Outcomes Improve When Patients, Doctors Speak Same Language

Carolyn Crist

July 12, 2022

Canadian patients who receive most of their healthcare from physicians who speak the same language have better quality and safety outcomes, according to a new report.

When older allophone patients (that is, those who spoke a primary language other than English or French) were admitted to the hospital, they benefited from having a doctor who could speak their language.

Dr Peter Tanuseputro

“These are staggering findings that make a strong case for providing care in the same language for linguistic minorities in hospitals,” senior study author Peter Tanuseputro, MD, an associate professor of palliative care at the University of Ottawa, Ottawa, Ontario, Canada, told Medscape Medical News.

The study was published online July 11 in the Canadian Medical Association Journal.

Fewer Adverse Events

More than 6 million people in Canada live in a province or territory where most of the population does not speak their primary language, which is not recognized as an official language, the study authors wrote. This includes French speakers outside of Quebec, English speakers in Quebec, and those who speak a language other than English or French across the country.

Tanuseputro and colleagues conducted a population-based, retrospective cohort study of 189,690 adult home care recipients who were admitted to the hospital in Ontario between 2010 and 2018. Based on home care assessments, they classified the patient language as English (anglophone), French (francophone), or other (allophone). They obtained physician language from the College of Physicians and Surgeons of Ontario, Toronto, Ontario, Canada.

The research team defined hospital admissions as “language concordant” when patients received more than 50% of their care from physicians who spoke the patients’ primary language. They looked at in-hospital outcomes such as adverse events, length of stay, and death, as well as post-discharge outcomes such as emergency department visits, readmissions, and death within 30 days of discharge.

In Ontario, Canada’s most populous province, about 33% of people speak a primary language other than English. In this study, about 84% of home care recipients spoke English, 2.7% spoke French, and 13% spoke other languages such as Italian, Mandarin, Ibero-Romance languages, and Indo-Aryan languages.

Language information was missing for 24.3% of physicians. About 58% of physicians spoke only English, and 42% were multilingual.

Few non-English speakers received language-concordant care. About 44% of francophones and 1.6% of allophones received care in their own language.

Overall, allophone patients who received language-concordant care had a 74% lower risk of adverse events such as falls, infections, and medication errors. They also had a 54% lower risk of in-hospital death and shorter hospital stays.

The results were similar for francophone patients, though the magnitude of the effect was lower. French-speaking patients had a 36% lower risk of adverse events and a 24% lower risk of death.

Language concordance or discordance wasn’t associated with significant differences in post-discharge outcomes.

‘Eye-Opening’ Results

Tanuseputro, also a scientist at the Ottawa Hospital Research Institute, Bruyère Research Institute, and Institut du Savoir Montfort, noted the necessity of coordinating language among patients, providers, and interpreters in hospitals.

“Before this study, we didn’t know how important it is for a physician to speak the same language as a patient who is admitted into hospital,” he said. “We’ve always known that it’s generally good, patient-centered care to do so, but our study showed that providing language-concordant care also reduces concrete outcomes such as death and potentially avoidable inpatient harms.

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

Tanuseputro and colleagues have previously published data about language concordance in nursing homes, where residents are particularly vulnerable. They’re planning additional studies in nursing homes, as well as in emergency rooms and in family medicine.

The research team suggested steps to provide language-concordant care, such as asking patients about the language they speak and their English proficiency, asking healthcare providers what languages they speak and creating an accessible registry for interpreters on the medical team, and matching healthcare providers with patients based on the languages spoken.

“We need to be willing to switch who is caring for the patient — something that doesn’t happen right now,” Tanuseputro said. “We also need to ensure access to and allow time to use interpreter services — the ones you can access over the phone — when there’s no healthcare provider on the team that can provide translation.”

Bilingualism Not Universal

Previous studies have also shown that language-discordant care affects the quality of care and patient safety for minority francophones in Canada. In a study published in the Journal of Patient Experience in March 2019, researchers found that language barriers led to misunderstandings, misdiagnoses, and delayed treatment.

Dr Danielle de Moissac

“The myth persists that francophones across Canada are bilingual, but for some segments of the population (children, elderly) or in some situations (pain, mental health), all can experience a language barrier,” lead author Danielle de Moissac, PhD, a professor of biological sciences at the Université de Saint-Boniface in Winnipeg, Manitoba, Canada, told Medscape.

De Moissac noted the importance of an “active offer” of services in English and French, which means that patients are greeted in both languages, the language of choice is noted in a patient’s file, and, when needed, patients are referred to bilingual providers or interpreter services.

“This study was possible because data pertaining to patients’ primary language and providers’ language proficiency were systematically collected,” she said. “This is not the case in many databases and jurisdictions across Canada, and, as such, it makes it very difficult to evaluate the impact of language discordance in health and social services.”

The study was primarily supported by the Institut du Savoir Montfort and the Programme de subventions Savoir Montfort, funded by Fondation Montfort. The study was also supported by the Bruyè re Centre for Individualized Health. Tanuseputro and de Moissac reported no relevant disclosures.

CMAJ. Published online July 11, 2022. Full text.

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