Lost between languages and symptoms: multilingual communication breakdowns and patient safety in Indonesian emergency care
DOI:
https://doi.org/10.67490/ijml.v1i2.945Keywords:
diagnostic safety, emergency care, Indonesia, multilingual communication, patient safetyAbstract
Background: Multilingual emergency care in Indonesia operates at the intersection of clinical urgency, regional language diversity, and patient-safety demands, where symptoms must be transformed rapidly into actionable diagnostic and triage information. Objective: This study examines how multilingual communication breakdowns are represented and how they become safety-relevant across Indonesian emergency-care discourse. Method: Using a qualitative corpus-based discourse-pragmatic design, this study analyzed 22 publicly verifiable documents, including Indonesian regulations, Ministry materials, national clinical-communication studies, emergency-language access research, and global patient-safety frameworks. Results: Findings show that communication risk is most visibly institutionalized through governance language, yet multilingual procedures remain under-specified in relation to dialect, interpreter access, family mediation, and patient-understandable explanation. Interactional analysis indicates that breakdowns cluster around symptom elicitation, consent, discharge instruction, documentation, and mediation, suggesting that misunderstanding emerges across care transitions rather than at a single conversational point. Implication: Safety-linkage analysis further shows that diagnostic uncertainty, triage prioritization, documentation continuity, disclosure, and institutional readiness are the main pathways through which linguistic ambiguity may become patient-safety vulnerability. Novelty: By integrating medical linguistics, discourse pragmatics, and diagnostic-safety analysis, this study reframes language access as emergency-care infrastructure and offers a cautious model for examining multilingual risk without claiming unsupported causality for future empirical work in multilingual, high-pressure clinical research settings.
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References
[1] World Health Organization, “Patient safety,” 2023. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/patient-safety
[2] Badan Pengembangan dan Pembinaan Bahasa, “Masa depan bahasa daerah,” Kementerian Pendidikan Dasar dan Menengah, 2025. [Online]. Available: https://badanbahasa.kemendikdasmen.go.id/artikel-detail/4540/masa-depan-bahasa-daerah
[3] N. M. Bakhsh, O. Fatani, R. Z. Melybari, R. Alabdullah, R. F. Bahakeem, S. H. Alsharif, J. K. Alharbi, and O. A. Fatani, “Language and communication barriers in emergency departments in Makkah: Physicians’ perspective,” Cureus, 16, 2024, doi: 10.7759/cureus.58987.
[4] A. Cox and K. Maryns, “Multilingual consultations in urgent medical care,” The Translator, 27(1), 75–93, 2021, doi: 10.1080/13556509.2020.1857501.
[5] A. Cox, M. C. Larocque, N. Dauby, and Y. Leanza, “On equal footing? The impact of patient companions on lifeworld integration and patient-centeredness in linguistically diverse emergency consultations,” International Journal for Equity in Health, 24, 2025, doi: 10.1186/s12939-025-02425-2.
[6] C. K. Gutman, K. C. Lion, C. L. Fisher, P. Aronson, M. Patterson, and R. Fernandez, “Breaking through barriers: The need for effective research to promote language-concordant communication as a facilitator of equitable emergency care,” Journal of the American College of Emergency Physicians Open, 3, 2022, doi: 10.1002/emp2.12639.
[7] R. Odedra, P. Averill, R. Nijman, V. Wiemker, B. Hariharan, and E. Mayer, “Understanding how language barriers in the paediatric emergency care setting influences safety of care delivery: A scoping review,” Emergency Medicine Journal, 2026, doi: 10.1136/emermed-2025-215617.
[8] D. W. Bates, D. Levine, H. Salmasian, A. Syrowatka, D. Shahian, S. Lipsitz, et al., “The safety of inpatient health care,” The New England Journal of Medicine, 388(2), 142–153, 2023, doi: 10.1056/NEJMsa2206117.
[9] M. Dahm, L. J. Chien, J. Morris, L. Lutze, S. Scanlan, and C. Crock, “Addressing diagnostic uncertainty and excellence in emergency care—from multicountry policy analysis to communication practice in Australian emergency departments: A multimethod study protocol,” BMJ Open, 14, 2024, doi: 10.1136/bmjopen-2024-085335.
[10] C. W. Mangus, T. James, S. J. Parker, E. Duffy, P. Chandanabhumma, C. M. Cassady, et al., “Frontline providers’ and patients’ perspectives on improving diagnostic safety in the emergency department: A qualitative study,” Joint Commission Journal on Quality and Patient Safety, 2024, doi: 10.1016/j.jcjq.2024.03.003.
[11] J. Russell, L. Boswell, A. Ip, J. Harris, H. Singh, A. N. D. Meyer, et al., “How is diagnostic uncertainty communicated and managed in real world primary care settings?,” BMC Primary Care, 25, 2024, doi: 10.1186/s12875-024-02526-x.
[12] I. Dhamanti, D. Indriani, M. Miftahussurur, E. R. Kurniawati, and C. Engineer, “Impact of hospital readiness on patient safety incidents during the COVID-19 pandemic in Indonesia: Health worker perceptions,” BMJ Open, 12, 2022, doi: 10.1136/bmjopen-2022-061702.
[13] I. Dhamanti, N. N. Juliasih, I. Semita, N. Zakaria, H.-R. Guo, and V. Sholikhah, “Health workers’ perspective on patient safety incident disclosure in Indonesian hospitals: A mixed-methods study,” Journal of Multidisciplinary Healthcare, 16, 1337–1348, 2023, doi: 10.2147/JMDH.S412327.
[14] D. Effendi, S. Handayani, A. Nugroho, I. Ardani, Y. Fitrianti, K. Karlina, and C. Latifah, “The significance of physician-patient communication on telemedicine patients’ health outcomes: Evidence from Indonesia,” Health Communication, 39, 1932–1941, 2023, doi: 10.1080/10410236.2023.2247852.
[15] N. Laila, “Medical jargon and patient comprehension: A linguistic analysis of informed consent practices in Indonesian hospitals,” Indonesian Journal of Medical Linguistics, 1(1), 13–25, 2026.
[16] I. L. Nazulpa, “Doctor–patient communication in rural Indonesia: A pragmatic study of directive speech acts in clinical consultations,” Indonesian Journal of Medical Linguistics, 1(1), 1–12, 2026.
[17] M. Nurtyas, “Language barriers in healthcare delivery: A sociolinguistic case study of multilingual patients in Indonesian urban clinics,” Indonesian Journal of Medical Linguistics, 1(1), 26–38, 2026.
[18] D. Cordova, J. R. Torres, S. Udagawa, X. Qi, T. Avra, and B. R. Taira, “Nursing perspectives on advancing language access in the emergency department: A qualitative study,” PLOS ONE, 20, e0336525, 2025, doi: 10.1371/journal.pone.0336525.
[19] H. Newton, E. S. H. Kwok, S. Standing, P. H. Vu, and V. Thiruganasambandamoorthy, “The impact of language barriers on patient care in the emergency department,” CJEM, 2025, doi: 10.1007/s43678-025-01046-6.
[20] C. Pavesi-Krieger, R. Yang, A. Plezia, V. Hamill, T. Barriga, M. A. Rech, and T. Nguyen, “Interpreter modalities and unplanned emergency department revisits in limited English proficiency patients,” Journal of Emergency Nursing, 2025, doi: 10.1016/j.jen.2024.12.012.
[21] C. Roberts, “Communicating decisions with a multilingual patient population,” Cahiers du Centre de Linguistique et des Sciences du Langage, 2022, doi: 10.26034/la.cdclsl.2010.1320.
[22] M. C. Larocque, P. Humblé, and E. Rosenberg, “Managing lifeworld issues during multilingual patient companion mediated emergency consultations,” Patient Education and Counseling, 2023, doi: 10.1016/j.pec.2022.10.330.
[23] C. Power, K. O’Neill, S.-K. Ng, E. Berry, M. Grigg, G. Williams, A. Luong, and M. J. Bloomer, “‘Because I couldn't understand and respond’: A mixed-method study examining the impact of language barriers on patient experiences of intensive care unit outreach team care,” Australian Critical Care, 38(3), 101198, 2025, doi: 10.1016/j.aucc.2025.101198.
[24] T. A. Alharbi, M. J. Rababa, H. Alsuwayl, A. Alsubail, and W. Alenizi, “Diagnostic challenges and patient safety: The critical role of accuracy—A systematic review,” Journal of Multidisciplinary Healthcare, 18, 3051–3064, 2025, doi: 10.2147/JMDH.S512254.
[25] A. Bradford, A. N. D. Meyer, S. P. Khan, T. Giardina, and H. Singh, “Diagnostic error in mental health: A review,” BMJ Quality & Safety, 33, 2024, doi: 10.1136/bmjqs-2023-016996.
[26] J. Hooftman, A. C. Dijkstra, I. Suurmeijer, A. K. Van Der Bij, E. Paap, and L. Zwaan, “Common contributing factors of diagnostic error: A retrospective analysis of 109 serious adverse event reports from Dutch hospitals,” BMJ Quality & Safety, 33, 2023, doi: 10.1136/bmjqs-2022-015876.
[27] P. Mahajan, “From diagnostic errors to diagnostic excellence in emergency care: Time to flip the script,” Academic Emergency Medicine, 32, 366–368, 2024, doi: 10.1111/acem.15033.
[28] M. M. Ladell, N. L. Jacobson, S. Yale, K. L. McDermott, E. Papautsky, K. Catchpole, and M. C. Scanlon, “The problem with how we view medical and diagnostic error in emergency medicine,” Academic Emergency Medicine, 32, 340–347, 2025, doi: 10.1111/acem.15076.
[29] R. Taylor, R. Sangal, M. E. Smith, A. Haimovich, A. Rodman, M. Iscoe, et al., “Leveraging artificial intelligence to reduce diagnostic errors in emergency medicine: Challenges, opportunities, and future directions,” Academic Emergency Medicine, 32, 327–339, 2024, doi: 10.1111/acem.15066.
[30] S. H. Alahmedi and A. M. Alodhialah, “Impact of the HIRAID emergency nursing framework on nurse and patient outcomes: A cross-sectional study in Saudi Arabia,” BMC Nursing, 24, 2025, doi: 10.1186/s12912-025-03866-4.
[31] K. Curtis, B. Munroe, M. Fry, J. Considine, E. Tuala, M. Watts, et al., “The implementation of an emergency nursing framework (HIRAID) reduces patient deterioration: A multi-centre quasi-experimental study,” International Emergency Nursing, 56, 100976, 2021, doi: 10.1016/j.ienj.2021.100976.
[32] Z. Fekonja, S. Kmetec, U. Fekonja, N. M. Reljić, M. Pajnkihar, and M. Strnad, “Factors contributing to patient safety during triage process in the emergency department: A systematic review,” Journal of Clinical Nursing, 2023, doi: 10.1111/jocn.16622.
[33] S. K. Bell, F. Bourgeois, J. Dong, A. Gillespie, L. H. Ngo, T. Reader, E. Thomas, and C. DesRoches, “Patient identification of diagnostic safety blindspots and participation in ‘good catches’ through shared visit notes,” The Milbank Quarterly, 2022, doi: 10.1111/1468-0009.12593.
[34] M. A. Hill, T. Coppinger, K. Sedig, W. Gallagher, K. M. Baker, H. Haskell, K. E. Miller, and K. M. Smith, “‘What else could it be?’ A scoping review of questions for patients to ask throughout the diagnostic process,” Journal of Patient Safety, 20, 529–534, 2024, doi: 10.1097/PTS.0000000000001273.
[35] F. C. Smith, H. Lunn, G. Wong, and B. Nicholson, “Optimising GPs’ communication of advice to facilitate patients’ self-care and prompt follow-up when diagnosis is uncertain: A realist review of safety-netting in primary care,” BMJ Quality & Safety, 31, 541–554, 2022, doi: 10.1136/bmjqs-2021-014529.
[36] R. Atinga, M. N. Gmaligan, A. Ayawine, and J. K. Yambah, “‘It’s the patient that suffers from poor communication’: Analysing communication gaps and associated consequences in handover events from nurses’ experiences,” SSM - Qualitative Research in Health, 2024, doi: 10.1016/j.ssmqr.2024.100482.
[37] Y.-R. Choi and S. Chang, “Exploring interprofessional communication during nursing home emergencies using the SBAR framework,” Journal of Interprofessional Care, 37, 83–90, 2021, doi: 10.1080/13561820.2021.1985985.
[38] S. Dúason, B. Gunnarsson, and M. H. Svavarsdóttir, “Patient handover between ambulance crew and healthcare professionals in Icelandic emergency departments: A qualitative study,” Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29, 2021, doi: 10.1186/s13049-021-00829-x.
[39] S. Haliq and T. AlShammari, “Communication handover barriers among nurses and paramedics in emergency care settings,” BMC Nursing, 24, 2025, doi: 10.1186/s12912-025-03286-4.
[40] M. J. Bloomer and K. Sundararajan, “Using professional interpreters to overcome language barriers: An imperative in the care of linguistically diverse patients in critical care,” Intensive & Critical Care Nursing, 89, 104017, 2025, doi: 10.1016/j.iccn.2025.104017.
[41] E. Hartford, L. Rutman, S. Fenstermacher, K. Eaton, J. L. Ramos, K. Carlin, and K. C. Lion, “Improving and sustaining interpreter use over 5 years in a pediatric emergency department,” Pediatrics, 2023, doi: 10.1542/peds.2022-058579.
[42] M. Kletečka-Pulker, S. Parrag, K. Doppler, S. Völkl-Kernstock, M. Wagner, and T. Wenzel, “Enhancing patient safety through the quality assured use of a low-tech video interpreting system to overcome language barriers in healthcare settings,” Wiener Klinische Wochenschrift, 133, 610–617, 2021, doi: 10.1007/s00508-020-01806-7.
[43] R. Kusuma and R. K. Wardahni, “Implementation of effective communication to realize patient safety in emergency installations,” World Journal of Advanced Research and Reviews, 2024, doi: 10.30574/wjarr.2024.21.2.0550.
[44] H. Li, S. Ali, L. Hartling, L. Dennett, E. Lopatina, K. Ganeshamoorthy, and J. Khangura, “Language interpretation and translation in emergency care: A scoping review protocol,” PLOS ONE, 19, e0314049, 2024, doi: 10.1371/journal.pone.0314049.
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