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Patients who speak languages other than English are up to 54 per cent less likely to die or experience other severe health outcomes when paired with physicians who speak the same language as them, according to a new study published in the Canadian Medical Association Journal (CMAJ) this week.

The study looked at the spoken language listed on the records of nearly 190,000 adult home care residents who visited a hospital from 2010 to 2018 and compared that with the languages listed on the official records of the physician who treated them the majority of the time. Researchers used this to identify patient-physician pairs that had language-concordant relationships.

The data showed a decrease in mortality of 24 per cent for francophone patients and 54 per cent for allophone patients (those whose first language is neither French nor English) whose physicians spoke the same language as them, as well as a 36- and 74-per-cent decrease respectively in harm caused to patients during their stay in hospital.

Researchers say the results are striking and speak to the overlooked need for multilingual staff and interpretation services to be offered in hospitals and other health care environments.

“In medicine, we often think that language is not that important because the pace is so frantic,” says Peter Tanuseputro, a public-health physician and researcher at the Ottawa Hospital, who co-authored the study.

“I think that our studies are showing that perhaps we should slow down, because if you don’t slow down, you have to accept the risk and consequences of bad things happening to patients.”

Dr. Tanuseputro also noted the study’s recognition of disparity between francophones and anglophones, Canada’s two biggest sociopolitical language groups, as an indicator of what allophones may face. Despite the fact that French-speaking communities are guaranteed language rights under the Canadian Charter of Rights and Freedoms, the study found that only 44 per cent of francophones were treated by French-speaking physicians. Allophones, who have no such protections, were treated by a physician speaking their language 1.6 per cent of the time.

“In law if you end up in front of a court, you have a right to interpretation. But it’s not the same in health,” says Kwame McKenzie, chief executive officer of the Wellesley Institute and director of equity at the Centre for Addiction and Mental Health (CAMH).

Dr. McKenzie argues that Canada’s current laws do not afford allophones, francophones and non-verbal speakers the same guarantees to quality care that English speakers have. However, he offered an example of potential precedent: A 1997 Supreme Court ruling in British Columbia that found health care providers had an obligation under the Charter to offer interpretation services after two deaf patients complained that the failure to offer these services impaired their ability to communicate with health care providers and put their health at risk.

Dr. McKenzie also says the type of language used in hospital settings, even for verbal and English speakers, is not simple to understand, which makes translating to a non-English speaker difficult. He added that there needs to be a backup for when verbal language fails, such as having videos, photos and tactile language such as braille.

“We know that effective communication is really important to have good health outcomes and safety while you’re in a hospital, and what this study seems to be showing is that if people are not English speakers, they are not as safe, which is very, very concerning,” Dr. McKenzie says.

Anjali Sergeant, an internal medicine resident at the University of British Columbia who has done research on the need for diversity in Canadian health care leadership, says a lack of relatable and humanizing communications between patients of non-English ethnic backgrounds and health care providers is a big problem in all parts of the country.

“Sometimes, when patients are presumed to not understand, there’s less time spent on them, and that’s really unfortunate,” Dr. Sergeant says. She recommends that health care providers spend more effort on trying to find creative and engaging ways to connect with patients.

“As clinicians, we should be thinking about how we can best serve each patient, even if it means taking a little bit more time out of our day to ensure that communication has been received.”

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