The last few weeks have been characterised by social media jokes on the Cuban doctors and the expected language barrier between them and patients.
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 can get the hang of local languages in view of their two-year contract.
The need for translators has become all the more real, and with it the dilemma of upholding patient confidentiality.
Away from the Cuban doctors, how well do doctors in general communicate with their patients?
Communication is the cornerstone of a healthy doctor-patient relationship. Yet many a time we get it so wrong.
A few years ago while working in the outpatient department, I would receive medicine samples from pharmaceutical company representatives as they sought to market their brands. At one time, I accumulated four months’ worth of anti-hypertensive medication (from different companies) that my aunt was using. When my cousin visited, I asked her to pass them on to my aunt, along with written instructions on how to take them.
Two weeks later, my cousin called to report that my aunt had developed unremitting dizziness that needed review.
Imagine my shock when I found out 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 four months. She assumed they were different medications to be taken concurrently, thus was taking four times the required dose!
Such simple instructions had put her in danger as her blood pressure dropped precipitously, causing dizziness. Thankfully she responded well upon restoring the normal dosage. This miscommunication had nothing to do with language.
Scientists are generally assumed to make terrible communicators.
They go on and on, giving explanations in scientific terms, 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 misunderstands the doctor.
One common example is when a patient with an infection is sent to the laboratory to do a full blood count. In the presence of bacterial infection, white blood cells will markedly increase in number.
Most patients take the report to mean that they have bacteria in their blood, yet the test simply shows how white blood cells increase in response to an infection, irrespective of where the infection is.
We expect white blood cells to rise whether the patient has tonsillitis or a urinary tract infection or meningitis. On the other hand, 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 must be encouraged to fully participate in the process of decision-making for their care. They must 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 to children, who often rely on their parents and guardians to give consent for their 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 will amaze you.
These little ones are smart enough to master their anti-cancer drugs, down to the complex scientific names!
HIV care has been successful because communication, patient education and patient involvement in decision-making was well-thought-out and implemented.
Patients understand their disease, its progression, the medication, its side effects and the periodic tests done to assess their well-being.
Unfortunately, we have not been able to achieve the same success with diabetes and high blood pressure patients.
Many are uncompliant, don’t understand the impact of lifestyle choices on their disease and don’t understand the role of the various care plans.
Many doctors refer their patients to nutritionists to give advice 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 should explain to his/her 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 have 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 that is not a guarantee that we are communicating!