08 May We Don't Speak the Same Language!
I live and work around Washington, D.C. I’ve heard that we have the 2nd worse traffic in America. There are lots of people here. Lots of different people here. Sometimes I can’t get my message across. Is it the culture or language?
Two weeks ago, a doctor referred a patient to for sudden loss of vision. The doctor and patient are from Korea. My patient speaks limited English. The patient had a vitreous hemorrhage. I couldn’t see in his eye and he couldn’t see out. The most common cause is a retinal tear. Retinal tears might develop into retinal detachments. On that day, I determined that it was safe to do nothing and asked the patient to come back in a week. I explained, as best as I could, that I was concerned that he might develop a retinal detachment (a potentially blinding problem). He agreed.
The patient returned as scheduled. His vision had improved as a lot of the blood had cleared. The patient incorrectly thought he was better due to his improved vision. I informed him that he had a retinal detachment. The detachment had yet to affect his central vision. His best choice was to operate within a few days. He wanted to wait a few months. We called the referring doctor to have him explain and translate. Surgery was scheduled.
The next day, I got a call from his the patient’s brother. The patient wanted to cancel surgery. The brother is a physician (not an eye doctor) and I explained that the need of the operation was to prevent blindness. The urgency was needed to preserve his perfect central vision. The brother promised to call back if the patient wouldn’t change his mind. I never got a call. The patient cancelled on the morning of surgery.
I can only guess what may have happened. There is the obvious language barrier, but I don’t think that was really the cause as I was able to communicate effectively through the patient’s own doctor and brother.
Maybe it was cultural. Despite my name and physical features, I am very westernized. Even my grandmothers were born here. I have had issues with ethnic groups that are in the midst of integrating into our culture. It is a trust issue. It is a comfort issue. Immigrants generally trust people who behave and speak the way they do. It is natural. Any new culture to the United States, however, has yet to fully integrate. They don’t have their own as professionals, that is, there are no or few doctors available that speak their language and understand them. I think this takes about 2 generations. In the US, most foreign trained doctors have to retrain (go through residency, again) in order to practice as a physician. Who wants to do that? As a result, few foreign docs ever come to the US.
Eye problems tend to be trivialized. Everything can be fixed with glasses. We know this isn’t so, but this is an issue I face with everyone, western or not. Retina disease is not intuitive, as in this case. My patient sees well. In fact, this patient’s original symptoms improved. My patient had no appreciation of a problem. My ability to communicate all of this, and gain trust, is limited. It is a problem of both culture and language.
My dad always said taking care of patients is harder than research,
Randall V. Wong, M.D.