Patients With Limited English Proficiency Do Not Take Extra Exam Time

Physicians must be conscious of adjusted behaviors and communication strategies for patients with limited English proficiency.

Patients with limited English proficiency (LEP) spend approximately as much time in the ophthalmologist’s office as those who speak English as a first language, a report published in BMC Ophthalmology shows. “It appears providers may adjust their communication strategies when patients self-identify as requiring an interpreter. Sometimes this may be beneficial, such as being more likely to provide written instructions in an after-visit summary, however adjusting communication strategies to aim for similar appointment lengths may lower the standard of care delivered to patients requiring an interpreter,” researchers report.

Of 87,157 clinic encounters during the study period, investigators retrospectively examined records for 26,443 LEP-related appointments from January 1, 2016 to March 13, 2020. When English was not the patient’s primary language, 79.0% self-identified as needing an interpreter. Data revealed patients requesting translation showed for visits to a greater extent compared with English speakers, and more often received a printed after-visit summary.

Initial results showed average time spent with a technician in interpreter-related visits was nearly 2 minutes longer when the language was something other than English or Spanish. 

After linear regression with adjustment for age, physician status of resident or attending, and whether the patient was new or at a repeat visit, no statistical difference occurred in wait time for a room or for the doctor, or length of contact with technician or physician

It appears providers may adjust their communication strategies when patients self-identify as requiring an interpreter.

Prior studies have found the use of language interpreters varies widely based on setting, along with barriers to care including perceived difficulty communicating with providers, and medical translation-related issues as obstacles to continuing care. Research has also shown longer wait times for non-English speakers may discourage them from looking for care, but the present analysis found longer waits were equally distributed for all.

The researchers suggest better attendance may have resulted from LEP patients preferring not to call back after initial scheduling, or are reminded by visit date printed on their summary.

Limitations include a possible data underestimation if fear of bias prevented self-identifying the need for an interpreter, or that a staff interpreter was not recorded in cases where friends or family translated. Phone or remote translation services may differ from in-person. Also, timestamps could vary based on physician timing for opening charts.


Mudie LI, Patnaik JL, Gill Z, et al. Disparities in eye clinic patient encounters among patients requiring language interpreter services. BMC Ophthalmol. Published online on March 2, 2023. doi: 10.1186/s12886-022-02756-6