Language Use in Medical Situations: Insecurity, Trust, and Privilege (by Melissa Enns)

During my time in Montreal (and thanks to my student medical/dental insurance), I have had several visits to the dentist. On each occasion, the use of language in the dentist’s office in a bi(/multi)lingual city in a French-speaking province has fascinated me.

At this point in time, my ability as a third language speaker of French is probably at about a B1 level according to the Common European Framework of Reference’s (2017) French self-assessment. This means that although I can easily confirm my appointment, sort out payment, and find whatever words I’m missing to tell the hygienists about a problem in French, I lack the specialized vocabulary to understand the responses and instructions they offer me. Although I normally make every attempt to carry out conversations in public places in French (at least to the best of my ability), in situations where a misunderstanding may jeopardize my health or well-being, the stakes are too high to risk attempting to have the whole conversation in French. When buying clothes or eating out it doesn’t matter if part of my comprehension is based on guesswork, but when I’m receiving instructions for post-extraction care, I don’t want to miss anything. However, as I often do when I have to rely on English, I typically feel slightly embarrassed about drawing attention to my Anglophone identity by speaking English in a French environment.

At the same time, the language used in a dental clinic is different from restaurants and retail settings in that the vocabulary is highly technical. Each time I’ve visited the dentist, I’ve found myself noticing the ways that dentists, hygienists, and receptionists use language. Since the clinic I visit is located in a primarily French-speaking part of Montreal, the staff and clients mainly speak French. Although the dentists whom I have visited there have explained things to me in English, the talk I have overheard between the dentist and the attending hygienist has naturally been in French, and I have had several interactions with hygienists that involved a collaborative effort using bits of both languages and added miming. They have been very gracious, and these communications have been enjoyable.

Observing and engaging in these interactions has been created food for reflection. For one thing, I am curious about the language requirements for hygienists. Cégep John Abbott College, for example, requires a Sec 5 level in both the language of instruction and a second language for admission into its dental hygiene program, and the coursework for the program includes classes in both French and English. Similarly, the dental hygiene program at Cégep Edouard Monpetit in Longueuil includes courses in both French and English in their grille de cours; however, these courses appear to focus on literature and/or basic language development rather than development of vocation-specific vocabulary.

Another topic of reflection during my times in the dentist’s chair—and particularly during my last visit, in which an impacted wisdom tooth was removed only after a long period of drilling, chipping, and difficulty—is the fact that, to an even greater degree than in my first language, I would be the last to know if something was actually going wrong. As I sat there focusing on staying calm despite the long time and hard work it was taking, I realized that with the conversation about the process going on in my third language, I might not pick up on some of the subtle cues about whether or not things were going according to plan. Trusting medical professionals can be a challenge for many at the best of times, according to an article in The New York Times and research by Hall et al. (2002) and Collier (2012), and I can only imagine that not being able to understand medical professionals would make experiences such as the removal of an impacted tooth or emergency medical procedures more difficult and terrifying.

This brings me to my main takeaway from this reflection on language. Privilege. Although I am on edge in the dentist’s chair and have noticed the added tension of understanding little of the dialogue between the dentist and the receptionist, I am in a position of knowing that if I need to lapse into English to understand the detailed instructions for post extraction care, for example, I can. My first language, although not a majority language in Quebec, is privileged and will be spoken sufficiently by medical professionals, unlike in the cases of newcomers who speak neither French nor English. Drawing from Peggy MacIntosh’s “White Privilege: Unpacking the Invisible Knapsack,” I could describe English as part of an “invisible package of unearned assets that I can count on cashing in each day, but about which I was ‘meant’ to remain oblivious” (MacIntosh, 1990). In other words, even in a (somewhat) minority language setting in Montreal, I can fairly consistently rely on my first language to get the job done if I want to, even if it is less convenient for my interlocutors.

Realizing this linguistic privilege—or linguistic capital, as Bourdieu (Bourdieu, 1986; Bourdieu & Passeron, 1990; Bourdieu & Thompson, 1991) would have called it—opens up new possibilities to use it accountably. As Peggy MacIntosh states, “one who writes about having white privilege must ask, ‘having described it, what will I do to lessen or end it?’” (MacIntosh, 1990). Although English can be productively used as a lingua franca in many settings, using it at the inconvenience of others is something I would like to avoid. While I have no solution to issues of linguistic privilege, these realizations stimulate me in my drive to improve my French, so that maybe one day I can go to the dentist without having to ask for explanations in English.



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