1. a) I believe that in this particular situation, the main problem with the communication had to do with cultural differences with the French language. There are subtleties and different expressions with all languages that vary by region. In this situation, the French speaking doctor was not Acadian and he did not catch Marie-Marthe's expression "foies". I also believe both doctors should have started with the active offer.

b) The doctors should have payed attention to their patient and seen that she was showing symptoms related to her lungs like coughing, wheezing, and shortness of breath. They also should have noticed that she generally looked unwell because she had a fever, and they should have asked more questions.

2. The two doctors could have asked Marie-Marthe to show them where her pain was on her body. This would have helped them understand that there was a misunderstanding. Similarly, they could have asked her to show them where her "foies/livers" were on her body, and then they would have realized that she wasn't actually talking about her liver. I think the doctors should also have asked her why she used the plural of "foies/livers", and they could have discovered the miscommunication. The doctors shouldn't have made any assumptions and investigated more, like for example getting her to explain her symptoms.

3. I think health care professionals should be connected with professional interpreters and be able to call them in when needed. I also think that the providers should have access to posters of the anatomy of the body, so that patients could point to the location that they are talking about.

4. To avoid this type of situation, I think facilities should start with the active offer when the patient is registering for the appointment, and note in their file their preferred language. This way they can plan in advance to have a physician that speaks the preferred language of the patient available. If this is not possible, then they should arrange to have interpretation services.

1. a. There was a clear miscommunication and lack of understanding between the health care providers and the patient. The main contributing issue of communication was the absence of the active offer (no service offered in French), as well as the lack of effort from the health care providers to try and fully understand the message the patient was trying to get across.

b. The doctors should have paid more attention to the expressions (i.e. hand gestures and motions) from the patient as well as her apparent symptoms (i.e. cough, trouble breathing, wheezing, etc.). The patient was apparently pointing to her chest area when referring to her “livers/foies” – this should have been the first sign of misunderstanding or at the very least, questioning/confusion.

2. Initially, there should have been an active offer in order to attend to the patient’s language preference. If neither doctor was able to speak (and/or understand) French, steps should have been taken to involve another professional (whether from within or outside the practice) who would have been in a position to interpret Mari-Marthe’s comments/description of symptoms. Bottom line – no assumptions should have been made in the case where there clearly was a lack of understanding, causing confusion on both the patient and the health care provider side.

3. An interpretation tool would be important (whether through a common document, translation application, etc.). Another way of making sure that the patient is being understood in terms of identifying symptoms would be to have charts, diagrams and pictures to show the patient. That way, the patient (in this case), the patient would have been able to identify the chest area as being the problem area, which according to her was the “livers”, but to the care provider, the lungs. Ideally, interpretation services should be available whenever possible to ensure that the patient’s get the proper care they deserve, just like any other patient.

4. Ideally, interpretation services should be available whenever possible to ensure that the patient’s get the proper care they deserve, just like any other patient. If not available, health care providers should be able to discuss these cases (where the preferred language is French), with other French-speaking providers to ensure that the case is being treated accordingly.