Medical Privilege, Let Me Show You It

[jesse_the_k]

In this week's Science Times, Dr. Pauline Chen meditates on her own reluctance to use interpreters, as well as a recent study in the Journal of Internal Medicine.

“[...] physician-patient communication is driven by the physician’s need for patient input rather than by the patient’s need to communicate. Communication is viewed as something that is supposed to change decisions that the doctor can foresee. So the use of interpreters may have more to do with how we think about communication with our patients and less to do with our views on interpreters, limited English proficiency patients or even time pressures.”

Chen provides a vivid example of the unquestioned medical assumption that what the doctor has to say is more important than the patient's needs. She decides her ability to ask Dolor? and that patient's response of thumbs'-up or thumbs'-down is adequate for "routine rounding" (i.e., post surgical check-ins).

Chen is a transplant surgeon; the patient she's routinely rounded has just had a liver transplant. As anyone who's been hospitalized for illness or injury will readily understand, there's nothing quite so intimidating, so important as those 5 minutes a day when you actually get to communicate with the doctor. This is thoughtless privilege at its most frightening. The JIM study concludes:

Although previous research has identified time constraints and lack of availability of interpreters as reasons for their underuse, our data suggest that the reasons are far more complex. Residents at the study institutions with interpreters readily available found it easier to “get by” without an interpreter, despite misgivings about negative implications for quality of care. Findings suggest that increasing interpreter use will require interventions targeted at both individual physicians and the practice environment.

The comments are interesting, if ill-informed. There's the predictable "don't get sick in a language you don't know," but most get stuck in two issues—cost and availability—for which the study controlled.

Do readers not really read? The willingness people have to defend the indefensible fascinates and repels me. Dr Chen has made a habit of bravely admitting hard realities in a national newspaper; the commenters largely want to give her a pass.

Comments

[jiawen]

It's certainly been my experience that there are too many doctors who don't actually care if communication happens. There's a particular doctor who, when I ask him to restate something due to his mumbling or other lack of clarity, says the same thing plus about two more sentences. This launches us into a vicious circle where my interpreting gets further and further behind. And he doesn't understand how to pause between sentences, and then he gets impatient with me for taking so long. And he doesn't wait for me to finish translating what the patient has said; if the patient asks two questions, he starts right in answering the first one after I've finished relaying it. I refuse to work with him.

Another example: I was working on a homecare visit with a nurse who asked the patient how she was feeling. The patient proceeded to go on and on and talk at length, and go on many tangents. (She was fairly old, and possibly very lonely.) I diligently translated the entire thing. The nurse kept on asking open-ended questions that resulted in very long answers, and got frustrated -- with me. She eventually told me to stop saying everything the patient said. "Um, lady, you don't understand my role, do you?" thought I.

And then there are the hordes of providers who refuse to talk to the patients... They always use third person and talk only to me, as if the patient wasn't there. But that's another headache...

[joannkatana.livejournal.com]

This is - there are reasons why there a signs (and, ok, that doesn't help people who can't read, but that's another issue...) up in all hospitals saying that translators are available. It's something that's required, it's something that should always be done when important information is being passed along. "Dolor?" and a thumbs-up is not - That's not how it ought to be done. The doctors should know, roughly when they're going to be there; call ahead and get the translator *there* for that visit. The translator ought to be there for the discharge as well - and so on and so forth. Though... I don't think every interaction can be through a translator - with nurse assessments several times a day, with medications given at different times of the day, I'm not sure that every patient can have a translator at all times. But for the rounding (once a day) and discharge (once a visit) and admission(once a visit) a translator should be available... *grrrrrr*

[maeveenroute.livejournal.com]

Honestly ... my partner was in the hospital last month, again, and the ability to ask "what medicine is that, and why are you administering it?" every single time they came in, including in the middle of the night, quite literally saved his life at least three times. (Twice when they tried to administer drugs he was allergic to, and once when they randomly decided it would be a good idea to add nearly a full day's dose of insulin to the IV all at once, while he was still wearing his insulin pump. ahem.)

Staying awake for it nearly killed me, on the other hand - but communication during every interaction was crucial.

[joannkatana.livejournal.com]

*sigh* Point. But I don't know that there are enough official translators to be able to do that. (family members while not technically allowed to translate, can help a lot here...) (though.. *boggles* Ok, hopefully that's gotten better? Most places have some sort of pharmacetical check to prevent that from happening.... along with people ordering and people administering actually, uh, paying attention)

[jesse_the_k]

The truly tragic thing is, this is a self-aware doctor. Chen has thought long and hard about life and death and medicine and healing and stuff.

I was a freelance ASL interpreter, mainly in medical settings, and I witnessed many unpleasant realities. I'd hoped that things had improved in the intervening twenty years, jiawen, but it sounds like, not so much.

My favorite experience was in the ER. I asked a doctor to spell something so I could fingerspell it correctly. Doc said, "why are you bothering with that?" and I was able to shorten my lag enough that the Deaf person on the table could reply, loudly, "Because it's my body and I want to know what's going on!"

[jadelennox]

have had this tab open ever since you first posted this story because it is too horrible to contemplate.

Sometimes I hate people.

Righteous Tab Lag!

[jesse_the_k]

You do that too? All my browsers* restore my tabs, and there are always some aging items I'm too boggled to close but too furious to respond to.


* (and why do I need to have OmniWeb, Safari, and FireFox always running, with side-trips into Lynx and Links? Geekiness is always easier than moral outrage.)