LEP patients reported providers overestimate their English comprehension and do not check for understanding

Description #

A central theme was that language-discordant providers overestimate LEP patients' understanding of English, while patients sometimes signal comprehension they do not have (e.g. to avoid appearing difficult), and providers do not check for understanding — so miscommunications go unrecognized by both sides.

"I think the doctor thought I understood everything. [I saw it in her] attitude, [her] face, because I didn't make a face that said I didn't understand." (Brooks, 2016, p. 32)

"Perhaps the most crucial revelation was that patients sometimes express understanding to the provider, even when they do not actually understand. Participants perceived that providers did not check for understanding or recognize when miscommunications had occurred." (Brooks, 2016, p. 32)

Methods Context #

What? #ⓘ

The observable: patient-perceived provider overestimation of their English comprehension and failure to verify understanding during encounters.

"Some participants added that physicians think their patients understand more than they actually do." (Brooks, 2016, p. 31)

How? #ⓘ

Four semi-structured Spanish-language focus groups (4–7 each), transcribed verbatim and coded by the immersion/crystallization method by multiple investigators to surface predominant themes and representative quotations.

"Coded reports were used to identify representative participant quotations." (Brooks, 2016, p. 31)

Who? #ⓘ

22 LEP Spanish-speaking adults from Providence County, Rhode Island, with ≥2 recent medical encounters; four countries/territories of origin; thematic saturation reached.

"All participants had limited English proficiency." (Brooks, 2016, p. 31)

Other Notes #

This perceived overestimation is the mechanism the authors flag as most consequential, since unrecognized miscommunication is invisible in encounter-level quality metrics.

Caveats #

• Findings are single-site patient perceptions from Spanish-speaking focus groups; providers were not interviewed and outcomes were not measured The evidence is the perceptions of 22 Spanish-speaking LEP patients in a single county (Providence, Rhode Island), elicited in focus groups. Providers were not interviewed about why they did or did not use professional interpreters, and no clinical outcomes were measured — so claims of inferior care and provider overestimation of comprehension reflect one side of the encounter and may not generalize to other languages, regions, or to chart-adjudicated outcomes. The authors note saturation was reached but the optimal qualitative sample size is unknown.