Diagnostic Challenges in Fava Bean Triggered G6PD Crisis A Case study and Narrative Review of Literature of Limited English Proficiency in the Inpatient Setting

Main Article Content

Avinash Pandey
Zainab Al Maqrashi
Mary Sedarous
Ahraaz Wyne



Limited English proficiency (LEP) affects many Canadians. Patients with LEP are at high risk of medical error, readmission, and increased length of stay. We report on the case of a 66-year-old male with LEP and a diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency associated hemolysis, and how the language barrier affected his care. Using our case as an example, we describe trends in the LEP literature in the inpatient setting, its effects on patient care and the evidence surrounding the use of point of care interpretation.

La maîtrise limitée de l’anglais (MLA) touche de nombreux Canadiens. Les patients ayant une MLA courent un risque élevé d’erreur médicale, de réadmission et de prolongation du séjour à l’hôpital. Nous faisons état du cas d’un homme de 66 ans ayant une MLA qui a reçu un diagnostic d’hémolyse associée à un déficit en glucose-6-phosphate déshydrogénase (G-6-PD) et de la façon dont la barrière linguistique nuit à ses soins. En utilisant notre cas comme exemple, nous décrivons les tendances de la documentation sur la MLA en milieu hospitalier, les effets de la MLA sur les soins aux patients et les données probantes concernant l’utilisation de l’interprétation au point de service.

Abstract 141 | PDF Downloads 60 XML Downloads 49 HTML Downloads 39


1. Bowen S. Language Barriers in Access to Health Care.; 2001.
2. Rawal S, Srighanthan J, Vasantharoopan A, Hu H, Tomlinson G, Cheung AM. Association Between Limited English Proficiency and Revisits and Readmissions After Hospitalization for Patients With Acute and Chronic Conditions in Toronto, Ontario, Canada. JAMA. 2019;322(16):1605. http://dx.doi.org/10.1001/jama.2019.13066
3. Hines A, Andrews R, Moy E, Barrett M, Coffey R. Disparities in Rates of Inpatient Mortality and Adverse Events: Race/ Ethnicity and Language as Independent Contributors. Int J Envron Res Public Health. 2014;11(12):13017-13034. http://dx.doi.org/10.3390/ijerph111213017
4. de Moissac D, Bowen S. Impact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada. J Patient Exp. 2019;6(1):24-32. http://dx.doi.org/10.1177/2374373518769008
5. Sentell T, Braun KL. Low Health Literacy, Limited English Proficiency, and Health Status in Asians, Latinos, and Other Racial/Ethnic Groups in California. J Health Commun. 2012;17(sup3):82-99. http://dx.doi.org/10.1080/10810730.2012.712621
6. Wong ST, Black C, Cutler F, Brooke R, Haggerty JL, Levesque JF. Patient-reported confidence in primary healthcare: are there disparities by ethnicity or language? BMJ Open. 2014;4(2):e003884. http://dx.doi.org/10.1136/ bmjopen-2013-003884
7. Wasserman M, Renfrew MR, Green AR, et al. Identifying and preventing medical errors in patients with limited English proficiency: key findings and tools for the field. J Healthc Qual Off Publ Natl Assoc Healthc Qual. 2014;36(3):5-16. http://dx.doi.org/10.1111/jhq.12065
8. Lindholm M, Hargraves JL, Ferguson WJ, Reed G. Professional Language Interpretation and Inpatient Length of Stay and Readmission Rates. J Gen Intern Med. 2012;27(10):1294-1299. http://dx.doi.org/10.1007/s11606-012-2041-5
9. Schenker Y, Pérez-Stable EJ, Nickleach D, Karliner LS. Patterns of Interpreter Use for Hospitalized Patients with Limited English Proficiency. J Gen Intern Med. 2011;26(7):712-717. http://dx.doi.org/10.1007/s11606-010-1619-z
10. Flores G, Abreu M, Barone CP, Bachur R, Lin H. Errors of Medical Interpretation and Their Potential Clinical Consequences: A Comparison of Professional Versus Ad Hoc Versus No Interpreters. Ann Emerg Med. 2012;60(5):545-553. http://dx.doi.org/10.1016/j.annemergmed.2012.01.025
11. Hadziabdic E, Hjelm K. Working with interpreters: practical advice for use of an interpreter in healthcare. Int J Evid Based Healthc. 2013;11(1):69-76. http://dx.doi.org/10.1111/1744-1609.12005
12. Parrish D, Ferrada P. Understanding our patient’s disparities and needs: a brief report in the use of a Spanish lesson to increase the comfort level during trauma situations. Am Surg. 2014;80(11):E287-289. http://dx.doi.org/10.1177/000313481408001104
13. Parsons JA, Baker NA, Smith-Gorvie T, Hudak PL. To “Get by” or “get help”? A qualitative study of physicians’ challenges and dilemmas when patients have limited English proficiency. BMJ Open. 2014;4(6):e004613-e004613. http://dx.doi.org/10.1136/bmjopen-2013-004613
14. Diamond LC, Jacobs EA, Karliner L. Providing equitable care to patients with limited dominant language proficiency amid the COVID-19 pandemic. Patient Educ Couns. 2020;103(8):1451-1452. http://dx.doi.org/0.1016/j.pec.2020.05.028