Health Care Roles in Communication Healthcare communication can be perceived and affected in many different ways. Some of these ways include the perspectives of the caregivers, the roles of the patients and the caregivers, cultural views or beliefs, over or under supporting strategies, boundaries of job parameters, body language, time restraints, environmental factors, and levels of stress and burnout. “How would patient care change if the entire team of providers (nurses, doctors, and therapists) did not accommodate a patient’s personal, cultural and religious preferences? This is a question that I see as being important in the discussion of health care communications roles. Would this scenario result in patients not seeking services or getting the services they need? Would it cause a rise in health care costs due to claims against providers for services which were inappropriate for that patient? Would incorrect diagnosis be more likely? Would more patients fail to seek necessary health care? Some of these issues already exist today even with providers attempting to become more proficient in acknowledging and accommodating cultural and religious differences that relate directly to health care delivery.
Today, “Health care providers take many different approaches to bridge barriers to communication and understanding that stem from racial, ethnic, cultural and linguistic differences. In recent years, the notion of “cultural competence” has come to encompass both interpersonal and organizational interventions and strategies that seek to facilitate achievement of clinical and public health goals when those differences come into play” (U. S. Department of Health and Human Services, 2007). Race is not a valid base for determining cultural, personal or religious beliefs.
People from all backgrounds differ a great deal in their moral convictions and cultural views. We all should be received with tolerance and respect regardless of our viewpoint. These differences are what set us apart as individuals. Personal experience is a great influence in what help people will seek or accept. The wide diversity in U. S. cultural origins makes this issue very important in our health care system. Communication is the key to providing high quality, effective care in our facilities. Appropriate respect and good communication can make all the difference in the world.
This is true from the first contact with a patient. The difficulties that can arise from poor communications are evident in the first scenario described. Given that we all have regional and global cultural differences in our upbringing and resulting beliefs, it is inevitable that health care providers and assistants are going to find themselves in situations where their own personal beliefs are challenged by a patient. Great trauma can be inflicted upon and frightened or uncomprehending patient if they are subjected unwilling to examination and treatment.
Training and personal discipline are both required to deal with these types of situations. The first scenario is about a young girl, Lena, who fainted in class. She is of Southeast Asian descent. She is brought to the emergency room by her friend, Susie, after she fainted in her classroom. She has not history of this and does not exhibit any other complications that might lead to this event. Susie had Lena taken to the emergency room without any knowledge that this would be against Lena’ wishes, since Lena was still unconscious at the time.
Lena and her family have resided in the U. S. for 10 years, but in spite of being superficially assimilated into the U. S. culture they strongly believe in their native customs. Lena was very angry about being brought to the hospital. The setting of the emergency room carries even worse connotations for her than just being subjected to a physical exam would have for her. She feels that only weak people go to these places. She turns this anger on Susie, thinking that her friend should know her better than she does. Lena also expresses this anger to the medical assistant.
The medical assistant made the situation even worse by restraining Lena. The assistant insists that Lena must wait for the doctor to discuss his findings with her. By the time the doctor arrives, Lena is so emotionally charged that she cannot focus on the doctor’s discussion. The doctor responds with frustration and simply leaves. I feel that Susie made the correct decision. She felt that her friend faced imminent danger and took the precautions that she felt were appropriate. I do understand Lena’s anger and frustration in this situation, which was, for her, a shocking place to awaken.
Lena may be justified in feeling that her friend was aware of her beliefs and may feel betrayed. She has not taken into account her friend’s own beliefs and fear for Lena’s well-being. However, since Lena is the injured party in this scenario, her concerns must be taken into consideration before all of the other parties involved are accommodated. For Lena, the implication that she is weakened by what she sees as an invasion of her rights can actually cause significant stress that may affect her health adversely. The medical assistance escalating the situation was a turning point in this scenario.
The assistant had no right to restrain the patient in this situation. It was not the medical assistant’s place to hold Lena until she had seen the doctor. The assistant also told Lena that she was sick, which was a form of diagnosis and, therefore, very inappropriate. It is both unprofessional for the assistant to respond in this manner and leads to a misapprehension on Lena’s part when she is told that she is sick. The medical assistant has no right to convey any information about her health status to her. This is the doctor’s responsibility.
The doctor seems to have been aware of the assistant’s part in the situation as he asks the assistant to leave the room when he sees that things are so obviously out of control. The doctor could have done better than just dismissing the assistant by taking the time to further assess the situation and make apologies for the assistant. The doctor should have relied on his own training in communications and showed more empathy for the patient. His verbal responses to her, indicating that he thought she did not wish to get better were cold and inappropriate as well. The Doctor simply said to Lena, “Fine, you are not going to respond?
I have many other patients to attend to who actually want to get better. ” When she did not respond to this accusation, the doctor simply left the room without making any provision for her right to request or deny treatment. He failed to provide her with any information at all regarding her condition or to recommend that if she wished to be discharged that she had that right. Both the actions of the medical assistant and the doctor inflamed the situation. Their responsibilities extend to maintaining order and keeping treatment options open, neither of which is managed here.
Overall, I would say that this scenario played out as part of a poorly run facility. The repeated poor treatment by several staff members indicates that this type of communication is tolerated by the hospital as a whole. This girl was clearly frightened. Both professionals in this situation could have shown compassion and respect and made the situation more bearable. “Improvement in physician-patient communication can result in better patient care and help patients adapt to illness and treatment. In addition, knowledge of communication strategies may decrease stress on physicians because elivering bad news, dealing with patients’ emotions, and sharing decision making, particularly around issues of informed consent or when medical information is extremely complex, have been recognized by physicians as communication challenges” (Back, 2002, Enhancing Physician-Patient Communication). The doctor has to be able to take the patient’s viewpoint first, regardless of his own personal situation that day. This would have offered a better resolution and would have given Lena the power to make the decision for herself of whether or not she would be treated.
These situations are part and parcel with becoming a physician. A different career path should be chosen by those individuals who are not willing to work with patients as whole individuals with needs and concerns. It is my view that Lena experienced a “shut down” from a deep emotional reaction. “In traditional Chinese medicine, emotions and physical health are intimately connected. Sadness, nervous tension and anger, worry, fear, and overwork are each associated with a particular organ in the body” (Wong, 2008, Understanding Emotions in Traditional Chinese Medicine). All aspects of a patient must be taken into account.
All patients do not exhibit the same responses to illness or pain based on their race, ethnicity or gender. Some cultures and religions actually prohibit the expression of pain or illness. Some cultures believe only in the use of traditional medicines. This may be the case for Lena. “The Asian American/Pacific Islander population in the U. S. is mostly foreign-born. Therefore, these families continue to hold on to traditional views of health and illness,” (Cantore, 2008, Modern Nursing Traditional Beliefs). It is imperative that health care professionals allow patients to express their concerns to their providers.
This ensures a better diagnosis and treatment with more successful and full recoveries. A positive patient-provider relationship also helps ensure compliance with treatment protocols that are applied. “Park explains that for patients to begin to trust modern health care procedures, which can be quite different from the health care system of their country of origin, they must first trust their care providers” (Cantore, 2008, Modern Nursing Traditional Beliefs). This may lead a patient to believe that a hospital staff is not competent or so poorly equipped that they cannot maintain a good staff.
Both professionals in this scenario clearly lack the experience and probably the training to work effectively with many patients. This can be remedied through proper training and through the hospital refusing to tolerate such behavior. Training in communications and tolerance of cultural diversity are needed for all health care professionals. A better resolution could have been achieved if the assistant had first greeted the patient in a friendly way, in spite of her agitated state. He could have then reassured her that he would go get the doctor for her and asked if there was anything else that he could do for her.
Use of comforting, reassuring language can help the patient to relax in this type of situation. The doctor could have been more professional in his entire approach to the patient. He could have taken just a moment to ascertain what the problem was and then responded more appropriately to her concerns. Just asking a few simple questions in a calm way would have helped here. In this scenario, Lena was possibly experiencing emotional disturbance, which may have caused her to ignore the doctor, even though little lasting harm seems to have been done to her physically.
However, it may have lent additional fuel to her emotional state and belief system in any future medical situations. Poor communication skills and disregard for patient beliefs can also inhibit a proper diagnosis and impair treatments. Providers that treat their patients with respect and empathy and carry themselves in a professional manner are more likely to be able to bring a difficult situation under control. Consistent communication can bring about a lifelong positive relationship. A demanding, authoritarian or uncaring provider can cause patients actual harm by disrupting their access to proper care.
Cultural training should be part of the training for every health care professional and their staff. Empathy and sensitivity to a patient’s cultural and religious belief systems make all the difference in helping the patient to feel supported in the medical setting. “Communication is one of the foundations of health care. Every health care interaction depends on effective communication, from making an appointment and registering for a visit to describing symptoms, discussing risks and benefits of treatments, and understanding care instructions.
Good communication is linked to improved patient satisfaction, adherence to medical recommendations, and health outcomes” (Wynia, 2006, Promising Practices for Patient-Centered Communication with Vulnerable Populations). References Back, A. (2002). The American Society of Hematology. Enhancing Physician-Patient Communication. Retrieved April 22, 2009, from http://asheducationbook. hematologylibrary. org Cantore, A. (2008). Minority Nurse. Modern Nursing Traditional Beliefs. Retrieved April 20, 2009, from http://www. minoritynurse. om Wong, C. (2008). Alternative Medicine. Understanding Emotions in Traditional Chinese Medicine. Retrieved April 17, 2009, from http://altmedicine. about. com Wynia, M. (2006). The Common Wealth Fund. Promising Practices for Patient-Centered Communication with Vulnerable Populations. Retrieved April 18, 2009, from http://www. commonwealthfund. org U. S. Department of Health and Human Services. (2007). Setting the Agenda for Research on Cultural Competence in Health Care. Retrieved April 20, 2009, from http://www. ahrq. gov