Every patient is an immigrant in the doctor's office

One of my favorite conferences is The Conference on Practice Improvement hosted by the Society of Teachers of Family Medicine (STFM) and American Academy of Family Physicians (AAFP).

For all the upset and negativity there seems to be toward doctors, these family docs are in it — each and every one that I’ve met — for the good of their patients. And that is why I think every one of them should take heed of the astute comment in his intro to the book, Patients and Doctors: Life-changing stories from Primary Care. Primary care physician Jeffrey Borkan observes: “Every encounter between doctor and patient is a cross-cultural event.”

Doesn’t that put we patients into perspective: whether in the doctor’s office, clinic, lab, hospital, long term care or hospice, we patients are the immigrants. We have to learn their language, protocols, processes and expectations. Then, we each have to figure out our role and how we’re going to negotiate the terrain. Even patients who are activated, engaged, empowered and Type A plus can be taken down by illness like Superman with Kryptonite. The Institute of Medicine (IOM) reports that even we who are educated and skilled find it daunting to wrap our heads around complex health information when made vulnerable by poor health.

Being thrust into sick-land is indeed like being dropped into a foreign culture, with dozens of languages and dialects. Each condition and each disease has its own nuances, acronyms, jargon and short-hand and we have to quickly get up to speed after finding ourselves on these foreign shores. Unlike the health-care professional “natives,” who’ve had years of acculturation and training, we’re expected not only to understand – if not speak – the language, but also to be able to assess, evaluate, analyze and come to an educated conclusion about our care.

It’s a tall order, and even seemingly simple words and concepts can be baffling:

… a middle-age woman, in line for coffee ahead of me, sighed heavily and loudly enough that I asked what was wrong. In accented but perfect English, she explained, “My husband is going for heart surgery. Last year, the doctor told us he was at risk and should take a coated aspirin every day. We didn’t know what he meant, ‘coated’ or why. So we didn’t. And now he’s in surgery.

Whether or not there’s a link between not taking the aspirin and the surgery isn’t the point here. Why were they expected to know the meaning and significance of “coated.” Why didn’t the doctor explain? Why didn’t they ask – if not the doctor, then the pharmacist. Or the doctor’s receptionist, or someone in their own community? Perhaps, as immigrants, they’re not empowered, activated, engaged. Or perhaps because ‘coated’ being such a simple word, they thought somehow they should know what it meant.

They felt stupid for not knowing. The repercussions of that exchange lost in translation go beyond the (possible) physical result. Guilt, anxiety, diminished self-worth, having to answer to other relatives. Why is it up to we who are not feeling well, and who are emotionally embattled and feeling vulnerable, to become acculturated and understand the language of this strange new world?

It’s not just MDs. In a recent committee meeting at the College of Occupational Therapists, an OT said she’d explained to a patient she’d been trained in wound care. As the only civvie at the table, I said – more as a statement than a question, “You’d never say wound care to a client would you.” A brief silence.

“Why not?”

“Because to us patients, ‘wound’ means a gunshot or knife or war wound.”

OTs: well meaning. Dedicated to patient-centered care. Yet they hadn’t considered the impact of the word ‘wound’ on someone without health care (or combat) training.

I sure wish every health care professional would consider Dr. Borkan’s observation. Patients and health care professionals: two different cultures. What will it take to get us speaking the same language?

Kathy Kastner is Founder and President of Ability for Life.