A 72-year-old woman admitted to the general medicine ward for “failure to cope;” a 75-year-old “difficult” patient who refused to calm down; a patient in the ICU with multi-organ failure whose family rejected their doctor’s advice.
Three patient encounters, three different hospitals, but what they all had in common was that they were racialized minorities who become disenfranchised simply by not having access to language-sensitive care.
The 72-year-old’s biggest concern was that she was unable to speak to her daughter and was burdening her daughter financially and emotionally. The “difficult” patient did not have delirium nor was he agitated. He was just anxious. In the ICU, after a productive conversation around goals of care, the family switched to comfort-care measures.
After my conversation in the ICU, the patient’s family affectionately called me the “brown” doctor thereafter. I had the good fortune of being able to communicate with each of these patients either directly or through an interpreter and was able to form a successful therapeutic bond.
In a multicultural city like Toronto, multilingualism is the norm. Based on the 2016 census, at least 43 per cent of the population in the Greater Toronto Area speak at least one language other than French and English at home. We do not have data on how many of this 43 per cent population do not communicate in English or French.
Multilingualism is at the heart of Canadian identity. But there are more than 11 Indigenous language groups that are spoken in Canada that are yet to be officially recognized at the federal level. Not to mention all the other immigrant languages that are spoken across the country.
Practicing medicine should never be just about pathophysiology, diagnosis and medications. While patient-centred care has been a welcome change that has taken medical care into the 21st century, I would like to make a case for “language-sensitive care.”
Without taking into consideration the language lens, culturally sensitive communication is incomplete.
Other concepts of sensitivity that are fairly recognizable in the health-care setting include cultural, ethical, moral and gender sensitivities. The common denominator is the ability of the provider/health-care team to recognize human differences while communicating with patients and not using a one-size fits all approach. Cultural sensitivity while communicating is a well taught concept in medical schools and nursing schools. However, this does not address language inequities. Without taking into consideration the language lens, culturally sensitive communication is incomplete.
While most citywide hospitals do provide interpretation services, there are barriers in accessing these services. Location of the translation phone lines, key information required to access services or new COVID precautions logistical disconcordance to name a few. Most hospitals do not document a patient’s preferred language of communication. Providing language sensitive care requires a systemic shift in how care is delivered. Relying on individual motivation to walk the extra mile to provide care is to do a dis-service to our patients.
Using a language equity lens while hiring health-care professionals is something to consider where necessary and possible. This may mean either recruiting people that are able to provide care in a specific language or providing incentives to existing health-care professionals to acquire new language skills. This is important in underserved communities. In the U.S., there have been initiatives in which health-care professionals are encouraged to learn the language of minority groups, although there is no objective data yet to understand the impact. The current change in the political climate and protective nationalism certainly has set many such initiatives back by decades. In May, Quebec adopted Bill 96, a bill that focuses more on communication in French as opposed to effective communication. The ambiguity in the bill regarding use of a non-French language with very narrow exceptions (historic Anglos and recent immigrants) in health-care communication is concerning.
Access to language-sensitive care is part of human rights. Language-sensitive care makes common sense; there is a body of evidence that shows language barriers affect timely access to health care, lead to poorer outcomes and increase misunderstandings between patients and the health-care system.
In a publicly funded health-care system, it also makes financial sense to make the extra effort to provide language-sensitive care and thereby reduce hospital admissions and costs.