Language Barriers and Medication Safety: How to Get Help

Imagine you’re given a new medicine. The bottle says "take one dropperful at bedtime". But you don’t know what a dropperful is. You don’t know if "bedtime" means 9 p.m. or when you fall asleep. You’re scared to ask because the pharmacist speaks only English, and your family member who helps you translate isn’t sure either. This isn’t a rare story. It’s happening every day in hospitals, clinics, and pharmacies across the U.S.

Why Language Barriers Put Lives at Risk

When patients can’t understand their medication instructions, mistakes happen. And those mistakes aren’t just inconvenient-they’re deadly. Studies show that children in families with limited English proficiency (LEP) are almost twice as likely to suffer medication errors compared to English-speaking families. One 2022 study from Children’s Hospital of Philadelphia found that 17.7% of LEP families experienced at least one medication error, compared to just 9.6% of English-proficient families.

It’s not just kids. Adults get confused too. A 2020 review of multiple studies found that 34.7% of non-English-speaking patients couldn’t understand how to take their pills. That’s more than one in three. Some took too much. Some took too little. Some took the wrong medicine entirely. One Reddit user shared how their Spanish-speaking mother was given insulin instructions translated by Google Translate. She ended up in the hospital. That’s not an outlier-it’s a pattern.

The problem isn’t that people aren’t trying. It’s that the system isn’t built for them. Pharmacies in the Bronx, where Spanish is widely spoken, still can’t print prescription labels in Spanish. In Milwaukee, half of pharmacies said they rarely or never offer translated instructions. And even when they do, the translations are often wrong. Terms like "twice daily," "with food," or "shake well" get mistranslated. A single word error can mean the difference between healing and harm.

What Works: Professional Interpreters Save Lives

The best solution isn’t a phone app. It’s not a family member. It’s not a printed flyer in a language you barely speak. It’s a trained medical interpreter.

Professional interpreters-whether in person, over the phone, or through video-are the only method proven to cut medication errors by up to 50%. Why? Because they know medical terms. They understand context. They don’t guess. They don’t simplify too much. They don’t leave out warnings.

A 2017 study in the Journal of General Internal Medicine showed that when patients were watched taking their medication by a trained interpreter, errors dropped dramatically-even if the patient still didn’t speak English fluently. This is called directly observed dosing. It’s simple: the provider watches the patient take the pill, asks them to repeat the instructions, and corrects any misunderstanding right then.

Compare that to using family members. One in nine pharmacies still rely on children, spouses, or friends to interpret. That’s dangerous. Studies show up to 25% of interpretations by untrained people are wrong. They might skip scary details like "this medicine can cause bleeding" or "don’t drink alcohol." They might translate "daily" as "every few days." They’re trying to help-but they’re not trained for this.

What’s Available-and What’s Missing

There are tools out there. Hospitals and pharmacies can use:

• Phone interpretation services (like LanguageLine Solutions)
• Video remote interpreters
• Bilingual staff members
• Translated prescription labels and patient handouts
• Electronic health records that flag language needs

But here’s the problem: they’re not used consistently. A 2023 University of Michigan study found nearly 3 in 10 hospitals still don’t offer any digital language services. Even when they do, staff often don’t know how to turn them on. One hospital survey found 68% of staff couldn’t identify which patients needed language help before the appointment even started.

And cost? It’s a big barrier. Hospitals spend $2.5 billion a year on interpretation services. But insurance rarely pays for it. Many clinics say they can’t afford it. Yet the cost of *not* doing it is worse. A 2017 analysis found communication-related errors cost the U.S. healthcare system $1.7 billion in avoidable harm-hospitalizations, lawsuits, extended stays.

What You Can Do: Practical Steps for Patients and Families

You don’t have to wait for the system to fix itself. Here’s what you can do right now:

1. Ask for an interpreter at every visit. Say: "I need a professional interpreter. I don’t speak English well, and I need to understand my medicines." You have a legal right to this under Title VI of the Civil Rights Act.
2. Never rely on family to translate meds. Even if they’re fluent, they’re not trained. Ask for a phone or video interpreter instead.
3. Use the teach-back method. After the provider explains your medicine, say: "Can you please show me how to take this?" Then repeat it back in your own words. If you’re unsure, say: "I’m not sure I understood. Can you explain it again?"
4. Check your prescription label. If it’s only in English and you don’t understand it, call the pharmacy. Ask for a translated version. If they say no, ask to speak to the pharmacist directly.
5. Write it down. Bring a notebook. Write the medicine name, dose, time, and purpose. Ask the provider to write it in your language if possible.

What Health Systems Need to Fix

Hospitals and pharmacies need to stop treating language access as an afterthought. Here’s what they must do:

• Ask every patient their language preference at registration. Make it a standard question, like asking for your birthday.
• Contract with professional interpretation services. Don’t rely on volunteers or apps. Use certified medical interpreters.
• Translate high-risk instructions. Insulin, blood thinners, heart meds-these need clear translations in the top 5-10 languages spoken in your area.
• Train staff on cultural humility. Not just language-understanding how fear, shame, or distrust can stop patients from asking questions.
• Use directly observed dosing for high-risk meds. Watch patients take their first dose. Confirm they understand.

What’s Changing-And What’s Coming

Good news: things are starting to shift. In 2022, the Centers for Medicare & Medicaid Services (CMS) began requiring health plans to track and report language access data. In 2023, Medicare started paying for remote interpreter services during telehealth visits.

The FDA is planning new rules in 2024 to require multilingual labeling on prescription bottles. The NIH is funding AI tools that can translate medication instructions accurately-no more Google Translate errors.

Epic and Cerner, the two biggest electronic health record systems, are rolling out new features in 2024 that automatically flag language needs and connect patients to interpreters with one click.

But progress is slow. And until these changes are fully adopted, patients are still at risk.

Real Stories, Real Consequences

One nurse in Chicago told of a patient who came in with dangerously low blood sugar. She didn’t know her insulin dose was doubled because the label was mistranslated. She thought "10 units" meant "10 drops." She had no idea the difference.

Another patient in Detroit, who spoke Arabic, was given a blood thinner. The pharmacist handed her a printed sheet in English. She didn’t read it. She didn’t ask. She took it the wrong way. She ended up in the ER with internal bleeding.

On the other side: a hospital in Philadelphia trained all staff to use video interpreters. Within a year, medication errors among LEP patients dropped by 40%. That’s 40% fewer people hurt because someone finally listened.

It’s Not Just About Words-It’s About Safety

Language isn’t just about speaking the same words. It’s about trust. It’s about knowing someone will make sure you understand. It’s about not being afraid to ask.

If you’re a patient, don’t stay silent. Ask for help. Demand an interpreter. Write things down. Repeat instructions back.

If you’re a provider, don’t assume someone understands because they nod. Don’t hand them a paper and walk away. Don’t wait for them to ask. Ask them first.

Medication safety isn’t just about pills and doses. It’s about communication. And when communication fails, people suffer.

Frequently Asked Questions

Next Steps for Patients and Providers

If you’re a patient: the next time you get a new prescription, ask for an interpreter before you leave the pharmacy. Write down the name, dose, and time. Repeat it back. If anything feels off, speak up.

If you’re a provider: start by asking every patient their preferred language at check-in. Don’t assume. Don’t guess. Use a simple form or digital prompt. Connect them to a certified interpreter. Train your team. Track your progress. Make language access part of your daily routine-not an emergency fix.

Medication safety isn’t a luxury. It’s a right. And language shouldn’t be a barrier to it.