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The Art of Doctor-Patient Communication
Kendra Campbell -- I was listening to a fellow student take a history from a local (Dominican) patient a few weeks ago. The student (who was American) was trying to ascertain how long ago the patient’s last menstrual cycle occurred. The patient thought that the student was asking her how long her menstruation lasts, so she responded “3 to 5 days.” Without verifying what the patient actually said, the student wrote down that the patient’s last menstrual cycle was 3 to 5 days ago. It turned out that the patient actually had not menstruated for over 3 months, which was an extremely important detail that the student missed.
Incidents like this happen all the time. Unfortunately, when it happens in medicine it can make the difference between life and death. It’s easy to assume that just because you are speaking the same language, that there is comprehension on both sides. In Dominica, where I live, the national language is English. Most of the students come here from the United States and Canada, where the national languages are also English (and French in Canada). However, the English that is spoken by Dominicans can be very different than what is spoken elsewhere. For example, in Dominica, alcohol is frequently considered synonymous with rum. So, if you ask a patient if they drink alcohol, they may honestly tell you “no.” However, they could be drinking 30 beers a day. Another example is that when they use the word “foot,” they frequently mean their entire leg. So, if you don’t ask them to specifically point to the pain, you might end up with an entirely different diagnosis.
These types of errors in communication aren’t restricted to differences in culture. There can be vastly different ways of communicating within the same culture but between different age groups. A teenager will likely describe their symptoms with different words than an elderly person. And the list goes on and on. There are so many subtleties involved in accurate communication and history taking that it’s no surprise that many patients end up not being treated properly due to poor doctor-patient communication.
I think that physicians should be particularly sensitive to the subtleties involved in talking to their patients. Just as a surgeon’s delicate use of a scalpel is an art, so is proper history taking and communication with patients. As with many forms of art, there is always an element of natural ability combined with practice and dedication. Even if you do have a natural ability to communicate well with patients, you should never forget that it is still an art, and as such should be continually practiced and adapted.
September 27, 2007 in Kendra Campbell | Permalink
Comments
That was well said, and you bring up a very important point! When you add a second language there is room for interpretation. Each language has its own style of phrasing and when translated into English can mean something totally different. I just came back from my first ever medical mission trip in Nava, Mexico; and although I am Hispanic and know Spanish pretty fluently I never thought that taking a patient history could sometimes be so confusing.
Posted by: Celina | Oct 2, 2007 2:40:19 PM
I completely agree. There is so much emphasis placed on other languages (and rightly so) but I think there also needs to be emphasis placed on plain old trying to understand your patient. The fact that your patient speaks English, does not necessarily you will understand them. Cultural background plays an important role as well. I'm from Jamaica and the same words can have a different meaning there, for example the word miserable, which means irritable or grumpy more or less, and not sad. You can see how this could create a misunderstanding if this word was used in a doctor patient encounter. So thank you very much for bringing this up.
Posted by: Tamara | Oct 10, 2007 1:35:05 PM
