Letter to the Editor
Medical attention in bilingual territories
La atención médica en los territorios bilingües
Rami Qanneta
Dirección asistencial, Hospital Sociosanitari Francolí, Gestió i Prestació de Serveis de Salut (GiPSS), Tarragona, Spain
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We are pleased to be able to express our opinion from a conceptual point of view and a holistic care perspective.</p><p id="par0010" class="elsevierStylePara elsevierViewall">As known, the concept of bilingualism refers to a person's ability to communicate independently and alternately in two languages (individual bilingualism). It also includes the coexistence of two languages in the same territory (social bilingualism). The determinants that explain bilingualism include colonialism, migration, the political unification of territories, border areas and demographic changes.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">There is no doubt that in order to improve patient medical care with minimum quality standards, it is crucial to adapt the core curriculum of the health professionals’ competencies. This should include knowledge of native languages and cultures and embracing healthcare which is person-centred, with comprehensive and integrated collaboration, as emphasised by Tolchinsky Wiesen et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, from the individual perspective of bilingualism as good practice in the doctor-patient relationship, the most flexible definition includes any individual with some knowledge of a second language. In this sense, receptive bilingualism – someone who is competent in their first language and can listen and read in the second language but is unable to speak or write it<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> – would be acceptable in bilingual territories, as it would enable the patient and the doctor (with active listening) to communicate in the specific healthcare situation, in an independent manner, each with their dominant language without the perception of limitations or language barriers. Therefore, we consider that receptive bilingualism is the minimally required communication phenomenon which is efficient and includes care and respect. The prior consent of this linguistic situation between the doctor and the patient, maintaining the communication skills of both parties using languages which differ but are official, is an occasion that will allow us to avoid unnecessary damage, minimise the emotional impact and reduce cognitive biases in vulnerable and fragile patients, under the umbrella of empathy, humility and diversity.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> All of this could promote the prevention of potentially avoidable healthcare-related adverse events, and help towards patient satisfaction, meeting their needs and expectations, with the <span class="elsevierStyleItalic">spirit</span> behind the care being person-centred<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> However, we cannot underestimate the shortcomings of receptive bilingualism compared to the balanced or productive bilingualism, as emphasised by the authors – the latter shows mastery and similar ability in two languages, as well as the effective use of both in diverse circumstances.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is often of simultaneous origin at childhood (bilingualism as the first language), unlike receptive bilingualism which is acquired sequentially (in a formal or informal manner). Even so, it is worth mentioning that resilience, creativity and <span class="elsevierStyleItalic">willing to try attitude</span> of the health professionals with receptive bilingualism, could create a space of bidirectional trust, moving these deficiencies into the background.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We fully agree with Tolchinsky Wiesen et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> about the necessity for the public administration and the health centres themselves where the professional practice is carried out, to initiate strategies aimed at language learning. This provides a vision of the future and of growth to enrich ourselves within the heterogeneity and reduce the variability of our usual clinical practice in an increasingly complex environment with ethical concerns. Our objective, as health professionals, is to provide a safe, effective, sustainable response adapted to the needs of each case at the right time.</p><p id="par0025" class="elsevierStylePara elsevierViewall">However, it must be taken into account that in bilingual communities each language tends to be used in different contexts and for different purposes.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This can give rise to situations of functional inequality of languages leading to an extreme need for rationality and common sense in differentiated and specialised medical care, as well as an adjusted asymptote aligned with individual, social, political and legal realities in bilingual territories.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally, we are guided by the possibility of freely and politely expressing our opinions and concerns with the sick person at the healthcare centre, in order to improve the information, communication and our understanding of what is happening now or what could happen in the future.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethics</span><p id="par0035" class="elsevierStylePara elsevierViewall">The corresponding author guarantees the accuracy, transparency and honesty of the submitted manuscript; that no relevant information required the obtaining of any informed consent.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">The corresponding author did not receive any funding or grant in connection with this publication.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">Rami Qanneta was in charge of the conception and writing of the submitted manuscript. The corresponding author has no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethics" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interests" ] 3 => array:2 [ "identificador" => "xack664789" "titulo" => "Acknowledgements" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical attention in bilingual territories" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Tolchinsky Wiesen" 1 => "R. Calvo Escalona" 2 => "M. Inzitari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2022.07.023" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)." "fecha" => "2023" "volumen" => "160" "paginaInicial" => "39" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36253207" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilingüismo y contacto de lenguas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Appel" 1 => "P. 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"fecha" => "2022" "volumen" => "54" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Feng Shui of an integral and person-centered attention as a key transversal process" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Qanneta" 1 => "J. Pi" 2 => "G. Claret" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2017.11.038" "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)." "fecha" => "2018" "volumen" => "151" "paginaInicial" => "e37" "paginaFinal" => "e38" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Talk to them: narrative care within a person-centered care framework" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Villar" 1 => "R. Serrat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.regg.2016.06.004" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Geriatr Gerontol." "fecha" => "2017" "volumen" => "52" "paginaInicial" => "216" "paginaFinal" => "222" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27461990" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack664789" "titulo" => "Acknowledgements" "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">To Elisa Bové Aleu, Meritxell Martínez Solé and Yolanda García Hernández, for their thoughts and advice that have added value and rationality to this publication.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016000000008/v1_202305031634/S2387020623001237/v1_202305031634/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016000000008/v1_202305031634/S2387020623001237/v1_202305031634/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623001237?idApp=UINPBA00004N" ]
