COMMUNICATION IN PATIENT CARE

The last two few weeks have seen an unprecedented number of social media memes doing the rounds about the Cuban doctors and the expected language barrier. In as much as this was expected, the stark reality of the magnitude of the problem hit home when attempts at interviewing them on television failed dismally.

The Spanish-speaking doctors have a rudimentary grasp of English, which has begged the question of how quickly they are expected to get the hang of the local languages in view of their two year contract. The need for translators becomes all the more real, along with the dilemma of ethics and upholding patient confidentiality.

However, away from the Cuban doctor challenges, how well do doctors in general communicate to their patients? This very elementary aspect of patient care is the cornerstone for building a healthy doctor-patient relationship. Yet many a times we get it so wrong.

A few years ago, while working in the outpatient department, I would receive many medicine samples from pharmaceutical company representatives as they sought to market their brands. At one time, I accumulated four months’ worth of antihypertensive medication from different companies that a hypertensive aunt of mine was using. When my cousin visited, I gave her to pass them on to my aunt, along with written instructions of how to take them.

Two weeks later, my cousin calls me to report that my aunt had developed unremitting dizziness that needed review. Imagine my shock when I found out that she had been taking all the four different tablets at the same time!

Along the way, the instructions had gotten muddied up and my aunt did not understand that the four packets, despite different brand names, were all the same drug. She was to take a packet a month for the four months. She assumed they were all different medications that were to be taken concurrently. She was taking four times the required dose!

Such simple instructions had put her in danger as her blood pressure precipitously dropped, causing her the dizziness. Thankfully she responded well upon restoring the normal dosage. This type of miscommunication had nothing to do with language.

Scientists are generally assumed to make terrible communicators. They may go on and on giving explanations in scientific terms, getting carried away and forgetting their audience has no clue what they are talking about.

Conversely, in an effort to simplify the language, the explanation is over-simplified to the point where the original meaning is lost and the patient ends up completely misunderstanding the doctor.

One of the commonest examples is when a patient with an infection is sent to the laboratory to do a full blood count. In the presence of bacterial infection, the white blood cells will markedly increase in number. Most patients will understand the report to mean that they have bacteria in their blood, yet that is not what was intended at all.

The test simply shows how the body’s white cells will increase in response to the infection, irrespective of where the said infection is localized. Hence we expect the white cells in the blood to rise in number whether the patient has tonsillitis or a urinary tract infection or meningitis. Bacteria in the blood is a life-threatening condition that cannot be taken lightly.

The cost of inadequate communication cannot be downplayed. Successful management of chronic medical conditions is highly dependent on communication. Patients are not only seeking care but must be highly encouraged to fully participate in the process of decision-making in their care. They must be able to select treatment options from an informed position, knowing the full implications of their decision; and not leave it to their doctor to decide for them.

This applies even for the young ones. Despite relying on their parents and guardians to give consent for their care, children must be involved in their own care. It is imperative to explain to the sick child what is happening to them in an age-appropriate manner. A visit to the paediatric oncology wards in this country will amaze you. These little ones, at tender ages, are smart enough to even master their anti-cancer drugs, down to the complex scientific names!

HIV care for instance has been fairly successful in Kenya because communication, patient education and patient involvement in decision-making was well thought out and well implemented. These patients understand their disease, its progression, the medication, its side effects and the periodic tests done to assess their well-being. They are highly empowered.

On the downside, we have not been able to achieve the same success with most diabetes or high blood pressure patients. We still see patients who are poorly compliant, who may not understand the impact of lifestyle choices on their disease and who may be more likely to follow instructions of care without understanding the role of the various care plans.

Many doctors are happy to refer their patients to nutritionists to advise on diet but fail to effectively communicate to the patient the role of nutrition in the overall outcome of their care. This makes it difficult for the patient to own the decision on what to eat, leading to numerous failed attempts at dietary modification.

A doctor is tasked with the responsibility of explaining to their patients about their condition in a language they can understand. One is not an effective communicator until they can break it down to the 80 year old grandmother what is ailing them, why they are having to undergo certain tests and the planned treatment and its impact on their condition. There is nobody too old, too young or too illiterate to understand what is wrong with their bodies. After all, they happen to own those bodies!

As caregivers, we may speak the same language with our patients; but it is no guarantee that we will be communicating!