Cultural Misunderstandings Affect Quality of Care—and Hurt Your Bottom Line

Updated on July 28, 2012

By George Rimalower

Nowhere is precise language more important than in a hospital ER – when a patient is trying to describe an illness or a pain.

That’s also the place where true communication can be hardest to achieve.

Healthcare is hard enough to understand when all parties speak the same language and share a cultural heritage.  It already involves someone with extremely specialized knowledge trying to make sense of complex information for people of varying degrees of cognitive abilities and education.

So imagine how challenging it can be for someone who not only doesn’t speak English and doesn’t understand our healthcare system, but also has an entirely different understanding of the doctor’s role, the level of family involvement in patient decisions, what is acceptable behavior in a hospital and what traditions should be followed when a loved one is dying.

Here’s an example: On the website Ethnomed.org1, Dr. Elinor A. Graham explains that the common term for illness in Cambodian is “krun,” and it is usually translated into English as “fever” – even though the original word can mean anything ranging from “feeling ill” to “feeling hot and cold,” having a specific illness such as an ear infection, common cold or flu and “having a warm body.”  Dr. Graham advises healthcare providers to ask more follow-up questions to determine the real complaint.  But anyone who isn’t already aware of that particular word would not know that they need to take extra care in understanding the patient’s symptoms.

In many cases, miscommunication is merely frustrating or confusing.  But in a healthcare setting the potential for the miscommunication to negatively affect someone’s health is all too real.

Most people are familiar with the soft spot on a baby’s head, the fontanelle.  In Spanish it’s called “mollera.”

People who are not healthcare professionals may not know that when a baby is dehydrated the fontanelle is more pronounced and looks almost concave.  In Spanish this is called “mollera caída.”  In some Latino communities there’s a belief that when babies have the more pronounced soft spot it can lead to mental retardation.

Older generations will put a thumb in the baby’s mouth to attempt to push it back out.  This action usually makes the baby cry, the parents give the child a bottle, and that ends up re-hydrating the baby and taking care of the soft spot.  But the people involved think it was the thumb action that resolved it.

Another tradition in those cases is to wrap the baby tight in a blanket and hold the child upside down and pat the feet.  Most often these actions are harmless, although there have been some cases when a lack of understanding has had devastating results.

In the Midwest, a Hispanic woman left her baby at home with her own mother – the child’s grandmother.  While the mother was out, the grandmother noticed the fontanelle and attempted to push it back with her thumb.  When that didn’t work she held the baby upside down.  When that didn’t work, she put her hand back in the infant’s mouth and started shaking the baby.  Tragically, she ended up severing the baby’s spinal cord.

That is a rare consequence, but it underscores the importance of making sure every patient and their family members have a full understanding of health-related issues that could affect them or their families.

And it also serves as a good reminder that cultural beliefs run strong, and can have significant effect on overall health.  It’s important for caregivers and interpreters to do what they can to make sure communication is successful.

Aside from the obvious health issues, this has a direct affect on a hospital’s bottom line.

As reported in this New York Times article, medication errors are a frequent cause of patient readmissions to the hospital after being discharged.  According to the U.S. Department of Health & Human Services, one in three Medicare patients returns to the hospital within a month of being discharged.  In 2009, these readmissions cost Medicare $26 billion.

Patients cannot follow advice they don’t understand.  Language and cultural misunderstandings directly affect quality of care, and have a direct impact on your bottom line.

George Rimalower is president of ISI Translation Services (, a language services company specializing in healthcare and other industries. ISI was one of the first translation companies to address the special linguistic and cultural needs of both non- and limited-English-proficient communities of the United States. Reach George Rimalower at [email protected]

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