She clutched her chest, gasping for words that would not come in English. The nurse leaned in, trying to decipher. Her son was not there to translate, and the phone interpreter line was not connected yet. I could see her distress worsening. Precious minutes slipped away before we finally realized she was describing classic heart attack symptoms. That patient survived, but the outcome could easily have been different. And in many cases, it is.
The scope of the problem
In the United States, more than 25 million people have limited English proficiency (LEP). In emergency situations (heart attacks, strokes, or medication errors), every second matters. Yet countless patients face delays and misunderstandings because their words are not understood.
Research has consistently shown that patients with LEP experience:
- Higher rates of misdiagnosis
- More medication errors
- Longer hospital stays
- Worse health outcomes overall
For a cardiologist, the stakes are painfully clear. If a patient cannot describe chest pain accurately (or cannot understand discharge instructions about blood thinners), the result can be catastrophic.
Why it still happens
Despite regulations that require interpreter services, hospitals remain inconsistent in providing them. The reasons are frustratingly simple:
- Interpreter shortages: Few hospitals have 24/7 professional interpreters available.
- Reliance on family members: Children or spouses are often asked to translate, risking confidentiality breaches and clinical mistakes.
- Technology gaps: Interpreter phone lines and apps exist, but they are underused, too slow, or unavailable in high-stress emergencies.
The result is that language remains a silent barrier, hidden in plain sight, inside some of the most advanced hospitals in the world.
The human cost
In cardiology, language gaps can be deadly. A patient with chest discomfort may struggle to explain the difference between burning, pressure, or stabbing pain, clues that guide us toward heart attack, reflux, or something else.
Beyond emergencies, patients who do not fully understand medication instructions are less likely to take them correctly. I have seen people return with worsening heart failure because they did not realize “take one pill daily” meant every day, not just when they felt symptoms. This is not simply about convenience. It is about safety and survival.
What we can do better
Fixing this requires more than policy; it requires urgency. Some solutions are straightforward:
- Rapid interpreter access: Hospitals must make professional interpreters instantly available, whether in person or via secure video.
- Cultural competence training: Language is one layer, but understanding health beliefs and fears makes communication far more effective.
- Bilingual clinicians: Recruiting and empowering multilingual providers can bridge trust and speed up care.
- Community outreach: Health fairs, local clinics, and partnerships with community leaders help build trust before emergencies happen.
If we can provide immediate access to cardiac catheterization labs in emergencies, we should also be able to guarantee immediate access to communication.
Closing reflection
The woman I described earlier survived her heart attack. But she survived because of luck and persistence, not because the system worked as it should. In medicine, luck should never decide who lives and who dies. Clear communication is not a luxury. It is as essential to patient care as oxygen and medication. Until language access is treated as a matter of patient safety, not convenience, too many patients will continue to pay the price.
Monzur Morshed is a cardiologist. Kaysan Morshed is a medical student.
