When you’re sick, you’re not bilingual

Recently published in the Canadian Medical Association Journal, a study led by 11 Canadian researchers shows that the language used by a physician can have a major impact not only on patient well-being, but also on survival. The study is based on ICES data and was conducted in collaboration with the Institut du Savoir Montfort and Hôpital Montfort. The researchers analyzed data from 189,690 Ontario adult recipients of home care who were admitted to Montfort between April 2010 and March 2018. 

“[Among] French-speaking patients receiving care in French, there was a 24% reduction in deaths after hospital admission. Among allophones, there was a 54% reduction,” explains Emily Seale, a medical student and researcher at the Institut du Savoir Montfort. 

“Understanding and addressing this problem is a key element of the mission of the Hôpital Montfort and its research institute, especially for our francophone community in eastern Ottawa and Ontario.” 

Sharon Johnston, Scientific Director of the Institut du Savoir Montfort

Patients’ chronic comorbidity (meaning that a person is living with various acute or chronic diseases and/or conditions in addition to the initial illness) was similar across all language groups. However, compared to English speakers, allophones were more likely to have functional limitations, while francophones were more likely to experience a greater decline in health, as indicated by a higher CHESS (changes in health, end-stage disease, and signs and symptoms) score. 

This may “be explained by enhanced patient–provider communication (e.g., ability to elicit symptoms and obtain a complete medical history), which can improve the accuracy and timeliness of diagnoses made by physicians.” 

On the flip side, if communication between provider and patient is not adequate, the physician is more likely to perform more tests, unnecessarily prolonging the hospital stay and increasing the risk of adverse events. 

As Elizabeth Tanguay, Director of the Ottawa East Ontario Health Team. mentions, “these effects not only have a negative impact on the quality of care received, but also generate significant costs to the system as they monopolize resources that could be redirected to another patient in need. The goal is that each person who comes to one of the 40 OHT partners will receive appropriate services in the language of their choice. In this way, clients are better served, resources are better used, and everyone gets the maximum benefit from the public health system.”

For Jacinthe Desaulniers, CEO of the Réseau des services de santé en français de l’Est de l’Ontario:

“This new study of 189,690 patients clearly demonstrates the impact of language concordance on safety (reduction of adverse events), efficiency (reduction in length of hospitalization) and effectiveness of care (reduction of deaths). With the health care system under pressure, this study reminds us [that] an active offer of health care services in French [is an] essential element of a patient-centered quality health care service. As we say in the Réseau, when we’re sick, we’re not bilingual.”

As the researchers indicate in their paper, until now there has been no scientific literature clearly demonstrating the importance of language in the treatment of patients admitted to hospital. The study co-conducted by Emily Seale, a student at the University of Ottawa’s Faculty of Medicine, remedies this situation. 

While just under half (44.4%) of Francophones were primarily treated in their language, the situation for allophones is far behind. In an environment as multicultural as Ontario, only 1.6% of allophones were treated by a physician who spoke their language. 

For the past few years, Ontario has been implementing various accessibility laws an. However, much remains to be done to improve access to health care and services in a language that is appropriate for the patient, or at least in both official languages. Through its integration mission, the Ottawa East Ontario Health team and its partners are working to reduce inefficiencies and inequities to enable equitable access to appropriate care in everyone’s language of choice. With the help of the Institut du Savoir Montfort’s research projects, it is possible to better understand certain issues and identify the strategies and actions needed to ensure the safety and well-being of the population. As the results of the study demonstrate, treating a person in a language they understand well could save their life.