Do You Know What Language You’re Speaking With Your Patients?

Sept. 20, 2021
In his Editor's Notes for the September-October issue, Editor-in-Chief Mark Hagland looks at a little bit of linguistic history in western Europe, and makes points about how language and framing are very important in the patient experience

Many Americans have visited the South of France, with its incredibly lovely cities and towns, its vast fields of lavender; and have visited Catalonia in the northeast corner of Spain, including its capital city, Barcelona, one of the most cultured cities in Europe, with its brilliant architecture by the Catalan-Spanish architect Antoni Gaudí. But how many realize that the people who lived in Barcelona and in Aix-en-Provence once spoke essentially the same language? It’s true.

That’s because, just a few centuries after the fall of the Roman Empire, the language known as Old Occitan had emerged, with written documents appearing as early as the eighth century, just a few hundred years after the definitive fall of the Roman Empire. For several hundred years, a variety of medieval counts, including the Counts of Toulouse, ruled southern France, while in Spain, by the tenth century, the County of Barcelona had become increasingly independent, eventually developing into the Kingdom of Aragon after 1137. Throughout this time, the people in southern France and northeastern Spain spoke dialects on the same language continuum, which gradually separated into Occitan and Catalan.

And, though the French central government, beginning as early as the reign of François I (1515-1547), became increasingly autocratic when it came to language, with Louis XIV and then later, the leaders of the revolutionary government, following the onset of the French Revolution, attempting to stamp out France’s several regional languages (not only Occitan, but also Breton, Alsatian, Flemish, and Basque), and although the Spanish government, beginning under the reign of Felipe V (1700-1724), and cresting under the dictatorship of Francisco Franco (1939-1975), attempted to destroy Catalan, both languages have survived. Indeed, Catalan is stronger and more dynamic than ever these days, as an official language of Catalonia, co-official with Spanish, with nearly all schoolchildren in Catalonia being educated in Catalan first rather than Spanish. Meanwhile, the revival of Occitan is ongoing in France.

What’s more, among the earliest great poetry in western Europe was written by formal and informal poets in the areas of Catalonia and Languedoc. Not only were there great Catalan poets as early as the thirteenth century, including the renowned Ramon Llull (1232-1315), but the great troubadours, those itinerant poet/singers who spread poetic and musical joy to the masses in France, Spain and Italy in the period from the late eleventh century through the fifteenth century, first composed their poetry and songs in Old Occitan. And all along, mutual intelligibility between Catalan and Occitan survive Meanwhile, mutual intelligibility between Catalan and Occitan remained very strong for centuries more, and with speakers of the two languages looking upon their languages as variants on a single language as recently as the nineteenth century.

Language and framing are important in so many spheres of activity, no less so in U.S. healthcare delivery. As Senior Contributing Editor David Raths writes in this issue’s cover story, “Patient engagement and ‘patient-centeredness’ are hot topics in healthcare these days, but health systems and clinical researchers run the risk of alienating patients or having their engagement efforts seen as mere public relations efforts unless they devote the effort to thinking about how they will engage with patients early on in designing care pathways and outcomes measures and developing research questions to explore.” How exactly is patient-centeredness evolving forward in the care delivery and clinical research spheres? Our cover story helps to explain the important work going into the development of a truly patient-centered experience in healthcare.

Meanwhile, as you next travel through the South of France and Catalonia, may the ancient rhymes and tunes of the troubadours echo in your mind.

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