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Deconstructing language barriers in healthcare: where are we going wrong?
  1. Tim Venkatesan1,
  2. Danial Naqvi1,
  3. Bakula Patel2
  1. 1North Middlesex University Hospital, London, UK
  2. 2School of Medicine, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Tim Venkatesan, North Middlesex University Hospital, London N18 1QX, UK; t.venkatesan99{at}

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The COVID-19 pandemic has sharply brought to light the need to address inequalities in health. Language barriers have been demonstrated to be a major determinant in the inequality in healthcare received by Black, Asian and Minority Ethnic (BAME) and migrant patients.1–3 While working in a busy, multicultural London hospital, bridging language barriers have been one of the biggest challenges to delivering healthcare in this setting.

In this short article, we wish to deconstruct what we believe to be the fundamental practical challenges to successfully communicating with Limited-English-Proficient (LEP) patients. We identify that although this is a complex issue, there are several key areas that need to be addressed. Although we do not have a comprehensive solution, we hope that through outlining the major issues, we can empower a mandate for change.

The options: availability and choice

At face-value, overcoming language barriers is simple: use a translator. However, the reality is more complicated. The timings of interactions with patients are often unpredictable (eg, a busy ward round, a medical clerking, an acutely unwell patient), alongside the nature of the barrier (eg, language spoken, English proficiency) and information that needs conveying. Understanding and accepting these practical difficulties are important and requires a flexible approach. Therefore, in any given scenario, there are two dimensions to assess: knowing the options available and making the right selection.

The options

Currently, there are a number of different modalities with which doctors can use to bridge a language barrier. They are roughly listed as follows:

  1. Nil (broken English, hand signals, gestures, written info, pictures)

  2. Phone translator apps (eg, Google translate, Babel fish)

  3. Over the phone translation services (eg, Big Word, Language Line)

  4. In-person translator services.

  5. Allied health professionals (AHPs).

  6. Next-of-kin /relatives.

Each modality has its own specific advantages and limitations, both of which are important for the user to understand. For example, phone …

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  • Correction notice This article has been corrceted since it appeared Online First. Amended author name Daniel Naqvi to Danial Naqvi.

  • Contributors Discussions regarding the content and ideas relayed in the article were had between all three authors, TV, DN and BP. TV and DN wrote the editorial, while BP made edits and suggestions for improvement. All three authors were involved in approving the final version before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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