Vulnerable Populations in Ontario

I started my career off in Brampton, ON, and moved on to Etobicoke, ON - both huge areas for immigration settling in Ontario. On a day-to-day basis, I would guess 10-40% of my patients are non-english or limited english speaking. This makes them extremely vulnerable in the healthcare field as language barriers create significant issues for healthcare providers. Doctors as health care providers cannot accurately assess and diagnose their patients or explain what they would like to do, consent cannot be obtained, patients are left scared and unsure, and miscommunications can lead to serious health conseqences. In my workplaces, language lines are available, and family members are used for translation - however neither of these are ideal (in my opinion).

Family members translating is a huge cause for concern. Family members can leave important information out when translated from the doctor to the patient or vice-versa. They may not know exactly how to translate medical terminology and confuse the patient more. Patient autonomy is huge in healthcare and using any family member translator may limit the patient's rights. "When clinicians lack the linguistic and cultural skills needed and interpreters are not available, patients may have to rely on medically inexperienced, bilingual relatives or non-medical staff, compromising quality of care and worsening health outcomes for migrant communities" (Meuter, Gallois, Segalowitz, Ryder & Hocking, 2015). Language barriers create an issue in this sense. From experience consenting my patients in CT, I would always rather use a co-worker who understands my procedure as much as I do to translate for the patient. This allows them to answer any questions directly and makes the patient feel much more calm. The ongoing issue in healthcare with regards to using family members as translators is in emergency departments. Doctors and nurses are so busy that they rely on family members when truly, they shouldn't - and could be compromising the patient's care.

Most hospitals now have 'language lines' set up. In my experience these do work when used correctly, but again, you do not know the person translating over the phone so there is always a small sense of doubt lodged in the back of your mind. I know that if I feel this doubt, the patient must as well. A key factor when using these lines is dual cordless phones - having two phones (one for you and one for the patient) allows for a fluid conversation with the translator.

Below is a short video that shows a case where language barriers can cause issues:

Physicians and health care providers need to ensure that a patient fully understands and treatment or procedure options. Risks are always associated and need to be understood. This video shows how miscommunications of language and even using an interpreter can fail.

"When communicating the details of a diagnosis or treatment, it is crucial to convey accurately the likelihood of the associated risk factors. Failure to communicate properly the seriousness of risk can have negative consequences: patients may fail to comply with instructions or elect not to have potentially life-saving treatment." (Meuter et al, 2015)

Language barriers continue to cause problems in healthcare across Canada. This needs to be addressed as everyone deserves good healthcare. I believe that every hospital should have a staff list of healthcare professionals who speak any language besides english. This would allow areas of the hospital to have them paged when absolutely necessary (if they're working) to provide translation services. I do believe this is for the extreme circumstances when using language lines just won't suffice. It should not be used for all translation. Translation services in specific populations could also be utilized. A hospital in Scarborough, ON employees a full time mandarin/cantonese/chinese interpreter for daytime Monday-Friday hours to better treat their patients knowing that a majority of their population does not speak english. Brampton, Mississauga, and other areas could benefit from these services as well.

Overall, interpretation services need to be better used across healthcare facilities in Ontario and Canada. Family members should only be used when the patient cannot be compromised in anyway.

Resources

Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC Health Services Research,15(1). doi:10.1186/s12913-015-1024-8

Sears, J., Khan, K., Ardern, C. I., & Tamim, H. (2013). Potential for patient-physician language discordance in Ontario. BMC Health Services Research,13(1). doi:10.1186/1472-6963-13-535