By Dr. Perrin Michalyshyn
Our ability to communicate and connect with patients is the most fundamental part of being a family physician. But what happens when this ability is taken away? In an increasingly multicultural Alberta, we can’t take for granted that all our patients know and communicate in English.
Language barriers create challenges for patients and providers alike. Non-English speaking patients often struggle access care, and may be labeled as ‘difficult’ or ‘non-compliant’ when in fact they never understood their treatment instructions in the first place. Language barriers also have detrimental impacts on providers. The risk of miscommunication, especially in higher acuity situations, can hamper obtaining informed consent, which can then lead to liability concerns if a treatment plan goes awry.
Translation Tools
For situations where you don’t speak or aren’t comfortable enough with a patient’s language, know that there are translation tools at your disposal:
- Live medical translation services are your best bet when an entire patient visit needs to be translated. ‘LanguageLine Solutions’ is the interpretation service used in AHS facilities and by many Primary Care Networks. It provides live telephone medical translation, 24/7, for over 200 different languages. Ask your facility or PCN for your dedicated LanguageLine telephone number and access code, or visit this link for information on how to access the service in the community
- Online translators such as Google Translate great for translating individual words or short phrases. I have used Google Translate when a patient has good conversational English skills, but needs help translating medical terminology. For many languages, there is even a ‘text to speech’ option, where Google Translate will read out translated phrases in the target language. This is especially valuable if you are unsure of your patient’s literacy skills.
On the other hand, many clinicians are multilingual themselves and may be interested in using these skills for patient care. However, it can be a daunting prospect if you have only ever trained in your native language. I, for example, trained in English and now work in a bilingual French-English clinic in Edmonton. I have come a long way in my comfort with seeing Francophone patients, but there are still many days where I leave thinking ‘I still provided good care, but boy, it wasn’t always eloquent!’.
Practising Multilingual Care Tips
For those of you using your additional language skills with patients directly, here are some tips I have gleaned from my own trials and tribulations with multilingual care:
- Give yourself grace: Using a second language is mentally taxing, especially when having to switch between languages throughout the day. Do not assume that mental fatigue is necessarily a sign that you are not up to par. For most of us, it’s simply part of the process!
- Lean on supports: Find language experts to learn from. These might be multilingual physician colleagues, language teachers, or even clinic staff. For example, I remember once asking a bilingual medical office assistant about the different connotations of various French synonyms for “sorry” to make sure that I was using each one in the right context. It may take time to find your own language support network, but it will be an invaluable resource.
- See your progress, not just your faults: As physicians, we are trained to be analytical and always ask “Am I missing something here?”. This approach works well for practicing safe medicine, but can create a tendency for us to second-guess ourselves and focus on our shortcomings rather than our strengths. Remember to pat yourself on the back for little language victories like using a new expression, correcting the grammar mistake you made yesterday, or finding a more concise way to explain a diagnosis.
Multilingual care comes with unique rewards and challenges. Providing care in a patient’s first language can have a transformative effect on patients and a protective effect on physicians. Don’t hesitate to use your skills and the resources around you. Even when it feels like a struggle, know that your patients will always be grateful for your efforts and the gift of understanding.
