Professional Warned About Use of Foreign Language in Presence of Patients

A recent case provides a warning to health care professionals to be mindful of the inappropriateness of speaking in front of patients in a language that he or she may not understand. Even if what the health care professional is saying is innocent and inconsequential, the patient may not know that. Patient perception is key.

The Complaint

In RK v NAJ 2016 CanLII 66674 (ON HPARB) a patient complained about an eye examination and prescription provided by an optometrist and that the optometrist communicated to a student in his office in a “foreign language” that the patient did not understand.

The Inquiries, Complaints and Reports Committee of the College of Optometrists of Ontario (ICRC) investigated the complaint which fell into two categories: issues pertaining to the care provided and issues related to communication and professionalism.

The ICRC was “puzzled” by the optometrist’s prescribing philosophy and judgement. The optometrist undertook to voluntarily complete a remedial program (at his own cost) to address areas of weakness in his skills including prescribing, general record keeping, and communication with patients.

The ICRC noted that the breakdown in communication between the patient and optometrist related to patient education and training. In addition to the coaching and remedial training, the ICRC recommended that the optometrist be “mindful that it is not appropriate to speak with an intern (or any other person associated with his practice) in another language in the presence of the patient, who may not understand the language”.

Review

The patient requested that the Health Professions Appeal and Review Board (HPARB) review the decision. In considering the “reasonableness” of the decision, the question for the HPARB was not whether it would arrive at the same decision, but whether the decision could reasonably be supported by the information provided and can withstand a somewhat probing examination. The HPARB must consider whether the decision falls within a range of possible, acceptable outcomes that are defensible in respect of the facts and law.

The HPARB concluded that the ICRC decision was reasonable. Remediation is educative in nature and is aimed at improving the optometrist’s practice and protecting the public interest. The decision to require coaching and remediation was supported by the record and reflected careful consideration by the ICRC.

Furthermore, the HPARB noted that the ICRC was concerned about the allegation that the optometrist communicated with a student working in his office in a language that the patient did not understand, and issued a reminder to be “mindful” that this is not appropriate. In light of the information in the record, the HPARB also considered this disposition to be reasonable. The HPARB appreciated that the patient was not satisfied with the outcome, but the ICRC took the complaint very seriously and its decision was responsive to the matters complained about and addressed them comprehensively.

Conclusion

A takeaway from this case is the importance of patient perception. The patient did not understand what the optometrist was saying, even if it was something innocent, and this put the patient on guard to question the optometrist’s behaviour. All health care professionals should be mindful that it is inappropriate to speak in front of a patient in a language that they may not understand, and the potential ramifications of this behaviour.