White Coat Black Art

Let's talk: Why Canadians need health care in their own language

If you get sick in Canada & you don't speak English or French, your health may be in danger says a CMAJ editorial. @NightshiftMD says there's a solution.
EMS ambulances parked in front of the emergency department at Bluewater Health in Sarnia, Ont. (Jonathan Pinto/CBC)

Canada prides itself on its diverse, multicultural population. But some newcomers who don't speak English or French may have serious difficulty communicating with their doctor.  An editorial published earlier today in the Canadian Medical Association Journal says the health care system needs to do better.  

The editorial says that universal access to health care means more than being permitted to walk through the hospital's sliding doors without having to pay.  It means receiving care in whatever language you happen to speak. That can take many forms. One is that you receive care from health professionals who speak your language. Another is that you are provided access to a medical interpreter either on-site and in person or via telephone or skype. 

It's hard to assess how widespread a problem this is, given the lack of data from across Canada. A study reported in the Toronto Star found that roughly two and a quarter per cent of Ontario`s nearly 14 million residents do not speak English or French. A 2014 study by the Centre for Research on Inner City Health found that roughly 18 per cent of the province`s 20,000 primary-care physicians can conduct a conversation in a language other than English or French.  Just under four per cent can speak one of the top unofficial languages spoken in Ontario. Those languages are Mandarin, Italian, Portuguese, Punjabi, and Spanish. 

Most of the patients who speak neither English nor French live in places with GPs who speak their language. But the 2014 study found places like Waterloo, a small city west of Toronto where close to 1,500 people speak Portuguese, but where no physician speaks their language.

Given the lack of trained medical intepreters, there is a strong tendency to rely on family members. I have used family members in my work as an ER physician.  But as we discussed last season on White Coat, Black Art, there are many serious problems with that.  I have seen young children of ill patients pressed into service. Sometimes, they omit, add, or change words because they aren't comfortable relaying sensitive health information about their parents. In the past, on rare occasions, I have been forced to use an adolescent child of my patient to inform them that they have cancer, compelling them to interpret information that is emotionally upsetting to them.

A trained medical interpreter I spoke with last season says she witnessed a husband who insisted on translating for his wife, following transplant surgery. The husband didn't want to admit that he was confused about the names of medications, and  the woman ended up taking the wrong medication as a result.  

Unfortunately, many studies have demonstrated that inaccurate interpretation puts patients at risk. When you have a heart attack, the faster you have an angioplasty to treat a blocked coronary artery, the better.  Studies have shown that patients who don't speak the language spoken by health professionals take close to an hour longer to receive an angioplasty.  A study in Ontario found that women who speak neither English nor French were less likely to receive mammograms or Pap smears. Miscommunication can increase the risk of medical errors, inappropriate treatment and increased emergency room visits.

The editorial in CMAJ says there are two potential fixes for a country like Canada. The first is to provide in-person interpretation in regions where there is a heavy need. For instance, in Waterloo, Ontario, the local hospitals should hire interpreters who speak Portuguese. In the Greater Sudbury area, they should hire interpreters who speak Italian, and Punjabi in Wellington, Ontario. 

For those parts of Canada in which it's not economically feasible to hire local interpreters, the next best thing is to set up a toll free national telephone interpretation service that's available 24/7.

The editorial says that all patients, no matter what language they speak, deserve to receive the best medical care available, something that will only happen when all patients can be understood.. That means in a language they understand.

With growing intolerance to newcomers in some countries, it may be tempting for some to believe it's up to new arrivals to learn one of Canada's official languages. I think critics need to consider how they would feel if they had a medical emergency, and couldn't make themselves understood.


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