Lost in translation: Patients more likely to die, have serious outcomes when their physicians don’t speak their preferred language

Serious study and implications. During my experience as a cancer patient, I often reflected on how hard it must be for patients with weaker language skills, education and income:

Patients treated by physicians who speak their own language are healthier and less likely to die while in hospital, according to a new study led by Ottawa researchers.

The study, published in the Canadian Medical Association Journal, showed significant differences in outcomes among frail, older patients who were treated by a physician in their own language, compared to those who were not.

Francophones treated by a French-speaking physician had a 24 per cent lower chance of death than those who received care from a non-French-speaking doctor, according to the study. They also had shorter hospital stays and had a 36 per cent lower chance of adverse events, such as falls, while in hospital.

For patients whose first language was neither English nor French, known as allophones, the impact was stark. This group had a 54 per cent lower chance of death when treated by a physician in their own language and a 74 per cent lower chance of hospital-related harms, according to the research.

But fewer than two per cent of allophones and fewer than half of the Francophones in the study received physician care in their own language.

Co-author Dr. Peter Tanuseputro, a physician-scientist at The Ottawa Hospital, Institute du Savior Montfort, Bruyere Research Institute and The Ottawa Hospital, called the findings staggering.

“It’s clearly easier to convey important information about your health in your primary language. Regardless, the more than doubling in odds of serious harms, including death, for patients receiving care in a different language is eye-opening.”

Tanuseputro said the research underscores why it is important for hospitals to pay attention to the language patients speak as well as the languages physicians and other health workers speak.

The findings are likely to resonate in Ottawa and Eastern Ontario, where the Franco-Ontarian community rallied to save Montfort hospital after the Ontario government announced plans to close it in 1997. The battle, won after five years of political activism and legal fights, galvanized the community. Today, Montfort is a Francophone university health institution that provides care in both languages and has a research institute.

Still, Tanuseputro noted that the majority of Franco-Ontarians studied did not get health services in French.

The study’s lead author, Emily Seale, a medical student at the University of Ottawa and Institut du Savoir Montfort, said more must be done to make sure patients are heard and understood by referring them to physicians who speak the same language or by using interpreter services.

“This is not only good patient-centred care, but our research shows that there are grave health consequences when it doesn’t happen.”

Dr. Sharon Johnston, scientific director and associate VP research at the Institut du Savoir Montfort said the study is important because: “(it) helps us quantify the risk of greater harm faced by patients who cannot receive medical care in their preferred language. Understanding and addressing this issue, particularly for our francophone community in Eastern Ottawa and Ontario, is a key part of the mission of Hôpital Montfort and l’Institut du Savoir Montfort.”

The researchers relied partly on data from home care services, which keeps track of patients’ first languages.

They studied more than 189,000 adult home care recipients who had been admitted to hospital between April 2010 and March 2018. They compared patients who received care from a physician in their primary language and those who received care in a different language.

Most of the home care recipients in the study spoke English. Thirteen per cent spoke French and 2.7 per cent spoke another language.

Just over half of the physicians in the study spoke only English and the remainder were multilingual. While 44 per cent of Francophones received care primarily from French-speaking physicians, only 1.6 per cent of allophones received most of their care from physicians who spoke their primary language or one they could understand.

Tanuseputro said, in his own experience, making attempts to find a physician who can provide care in a patient’s language, or translation services, is not always a priority in a busy hospital.

“I am guilty of this too. What our study shows is that there are risks and consequences if you don’t do that.”

Among other suggestions, Tanuseputro said teams of physicians should consider a patient’s language and find someone better able to communicate with the patient. And translation services should be used, even if it takes time.

He also said hospitals should assess patients to understand how well they understand English. If they can’t, hospitals should have interpretive services or multi-lingual family available.

While the study looked at home care patients who were in hospital between 2010 and 2018, Tanuseputro said the situation may well have worsened during periods of the pandemic when family members were generally kept out of the hospital and unable to help interpret.

The study can be found at: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.212155

Source: Lost in translation: Patients more likely to die, have serious outcomes when their physicians don’t speak their preferred language

About Andrew
Andrew blogs and tweets public policy issues, particularly the relationship between the political and bureaucratic levels, citizenship and multiculturalism. His latest book, Policy Arrogance or Innocent Bias, recounts his experience as a senior public servant in this area.

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