even with all of this support, questions still arise both during and after the visit.

"Do I need to continue this medicine as my labs are fine now?"

"Why do I need all these blood draws?"

"Do I need to follow up with the doctor when my prescription runs out? I'm not sure I understand the instructions."

Nearly one in five people in the U.S. now speak a language other than English in the home. These people will likely require interpreter (verbal) and translation (written) services when hospitalized.

Despite advancements in technology with video interpretation and laws that in healthcare for institutions with federal funding, there has been an observed disparity in of non-English speakers, which could be in part tied to communication challenges.

There is a for written translation of "vital documents." However, real-time written translation services are less available than interpreters who are present for verbal interpretation, and not all AI systems are vetted systematically for accuracy, although there have been some promising studies in this regard.

In today's healthcare environment, when hospital beds and space are at a premium and the necessity of early discharge is constantly impressed on all hospital providers, the ability to accurately translate personalized instructions to patients and families into their language of choice at discharge remains elusive, creating a dangerous situation for non-English speakers.

Of note, there is a proliferation of patient information sheets in various languages. showed that 74% of institutions surveyed reported translating discharge instructions; of those, most reported use of pre-translated documents (87%) or staff interpreters (81%). But when it comes to real-time translation of specific information and tailored take-home patient instructions, are hospitals equipped to provide this? Many don't have the resources: it is expensive and there is a lack of trained translators.

We need to prioritize feasible solutions.

Investment in the AI space, to provide accurate medical translation, and government support for increased reimbursement or funding, is one avenue through which to improve the transition from hospital to home, and mitigate the risk of readmissions.

Other innovative solutions, such as videos of verbal instructions (in the patient's preferred language) that can be texted to patients, could also be useful. More research and implementation funding can help make this goal a reality.

With so many competing priorities and the cost of healthcare continuing to rise, it's hard to imagine allocating more dollars to hospitalized patients. However, given the amount of money spent on related to communication failures, perhaps investing more in interpreters and written translation of discharge materials could alleviate some of that malpractice cost burden, as well as some of the associated with preventable adverse events linked to communication challenges.

Certainly, one could argue that just because healthcare providers offer written instruction in the patient's language, that does not mean every patient will read or follow them. However, the same is true of English-speaking patients, and providers do not withhold this same opportunity.

Legislation in place from the must be made more specific to require personalized translation services for discharge instructions.

At the end of the day, I don't know for certain if a video of the physicians' instructions or written instructions in Mandarin would decrease the amount of questions my parents ask me, as their physician daughter. But I can't help but think that if it's this hard for my English-proficient parents with a physician daughter to understand their treatment course, what are patients who speak limited English or who do not have a healthcare provider as a family member struggling with after they are discharged from a complex hospital stay?

This is not fair. We can and must do better.

is a hospitalist and co-founder of the division of Pediatric Hospital Medicine at Mass General for Children. She is a former fellow of the Commonwealth Fellowship in Minority Health Policy at the Harvard School of Public Health and is an assistant professor in Pediatrics and Medicine at Harvard Medical School. She is a 2024 Public Voices Fellow through The OpEd Project.