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English language proficiency and concordance between doctors and patients in ED: a research study

A study looking into the experiences of Arabic-speaking people at Fairfield Hospital’s Emergency Department (ED) has found that recent migrants, those with more severe illness, and people from NESB who are not supported by an interpreter, are at risk of miscommunication.

                Dr Michael Tam

“This communication can lead to errors, patient dissatisfaction and most worryingly, patient harm,” explains Dr Michael Tam, lead researcher and Staff Specialist, Primary and Integrated Care Unit, SWSLHD.

“We know that a large percentage of people who present to Fairfield Hospital’s ED come from Arabic speaking backgrounds with many having limited English. What we sought to measure in the study ‘Hal tafahum ealay (Do you understand me)?’ was the concordance between Arabic speaking patients and ED doctors at the hospital. Part of that included examining how concordance varied according to English language proficiency,” Dr Tam explains.

In the study, which was conducted with a SWSR Small grant, 172 patient-doctor pairs were interviewed in the ED in Arabic and/or English. The responses from the patient-doctor pairs to three interview questions: ‘What was the presenting problem?’ ‘What was the diagnosis?’ and ‘What were the discharge instructions?’ were compared to construct a ‘concordance score’ This score ranged from 0/3 (completely discordant) to 3/3 being completely concordant.

Whilst the initial results showed that there was no obvious relationship between language proficiency and degree of concordance, the results did show that a significant factor affecting concordance was the number of years the patient had lived in Australia. That is, more recent migrants had a lower rate of concordance compared to patient who had lived in Australia longer. In addition the study found that patients with more serious illness had lower concordance whilst patients who had access to an interpreter had higher concordance scores.

“Knowing this information allows us to design interventions to improve the quality of communication with all patients. What comes through in the results is the importance of interpreters, and the barriers to using professional interpreters in the ED workflow.”

Dr Tam says that this year, the team has been undertaking a qualitative analysis of the responses to gain further insights into the nature of patient-doctor miscommunication in the ED. One of the early interesting findings was the discordance around descriptions of “time”.  This was a potential source of serious verbal miscommunication – for instance, when a patient needed to attend to a health intervention after discharge.

It is expected that the analysis will be completed later this year.

By Linda Music