Tuesday, April 22, 2008

Presentation reflections

I was surprised that many of my classmates want to pursue their eduction in the medical field. As many of their minor issues were different they all shared one major issue in common. All the students agree that building a strong physician-patient relationship is essential. It is necessary to make this bond with their patient in order to effectively communicate.

Effective communication involves clarity and understanding. A tight bond with a physician eliminates the chance of mistakes. As my classmates stated how doctors should communicate with their patients, I constantly thought of my past experiences with physicians. It reminded me of one incident in particular. Two years ago I was involved in a car accident in which I broke multiple bones in my right hand. Because of the seriousness of my accident, I spent a week in the hospital. I interacted with my doctor on a regular basis during this week.

My classmates informed our class in their presentations that a doctor must build a strong relationship with their patients in order to be successful. One student mentioned that a doctor should be conscience in the manner in which he relays information. The best way a doctor should do this is by stating the benefits or ways they can improve their condition before relaying the "bad news." My physician did just this. He first told me that with multiple surgeries and extensive therapy, my hand would be alright. He then proceeded to tell me that I most likely would not be able to have full range in mobility and that I would not be able to play volleyball for a year. This was obviously devastating to me.

Another classmate shared with the class the different approaches doctors can take; the best approach being the shared approach. My physician carried the shared approach in every decision he made. He made sure that he discussed everything with me before so that he could hear my input. My doctor would listen to my opinion before surgeries or changing up my therapy routine. The openness of my doctors attitude led me to gain trust in him, and assurance that he was making the right choices.

A student that is not wanting to go into the medical field but accounting shared a same issue that is commonly used in healthcare. He stated that visuals such as handouts are a great way to communicate clearly for further understanding. While I was in the hospital and throughout my therapy experience I received handouts. The handouts included the diet I should be on, precautions that should be taken, and stretching instructions. These visuals truly helped me effectively perform all the necessary steps that needed to be taken for a quick and successful recovery.

My experience in the hospital and the reoccurring theme that my classmates presented, further demonstrates the importance of efficient communication skills in healthcare. Proper communication in healthcare embodies qualities of trust, understanding, and respect which ultimately leads to a strong patient-physician relationship.

Wednesday, April 16, 2008

Bridging the Medical Gap

An increase in globalization contributes to many positive aspects in our world; however this diversification brings challenges among physicians and patients in healthcare. Physicians face the dilemma of communicating effectively with patients who immigrate to the United States and are not proficient in the English Language. Health care professionals must overcome the linguistic and cultural barriers that impede essential communication in the medical field.

Physician and patient communication is crucial. Miscommunications often arise in health care even at times when both parties speak the same language. Nevertheless, there are approximately 311 languages spoken in the United States1 and not a sufficient amount of physicians that speak these languages.


Serious problems develop when non-English-speaking patients do not use an interpreter to communicate with medical staff. Additionally, when patients are not able to fully communicate with their clinician, they feel distanced or excluded2. A sense of mistrust builds within the patient when they are not able to understand their doctor. “Recent immigrants with limited English proficiency... may be more vulnerable to poor quality care2.”

Interacting with patients who have limited English proficiency is always an obstacle but “using a trained medical interpreter is the right medicine1.” Although difficulty in communication exists physicians agree that it can be improved with language interpreters.


The most exceptional kinds of interpreters preferred by physicians include the following: bilingual health care providers, hospital interpreters, bilingual staff, and volunteers3. While it is not recommended, a family member may be used as an interpreter when no other interpretation service is available.

Adequate communication between a physician and patient improves the quality of life. Studies show that an interpreter can increase the patient’s understanding, improve physician-patient relations, overall health status of the patient, and follow-up examinations4. Medical interpreters help resolve the confusion that comes accompanies how patients should properly follow the prescription labels, make appointments, and understand discharge instructions. The main tasks for interpreters are to eliminate misunderstandings and reduce errors. “Bilingual, bicultural social workers and health care advocates may play key roles in improving patient care2.”

Some physicians however oppose the use of medical interpreters. The main issues that arise with the use of interpreters in health care are money, time, and unnecessary errors. Many health care facilities do not have the resources to provide interpretation services. Health care systems with restricted budgets find it difficult to fiscally support interpreter services2.

Clinicians spend a significant amount of time making phone calls and scheduling appointments in an attempt to find appropriate interpretation services. An excessive amount of time is also consumed during the actual process of interpretation between the physician, interpreter, and patient. Various physicians sense it is a waste of time. An anonymous doctor states that finding interpreters are not exactly his duty as a physician; his responsibilities include “diagnosing, treating, looking at the results, analyzing, etc5.” In the mind of some physicians, medical interpreters are seen as a burden.

Interactions between physicians, interpreters, and patients, can cause error in their conversation. Interpreters significantly reduce what is actually being said by physicians and patients. A recent study shows that in a typical conversation, physicians usually speak 49% of the visit, interpreters translate 27%, and patients speak 24%6. In actuality interpreters should be speaking 50% of the conversation.

In addition to reducing the time spent speaking, interpreters also alter the content of the conversation. Interpreters are at fault of omitting and revising content6. In other words, interpreters exclude significant information and modify critical matter in conversation.


Furthermore, “small talk” is almost entirely nonexistent when an interpreter is utilized6. Small talk is a method for physicians to interact with their patients by speaking about issues unrelated to medicine. Without “small talk,” the clinician-patient relation is weakened.

When speaking to individuals who lack proficiency in English, it seems most logical to use a medical interpreter. Although misunderstanding and issues arise as interpreters are employed, it appears that interpreters are responsible for more benefits than disadvantages. Physicians and patients would not be able to communicate in the first place if interpreters were not used. There is more chance of misdiagnosis, deterioration of health, or even death if an interpreter is not present. Although medical interpreters do not completely eliminate the language barrier that exists in the medical field, it certainly does improve the possibility of overcoming this obstacle.


References


1. Chen, A. Doctoring across the language divide. Health Affairs [database]. 2006 [cited 2008 Apr 06]; 25 (3): 808-813. Available at Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu:90/.
2. Ngo-Metzger, Q., Massagli, M., Clarridge, B., Manocchia, M., Davis, R., Lezzoni, L., Phillips, R. Linguistic and cultural barriers to care. Journal of General Internal Medicine [database]. 2003 [cited 2008 Apr 06]; 18 (1): 44-52. Available from Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu:90/.
3. Phokeo, V., Hyman, I. Provision of pharmaceutical care to patients with limited English proficiency. American Journal of Health-System Pharmacy [database]. 2007 [cited 2008 Apr 15]; 64 (4): 423-429. Available at Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu:90/.
4. Wilson, E., Chen, A., Grumbach, K., Wang, F., Fernandez, A. Effects of limited English proficiency and physician language on health care comprehension. Journal of General Internal Medicine [database]. 2005 [cited 2008 Apr 06]; 20 (9): 800-806. Available from Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu:90/.
5. Contextualizing cultural competence training of residents: results of a formative research study in Geneva, Switzerland. Medical Teacher [database]. 2006 [cited 2008 Apr 15]; 28 (5): 465-471. Available at Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu:90/.
6. Aranguri, C., Davidson, B., Ramirez, R. Patterns of communication through interpreters; a detailed sociolinguistic analysis. Journal of General Internal Medicine [database]. 2006 [cited 2008 Apr 15]; 21 (6): 623-629. Available at Academic Search Premier:
http://web.ebscohost.com.proxy.lib.utk.edu:90/.


*I had trouble formating the superscripts in the in-text citations so I know they look weird right now. Also I could not get my indentions to line up for my references.

Tuesday, April 8, 2008

Bridging the Gap in the Medical Field

My ultimate career goal would be in the field of medicine. When I think about issues that surround the medical field, they all relate to misunderstanding. What the physician explains to a patient does not seem all that crystal. Many people who speak to a physician hope to be enlightened. After a conversation with their doctor, however, these patients are more lost than before.

A reoccurring language issue that affects the medical field is the use of technical jargon. Many times physicians do not clarify enough when speaking to their patients. They overlook the fact that the majority of their patients have lower health literacy and do not understand the medical terminology that doctors are accustomed to. Problems occur when doctors explain the conditions of their patients’ health issues and even medical instructions.

An additional issue that appeared often in my research deals with patients with English proficiency. With a rapidly increasing number of immigrants in the U.S., doctors find it more difficult to communicate effectively with their patients.

Doctors may use trained medical translators to aid in the communication process with foreigners. Even bilingual staff members can be off assistance. When these translators are not available, doctors must communicate by themselves. They must use a slower rate of speech, simple diction, and visual aids.

Physicians must communicate clearly by catering to their patients. Doctors must clarify exactly what the health issues are and clearly state how the patients can combat it. If this issue is not addressed, patients are left confused, misguided, and untrustworthy. This confusion can lead to not having full confidence in their doctor or not knowing how to deal with their health problems. This in turn may lead to a diminishing of their health or the possibility of death.