Rethinking the Term "Limited English Proficiency" to Improve Language-Appropriate Healthcare for All

Abstract

The concept of limited English proficiency (LEP) presents significant challenges when applied to the healthcare needs of the diverse and growing multilingual population in the U.S. We expound on the following ways in which the concept of LEP is problematic: the ethnocentric notion of a "primary language," the ambiguous idea of "limited ability," and the deficit-oriented construct of "language assistance." We provide examples that illustrate the negative healthcare impact of LEP terminology, including the unaccounted-for complexities of health communication within the concept of "primary language," the "limited abilities" of health professionals whose language skills are often unassessed, and the ignored role of "language assistance" resources such as interpreters as essential collaborators. Finally, we propose rethinking LEP by (a) reframing patient language using the term non-English language preference and (b) assessing health professional non-English language skills. These actionable strategies have the potential to improve language-appropriate healthcare for diverse populations.

Keywords: Healthcare communication; Language assistance; Language barriers; Language concordance; Limited English proficiency; Medical interpreters; Patient-centered communication.