Patient diversity in healthcare settings

¶ … Health-Related Interactions:

The cases of Todd vs. Mr. Gomez

When dealing with a situation in which communications between a patient and a physician is difficult -- for example, if the patient has limited English proficiency or is deaf -- inevitably barriers are created which prevent a fully patient-centered communications process. Physicians often cite limited time as a reason for being insufficiently patient-focused. In the case study of Todd, the interaction was challenging because of the lack of the presence of an ASL interpreter. This was a lose-lose situation for both the patient and the physician. The physician was frustrated because of the extra time needed to complete the interaction by writing everything down; the patient was frustrated because of the fact the physician often misunderstood him and tried to lip-read as a shortcut or ask him yes and no questions which did not sufficiently address his concerns.

Perhaps the area of greatest concern is that the physician broached standard confidentiality when speaking with the patient's family. Although this was done to help the patient, given the physician's frustrations with their limited interactions and it did yield some important information about the patient's medical history, it is unjust that a patient merely because he is deaf should not have the same privacy as someone who is not hearing impaired. The physician seems to have engaged in a 'physician-centered' rather than a collaborative interaction -- the need for expediency were put above the rights of the patient.

The case of Mr. Gomez, Megan, and Lydia at least involved a translator and allowed Mr. Gomez to communicate more fully. However, a problem arose given that Megan is a Spanish language interpreter and Mr. Gomez was hard of hearing. This involved Mr. Gomez having to lip-read what Megan was saying, who then conveyed what he said in Spanish as best she could to Lydia. This inevitably created a twice-mediated form of communication and Lydia, like the physician in Todd's interactions, was frustrated by the additional time which is required with a patient who cannot easily communicate with the outside world.

Lydia also relied upon other sources of health information, in this case the patient's granddaughter who seemed uncertain about what type of medication her grandfather was taking. The grandfather also had a different cultural worldview of references (such as not knowing what snow was) as well as different preoccupations than the physician (being treated at a familiar clinic and being in the country legally vs. medically related questions).

Both interactions were collaborative in the sense that they involved multiple individuals but did not really produce high-quality information and were not truly collaborative in the sense that there was a real 'sharing' between physician and patient. Diversity regarding race and ethnicity as well as language barriers was significant impediments in this exchange. Furthermore, unlike Todd, there was not someone to take charge of Mr. Gomez's care who seemed highly competent and while Todd was able to evaluate the advice he was given, Mr. Gomez's age and fears about questions about his immigration status raise serious questions about the quality of his care.