Patients in the US healthcare system are speaking more languages than ever before

September 13, 2021

By Ofer Tirosh

Do you know how to say “this might sting” in Korean? In Spanish? In Mandarin? Could be your nurse does already. In the future medical staff may need to be able to say “does it hurt when I press here” in a wider range of languages than ever before.

The number of citizens in the U.S. who speak a language other than English at home has more than tripled since 1980, according to the U.S. Census Bureau. A new study found that this is translating into a growing need for more translation, interpretation, and diverse health care services. In addition to English, there are more than 50 different languages commonly used in daily interactions between patients and their health care providers.

This new AMN Healthcare report is based on over 110 million minutes of interpretation services the company provided to patients in hospitals, medical groups, and other clinical settings over the last 12 months.

“The pattern is clear,” said Maureen Huber, President of AMN Healthcare Workforce Technology Solutions. “From Mandarin to Arabic to Swahili to Hmong, and many others, patients in U.S. healthcare facilities are speaking a broader array of languages than ever before.”

According to the report, the top ten most frequently encountered languages requiring interpretation are Spanish, languages commonly spoken in China (Mandarin and Cantonese), Vietnamese, Arabic, American Sign Language (ASL), Russian, Portuguese, Haitian Creole, and Korean.

Top Languages by State

The report also identifies the most frequently used languages on a state-by-state basis. Findings for the top ten languages show:


  • 47 states include Mandarin
  • 47 states include Arabic
  • 38 states include Vietnamese
  • 26 states include a sub-Saharan language
  • 26 states include Russian
  • 24 states include Korean

Arabic, Russian, Portuguese, Haitian Creole, and Korean are also in the top ten commonly spoken languages and the study noted that many of these languages originate from countries with significant refugee populations in the United States. In more than half the states, sub-Saharan African languages are also commonly spoken, according to the analysis of more than 110 million minutes of interpretation services by AMN over the last 12 months. Other languages in the top ten for all 50 states included Hmong, Tagalog, Hindi, Pashto, Polish, and Khmer — to name a few.

Limited English Proficiency (LEP) Patients

Patients who face language barriers in obtaining healthcare will often have poorer medical outcomes than those who don’t.
From the medical perspective barriers to providing high-quality health care to LEP can leave patients, doctors, and interpreters frustrated. They face uncertainty about whether to present physically to a doctor, or to seek testing, and have difficulty finding out where to go for necessary services.

Never has been more of an issue than during the COVID-19 pandemic. For patients with Limited English Proficiency (LEP)—defined as speaking English less than “very well”—language barriers have increasingly become a life-or-death concern.

Being able to comprehend a patient saying “I can’t breathe”, often when in duress and medicated, is a dangerous phrase to misunderstand or dismiss. Although New York City set up a telephone triage system to help provide information on COVID-19, many callers to (for example) Bengali-specific hotlines in New York City have encountered significant challenges in translation and navigation of the primarily English health care system.

Despite the presence in healthcare of interpretation agencies and translation providers, the language barriers remain, impeding both the access and delivery of important medical services.
“New York LEP citizens who need to message their medical providers,” said Ofer Tirosh of New York-based translation agency, Tomedes. “Should naturally expect to be understood clearly, and have their replies in their own preferred language.”

The report also notes that cultural misunderstandings and language barriers can affect the quality of health care outcomes, and even lead to the mischarging of patients for services. It is common for LEP patients to rely on close family members, including their children, to translate and interpret for them. These relatives may or may not possess the language skills to convey information accurately, or may want to shield the patient from frank health opinions.

A Need for Change in U.S Health Care Systems

LEP citizens who are seeking information and guidance from helplines or websites should expect to be able to communicate with these care services in their native language. 

In light of the evolving situation patients and health professionals face, fundamental changes are needed in health technology systems. Websites, apps, and in particular online patient portals should be made accessible in different languages with custom UI and subtitles to help with ease of access. 

LEP patients will find that almost all personal health records (PHRs) are offered in English-only. This can be a major obstacle for patients with limited health literacy, who will have difficulty in understanding their diagnosis, and as a result in managing their daily health needs.

This focus on LEP patient’s needs will require an increasing role for companies that have translators with expertise in the medical services sector (and related areas such as chemical, pharmaceutical, legal) such as CMT in North America, and Tomedes internationally.

On a final note, telemedicine solutions and drug information should incorporate video interpreters, sign language, and subtitles in a wide variety of languages, especially for patients who may suffer from hearing and speech impediments.

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