Foreign languages in healthcare
Language barriers disrupt communication with patients and lower the quality of care. A joint project of EAÜS, the Estonian Junior Doctors’ Association and the nursing students’ society is looking for solutions.
Background
Language barriers disrupt communication with patients and lower the quality of care. One doctor in three needs help with translation every week; among emergency department and ambulance staff, close to half need help weekly — 33% of doctors need help with Russian and 20% with English. This shows how serious the language problem really is among future doctors and junior doctors. EAÜS and the Estonian Junior Doctors’ Association have therefore taken up the subject together, and it has grown into a major joint project.
The problem
The Estonian Medical Students’ Association (EAÜS), together with the Estonian Junior Doctors’ Association (ENÜ) and the nursing students’ society, has set out to find solutions to language-related problems in Estonian healthcare. For junior doctors and medical students the difficulties fall into two groups: communication with patients and communication with colleagues.
The Chancellor of Justice’s position
In December 2024 members of the working group approached the Chancellor of Justice to clarify the legal meaning of the language barrier. The reply established that under Estonian law responsibility for overcoming the language barrier rests with the patient. A healthcare worker may provide a service in a foreign language if they wish to and judge their own competence sufficient. In law, a provider is entitled to turn a patient away from an outpatient appointment if the patient does not speak Estonian and has not brought an interpreter. Emergency departments are the exception: because of the duty to provide emergency care, responsibility for overcoming the language barrier stays with the provider (Madise, 2025).
The 2025 survey
In January 2025 the working group ran a survey to map the extent of language problems in the Estonian healthcare system. 2,289 healthcare workers responded, among them 960 doctors, 921 nurses and midwives, 84 care workers, 138 students, 102 mid-level specialists and 84 support staff. According to Health Board figures, that means one Estonian doctor in five and one nurse or midwife in ten responded.
Key findings:
- Only a third of doctors consider themselves linguistically competent to give professional care in Russian.
- Close to half of emergency department and ambulance staff need help with translation every week.
- A third of healthcare workers in Tallinn speak Russian only at beginner level or not at all.
- Language problems are most frequent in paediatric departments and surgical clinics.
- Of the respondents who rated their Russian below B1, 92% were aged 20–49.
- In 15 years the expected median level of Russian among doctors is A1–A2. In Tallinn 31% of respondents would fall below B1, in western Estonia 35%, in southern Estonia 37%, and in northern and central Estonia 36%.
- In Tartu almost every second healthcare worker (46%) would not qualify to provide a health service in Russian even in a care worker or support role.
- 19 doctors in 20 had had at least one Russian-speaking patient in the two working weeks before responding.
- Close to 33% of native Estonian-speaking doctors said an appointment had previously been cancelled or postponed because of a language barrier.
Earlier studies have shown that a language barrier between healthcare worker and patient:
- reduces patient satisfaction,
- increases the number of treatment errors,
- increases readmissions,
- lengthens hospital stays and appointments,
- causes unnecessary investigations,
- and raises healthcare workers’ workload.
It therefore matters that the Estonian healthcare system builds the structures and allocates the resources for professional translation services, so that quality medical care is ensured for all patients — including Russian speakers. That reduces the negative consequences of the language barrier and improves the performance of the whole system. At the same time, in emergencies a doctor must be able to provide care even when the patient’s language skills are inadequate, which calls for practical solutions for such cases.
The second significant problem is the language barrier between colleagues. It arises mainly from insufficient oversight in workplaces where the language requirements set for healthcare workers cannot be met or enforced.
Proposed solutions
Language difficulties in healthcare fall into two groups: communication with the patient and communication with colleagues. For communication with patients we have proposed three solutions:
- Informing patients that bringing an interpreter is their responsibility — we recommend coming to the appointment with someone who can translate if needed.
- Building a digital solution, usable above all in emergency situations.
- Making professional translation services available on a patient co-payment basis.
Our main partner in developing the digital solution is the Estonian Health Insurance Fund. We have also begun working with the medical translation app Care To Translate, to which we want to add Estonian language support.
Communication problems between colleagues often stem from language barriers and can be eased through awareness-raising and oversight. It is important to understand that treatment errors caused by language problems are already a reality today, but they can be prevented. Avoiding such situations must be a shared goal for every healthcare worker.
Project team
- Jan Oskar Kõiv — foreign languages project lead 2025/26, fourth-year medical student
- Anette Remmelg — auxiliary medicine project lead 2025/26, fifth-year medical student
- Johanna Rõigas — internal medicine doctor, clinical expert
The project is also supported by Gerli Pihelgas and Pisar Pind. Special thanks to the article’s supervisor Mikk Jürisson and to statistics students Maarit Põllu and Anett Sits.