Communication is a very important part of all good medical care. If we are unable to effectively communicate with our patients; regardless if it is their inability to communicate, or our dedication to medical language that they wouldn’t understand, we cannot effectively get to the underlying cause of the issue and provide treatment.
Many maladies or preexisting conditions may cause a huge barrier to communication. The first is not a malady, yet a major problem if your patient’s experience is different from yours. Since the Tower of Babble (likely before) there have been many languages in the world. Some of these languages stem from common roots to our own, while others are incomprehensibly foreign. How do we as medical professionals learn from the patient their history or even the reason for our encounter? The easiest way is to find a family member, or hopefully the patient himself or herself, at least have a rudimentary understanding of a common language with you. I met a young lady from Japan that didn’t understand English, and my Japanese was far worse. We found a common language, albeit rudimentary, in Spanish.
If there are family members available, many times they are children who experience your language in school, they may have a better understanding of both languages and be able to translate for us until an official interpreter can be secured. Many apps that may be used on your phone allow for spoken communication and translation. Be careful! The same Japanese lady was mortified when I tried the electronic translator and it came back with something inappropriate.
New services are emerging that allow the use of your phone or internet that can connect you with a translator located far from your location. The patient will speak their information to the translator, who will then translate. Some of these services are completely voice based, while others incorporate video calls to allow for understanding of facial features along with the words. This technology has revolutionized our communication, particularly with the deaf.
Beyond language, there are occurrences that may affect the words that our patients use, even with a common language. A stroke, traumatic brain injury or even cerebral infection can lead to aphasia. Aphasia can range from the complete inability to form sounds through speaking well-formed words in a completely disjointed order or relation to the subject discussed. Frustrating as it may sound, the patient is generally aware of the problem and may exhibit extreme frustration. Because the speech and hearing centers are separate in the brain, the patient may be able to hear and understand you correctly but still not able to get out the words.
Congenital issues may also leave the patient with a reduced language or understanding. In these instances, trying to use simple concepts seems to work best. Some have caregivers, or friends that have learned to understand their utterances, while others can use pointer boards or computers speech synthesizers (Steven Hawking) to be able to communicate. Be aware that these systems also have limitations; there are over 1 million words in the English language, generally, there’s not enough space on a pointer board to store that many words. Regardless of the situation, communication through this method will be slow.
Sensory issues may also affect how we communicate with our patients. While people who sense the world differently than we have normal lives, the cross between the two may be difficult. Imagine trying to communicate with a deaf patient. We have learned that we don’t have to be in direct sight, or even in the same room to communicate, but the Deaf /Hard of Hearing community must use their eyes to understand what we are saying. Looking directly at the patient will help them dramatically to read lips. Learning a few words of their language can also be beneficial. Facial hair can make lips harder to see as well as speaking very fast or slow. Speak at a normal rate and in a normal voice; yelling at a deaf guy doesn’t work.
Over the years I’ve learned to speak every language in the world but Greek. . . Unfortunately many of my patients are speaking “Greek to me.”
We can never learn while talking. Learning is a process of inputting information to your brain, while talking, only output information that you already know. If we ever want to learn from our patient, we must take the time to listen to what they are telling us, regardless of how difficult.
Next week, I’d like to cover the opposite side of this communication. . . Our own inability to communicate within the patient’s understanding.
This program offered by Dr. Bill Vicers (deaf himself) is an excellent free resource and can be used to increase your medical ASL vocabulary.
This video is a sample of a for sale version that will mix sign, English and Spanish