Lost in translation

You visit your friendly neighbourhood GP for what seems to be a mild throat pain. His diagnosis? That you are suffering from a 'putrid sore throat'? Putrid? Your throat is putrid?!!!

Or imagine this: you are at the dermatologist to consult on an outbreak of pimples. He informs you that you have 'acne vulgaris'.

Vulgaris? What's that supposed to mean? Embarrassed, your mind abandons the possibility of any further questions.

But relax. The term vulgaris has nothing to do with your interpretation of it. It is simply a medical term identifying a particular kind of acne outbreak.

Putrid sore throat and acne vulgaris are many of the routine terms for inflamed tonsils and acne – both of which can be effectively treated with by medications.

The doctor-patient communication is full of such pitfalls. For many patients, the fact that they are not familiar with medical terms is a source of deep terror.

Even if the medical term the doctor has used is perfectly safe, it can make you think of the worst-case scenario.

Not surprisingly, studies conducted by US-based sociologists H. B. Beckham and R. M. Frankel in the 1980s prove that good communication leads to better health for patients.

The bonus is that the doctor enjoys better understanding with his patient and his clinic remains well-attended.

But what causes a breakdown in effective communication?

Here are a few pointers:

The know-it-all patient

You can spot this kind, unmistakably loud in the throng of a party where he holds court about the latest viral fever he has just read about.

Usually, he spends one-third of his lifetime surfing the net for medical information. Every bit of information on an ailment, its origin, its discovery, statistics on how many people suffer from it around the world, the causes, medications, their side effects are just a scroll away in his mental favourites.

All you do to get educated (in 2 minutes) is to google him with your query,

'Did you hear of this new viral cough ...? In a matter of minutes, he will tell you more than what your gigabyte brain can process in ten.

It's no surprise then that people who exhibit this kind of behaviour irk qualified medical practitioners.

After all, it's not for nothing that docs spend years gaining experience in their relevant field. Can all those years of experience be compressed into the time it takes to surf the net on the off chance that you may be the star attraction of the party tonight? Definitely not, say experts.

Nevertheless, it is just this kind of patient who visits a doctor, rattles off the long list of symptoms and then with a significant pause the good doc is terrified to encounter, pronounces, 'Yes, I think I have pneumonia.'

Now all he wishes the doctor to do is nod his head in agreement and write him a prescription (and chances are, he will also tell the doctor the names of the medicines he thinks he should be taking).

The result: an end to this particular doctor-patient relationship!

Cultural sensitivity

Doctors practising in cosmopolitan cities – such as London, New York or Dubai – are bound to have patients of different nationalities.

It is natural that cultural and linguistic differences exist between the doctor and his patient and, thanks to variations in pronunciation of English in different parts of the world, medical terms are likely to be misinterpreted or misunderstood by a patient.

Interestingly, apart from verbal gestures, non-verbal gestures too are at risk of being misunderstood.
A GP's harmless, reassuring pat on the patient's shoulder, or maintenance of direct eye contact can sometimes upset a patient.

A conservative approach

Doctors who belong to the old school of thought believe in not letting the patient know more than he needs to. They often ask a patient about his symptoms as they continue their examination.

And when it comes to delivering a verdict and the diagnosis, most old-school doctors say ... well, precious little. They scribble out a prescription, tell the patient when to take the medicines and ring for the next patient to be shown in.

Interaction such as this, in today's times, when so much medical info is freely available on the net, doesn't exactly inspire a patient. Which is not to say that not everything you read on the net is absolutely reliable.

But then again, it does not diminish the need for a doctor to rethink his approach and adopt an extrovert behaviour. In fact doctors are being called upon to be extroverts and to talk to patients more. Doctors today, say medical experts, need to act as educators.

They should inform patients about their illness and this should be done using simple, elementary terms. Sometimes, a doctor's soothing voice and non-alarmist tone act as a placebo, relieving patients of other side effects such as anxiety and fear. This in itself makes a big difference to the rate at which the patient recovers.

Most physiological ailments have their roots in psychology and addressing the emotional needs of the patient often reduces the physical symptoms of an illness, it has been observed.

Prescriptions for doctors

So what are the essentials doctors need to take care of?

n First, make a patient comfortable by greeting him, asking about his family, etc. (In the olden days, the family GP would often drop in for a cup of tea during his evening walk, perhaps even share a meal.

But those were close-knit communities minus the frenzy of modern life.) But even in today's times, particularly in today's times, when stress leaves so many of us vulnerable and fearful, a doctor spending just those few extra minutes goes a long way in palliative cure.

Prescriptions for patients

The patient, on the other hand, should:

Voices, mind and diagnoses

Dr Stephen Hardcastle, of the Dubai-London Clinic, is always attending to a rush of patients.

He puts it down to enjoying a good bond with his patients and being sensitive to cultural differences.

Dr Hardcastle, who came to Dubai a few months ago, has been in the region for six years and prides himself on being able to communicate effectively with his patients.

"I trained in South Africa with a very typical Western approach to health care. Medical school taught me about patient's diseases and body parts,'' he says.

An important part of the job is being sensitive to accent and cultural differences, he adds.

"My time in clinical practice has taught me the importance of acknowledging the patient as part of a family and community, each with his or her own cultures and beliefs.

Appreciating and accepting differences in cultures while still providing optimal care can be challenging. More especially so, as I am a monolingual Western healthcare provider."

Dr Hardcastle takes pains to understand the cultural background of his patients.

"Dubai must rank among the cities with one of the highest number of nationalities. This multiculturalism is a challenge for healthcare providers to provide optimal care, while remaining sensitive to cultural traditions of patients.

"I am only too aware of my lack of knowledge of unfamiliar cultures, which can lead to misunderstanding, compromise care and assumptions based on my own culture and training.''

He believes a doctor must try and take non-verbal communication into account as well.

"Messages are communicated by facial expressions and body movements that are specific to each culture. It is important to be aware of variations in non-verbal communication to avoid misunderstanding," he says.

"For instance, the head shake frequently used by those from southern India can cause confusion [to a Western person] – is it a 'yes' or a 'no'?"

"The 'safest' consequence of recognising cultural differences should be to assume that everyone's thoughts and actions are not just like ours and develop a respect for beliefs that are different from your own."

Dr Hardcastle has some interesting anecdotes. A patient once told him: 'Voices are speaking to me and I have a great emptiness'.

"This did not indicate a schizophrenic person,'' says Dr Hardcastle. "It was only the patient's way of explaining how homesick he was and that he was missing his family!

"Miscommunication – which affects the doctor-patient relationship or even accurate diagnosis – can arise from failure to recognise non-verbal signals, attitudes towards the concept of illness and health and [sometimes] the influence of religion on medical treatment. Cultural differences in lifestyle, gender roles, discrimination and status issues are also factors, which need to be considered.

"Becoming culturally competent is a developmental process and takes time. The ability to determine and assess the patient's level of acculturation is equally important," he says.

"The latter will determine the approach to each individual patient. The 'need to know' is a unique American trait, which does not apply to everyone. Many local cultures do not want to know or hear bad news.

"Among native English speakers, many different accents exist. Some regional accents can easily be recognised. The greatest difficulty is usually with the Scottish or Irish – the latter especially so!

"Spoken English proficiency, however, does not reflect literate English proficiency or language of origin proficiency or literacy.

"Intercultural communication is a key clinical issue in medicine and can determine quality of care. It is also a challenge for any patient to try to understand medical jargon. A competent provider is aware of the cultural differences and even more aware of the individual and his or her personal needs."

Communication tips

So how can patients communicate better with a doctor, irrespective of their background?

"Speak openly and honestly, try and identify and describe symptoms clearly. Don't be embarrassed, let the doctor know if he uses unfamiliar words or medical terms and remember the doctor is not a mind reader!" says Dr Hardcastle.

And how can the doctor communicate better?

"Begin by being more formal with patients who are from another culture,'' says Dr Hardcastle.

"Do not discount traditional beliefs. Recognise when a patient has learned as much as they are able to deal with and be circumspect with bad news.

Medical decisions often involve the whole family and recognising this can greatly facilitate future treatment and care.

"Attending to a patient is not just about administering the right dose of a pill or potion, but it is more about reaching out, making the patient feel comfortable and at home.

"Once that is done, half the job of the doctor is really taken
care of!"

Numberspeak

The Health Association of Canada has come up with interesting facts in a doctor patient relationship:

18: The average number of seconds a doctor waits before interrupting a patient's description of a problem.

90: The average number
of seconds a patient
spends describing his problem when not interrupted.

45: The percentage of patients' concerns about their problems that are not elicited by doctors.

50: The percentage of
psychosocial and psychiatric problems that are missed by doctors.

50: Percentage of visits
during which patient and
doctor do not agree on the nature of the problem.

Some more findings:

That doctors feel more satisfied when dealing with concrete issues of examination and treatment and tend to see the interview as the wrong time and place for a 'social interaction'.

Patients feel more satisfied when they can discuss their problems fully with an empathetic doctor.
Courtesy: Zeneca Pharma Inc