Communicating with Patients in Healthcare

Q1. What positive and negative impacts do chronic health conditions have on someone's view of their selves?

Although almost patients at some point in their lives find themselves suffering some degree of sickness and ill health, experiencing a chronic illness, especially when someone is young, can put the patient outside of the normal growth trajectory of someone in their age group, psychologically as well as physically. Chronic illnesses can foster a sense of depression, a lack of self-efficacy, and can force young people to delay common milestones such as going away to college and embarking upon a new occupation. Feeling “fear, anxiety, tension, anger, and depression” is common and can “cause patients to underestimate their abilities” (Ebrahimi Belil, et al., 2018, par. 3.2.2). When chronically ill patients feel a greater sense of self-efficacy and ability to manage their symptoms, while acknowledging their limitations, they are less likely to suffer from such issues (Ebrahimi Belil, et al., 2018).

Chronic illnesses can be instructive in the compassion and sense of self-reflection patients may experience as a result of their illnesses. They may also feel greater resiliency and determination to make the most of the times that they do feel well, in contrast to their fully able-bodied contemporaries. Patients need to learn to tolerate disruptions and identify what they cannot and can control in a proactive fashion. This is a hard lesson that many able-bodied persons struggle to cope with, given the great emphasis placed upon achievement, control, and maximizing productivity in daily life.

Chronic illnesses also force patients to self-advocate both within the healthcare system, but also on a social level, as they must navigate treatment, medication schedules, or simply the energy drain their illness creates. They also can become aware, as a form of self-protection, of the dangers of relationships where boundaries are not respected, as they require people to understand and empathize with their limitations. All of these were important lessons for all patients, regardless of health status, during the quarantine and recent pandemic.

Q2. How can we improve healthcare in the United States for those who do not speak English?

Quite simply, a failure to adequately comprehend English can be deadly. It can make it more difficult for patients to self-advocate for healthcare services, and also to communicate with providers and comprehend treatment requirements. Populations which are less likely to be fluent in English have lower rates of general health literacy and suffer the consequences. For example, Latinos have historically been more likely than many other population groups to suffer from diabetes, TB, hepatitis B, liver and lung cancer and to have children in similarly poor health (Taira, 1999). Such diseases are not only serious if not treated, but also are largely preventable with primary care. (Taira, 1999). First and foremost, increasing the number of bilingual and bicultural providers is critical, so that providers will know the right questions to ask, and also present a less intimidating view of the healthcare system to patients.

Until this imbalance is rectified, having translators to act as facilitators between providers and patients, to communicate in the patient’s native language, can also lower the intimidation of going to a provider, and ideally find out important information, such as the patient’s health beliefs and what home treatments may have been used before going to a provider. Providers must strive to create a non-intimidating experience going to a physician, and be aware of historical injustices which have previously acted as barriers. Tailoring the specific translation needs to the setting is likewise critical, given that demographics will vary across the country (Taira, 1999).

Hospitals and other healthcare treatment facilities can also offer courses in how to communicate with patients with limited English proficiency, highlighting how to put them at ease and specific areas of concern (including concerns related to immigration and navigating health insurance bureaucracy, given cost may be a barrier to patients seeking treatment). Providers should also be aware of the child-parent roles and expectations, in terms of who may request to be present during a consultation.

Q3. Should programs and careers in healthcare require their employees/students to take cultural classes in order to better understand the different social aspects that come with an individual’s territory?

Offering well-constructed courses in the different cultural expectations regarding healthcare have been a cornerstone in increasing efficacy for multicultural populations. It is not simply enough for a provider to be technically competent to provide effective care. The provider must be able to communicate to and with patients to understand patient needs, and to ensure that the patient can engage in effective self-care later on. However, systematic reviews of such programs have found limited evidence that such training, as currently constructed, results in marked improvement in patient health. A review by Jongen, McCalman, & Bainbridge (2018) found “significant heterogeneity in workforce intervention strategies, measures and outcomes reported across studies making comparisons of intervention effects difficult,” and while improvements in practitioner knowledge were statistically significant regarding knowledge, skills, and changes in attitudes, the health and health-related outcomes of the affected populations was not (par.3).

This does not necessarily mean that such interventions have no value, but that the socioeconomic and health-related barriers populations face may be so significant, training in improved communication is clearly not enough to make a difference. Training may still be valuable, but different approaches may be required. Also, making active efforts to diversify the workforce is also important.