When doctors become detectives

A doctor's stephescope


The difficulties communicating with foreign patients

There is a short moment of total silence and we all just watch each other. “We” is my “doctor-godfather” (a doctor I am assigned to work with to receive insight into practicing in the medical field), a foreign patient, her interpreter and me (medical student in the second semester). My doctor-godfather, warned me just before our appointment with the patient: “That’s going to take some doing”. Why? Because the patient does not speak or understand German or English and we would therefore be totally dependent on an interpreter.

My doctor-godfather looks at the patient, then the interpreter and then asks: “So what does she have?”. The interpreter turns to the patient and asks her, then answers back to my doctor, “Well she has problems with her hands – rheumatism I guess – and she said that another doctor has not given her any medication … she is in pain … she wants you to do something.” Saying this the patient gives us a result-paper with a clearly noted diagnosis of muscular problems in the back and a prescription to tablets and health sports. My doctor addresses this circumstance and the translator translates. Suddenly the patient begins to scream and the interpreter can only translate scraps of conversation: “I swear I have received nothing! … Doctor you want me to die! … I am in so much pain! … If you give me nothing I will have to kill myself! etc. etc. etc.”

My doctor-godfather and the translator calm her down and tell her that everything will be fine. My doctor begins to fill out a prescription paper for new tablets when suddenly the bag of the patient falls to the ground … and by magic there is a packet of tablets … the tablets she claims she has never received.

A second round of interrogations begins until we can finally send the patient home with all of the information and prescription she needs. It turned out that the patient had consulted another doctor some weeks before … a diagnosis and medication was given … but the patient did not understand anything of that, let alone how the therapy will proceed.

At the end we spend more than 30 min on the case history struggling to receive the needed information to make a well-founded diagnosis and prescribe the right medication. The general practitioner normally has 7 min per patient (average for Germany).

This experience has shown me the important role that understandable, respectful and honest communication plays in the relationship between doctors and their patients. It is a key means to connect with a patient, and to create a trustworthy relationship and pleasant environment in which the patient is able to and feels comfortable to open up and address very intimate topics and concerns that they would classify as private or awkward in normal conditions. This includes discussing a very wide field of feelings and topics ranging from fears, to difficulties in the workplace, to sexuality. This information is a precondition and imperative for a doctor to be able to make a well-founded diagnosis and to start adequate therapies. Misunderstandings or concealed information can be harmful, potentially leading to undiscovered illnesses, side-effects and mutual reactions with medication etc.