How Can Canadian Doctors Best Care for Francophone Patients?

Healthcare providers in Canada should offer French language services when caring for francophone patients and speaking with their families and caregivers, according to a new resource for physicians.

Although many French speakers in Canada report bilingualism, previous research shows that many francophone patients don't feel comfortable speaking English in healthcare settings.

"Francophone patients represent a considerable proportion of the Canadian population," said lead author Mélanie Patrie, MD, an assistant professor at the Northern Ontario School of Medicine University in Sudbury, Ontario, Canada. Patrie is a family physician who works with francophone patients.

"It is well known that language concordance between patients and healthcare providers contributes to increased patient and provider satisfaction, increased patient safety, and better health outcomes," said Patrie. "When language concordance is not possible, the strategies highlighted in our article can serve to mitigate the negative impacts of linguistic barriers."

The resource was published online on May 27, 2024, in CMAJ.

Supporting Francophone Patients

When CMAJ began a new series on ways to support specific patient populations, Patrie and colleagues wanted to write about francophone patients, particularly those in minority settings, to raise awareness of their specific needs and to support equitable access to care.

For instance, outside of Quebec, more than one million people in Canada identify French as their first language. But the geographic distribution of French-speaking doctors doesn't always line up with the distribution of francophone patients, the authors wrote. That means that healthcare settings may provide discordant linguistic care, even if they don't realize it.

The first step in breaking down this barrier is recognizing it and measuring it, said Patrie. Healthcare providers should identify francophone patients in their practice by asking all patients which language they're most comfortable using in a healthcare setting.

"As language is a social determinant of health, there is much to be gained by asking our patients to identify their language of preference in a healthcare setting, even though we may not share or speak that same language," Patrie said. "By doing so, we become more aware of the patient as a whole and his or her needs. We can be more attuned to the potential language barriers and take steps to mitigate their impact on a patient's health."

When providing care to francophone patients, a clinician can help by actively offering French language services, the authors wrote. An active offer requires deliberately offering language services before patients need to request it, with visible and clear communication about the availability of services. Previous studies in Canada have found that francophone patients are less likely to request services in French if no offer is made. Active offers can include bilingual signage, bilingual health information and brochures, a bilingual greeting, or basic conversations in French, even if a healthcare provider isn't bilingual.

In healthcare settings where physicians don't speak French, providers should consider using interpreters, the authors noted. Interpreters with formal training can typically be arranged through most hospitals, with in-person and virtual options. If an interpreter is not available, providers should be cautious about using family members, caregivers, or other health professionals, which can cause language barriers and affect quality of care.

When possible, physicians should also try to provide French-language continuity of care, the authors wrote. For instance, francophone patients should be referred to French-speaking professionals for specialist or allied healthcare.

Broader Healthcare Questions

Recent research in Canada has illuminated several examples of how official language minority populations — such as francophones in Ontario — have worse health outcomes than the general population, said Patrick Timony, PhD, a senior research associate at the Centre for Rural and Northern Health Research at Laurentian University, Sudbury, Ontario, Canada. One of the major contributors is a lack of health services adapted to the linguistic needs of patients, he added. Timony did not participate in drafting the current resource.

"Current health human resource shortages have exacerbated access issues to French language services, with few French-speaking healthcare professionals choosing to practice in communities where more francophones reside," said Timony. "Recruiting and training more French-speaking providers has been insufficient to improve access in these underserved areas, particularly in the midst of a health human resource crisis."

Instead, all providers should do their part to provide patient-centered communication that is sensitive to linguistic needs and preferences, he added. Patients who speak French may not feel they can request language services, which is why an active offer is important.

"Francophones have a history of being ignored or marginalized, and as a result, have become hesitant to demand their services in French or even use French language services when they are offered," Timony said. "However, a lack of demand or use should not be confused with a lack of desire or need."

An active offer may not result in immediate uptake by francophone patients, he noted. To promote progress, providers should continue to make active offers with consistency, transparency, and commitment.

"Improved access to French language services will need to be sustained over time to decondition francophones and for patients to feel confident and comfortable using French services in a system that has historically been Anglo-dominant," he said.

The resource was drafted without outside funding. Patrie and Timony reported no relevant financial relationships.

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.