Stop! The plan isn’t working as expected.

Sometimes, in spite of our best efforts, the plan we designed for the person in our care, doesn’t work or stops working. When this happens, it is important to reconsider the treatment plan. Otherwise, you’re driving down the wrong road: You can keep driving and driving, but you will never get to where you are going. You need to stop, ask for new directions and then start down a new path.

We may also need to help patients/families modify their expectations when things don’t work. Sometimes people are so desperate for the plan to work that they can’t bear to see the truth when the plan fails. You are not helping your your patient by continuing treatments that don’t work. You are only subjecting the patient to needless side effects and increased suffering.

One thing you may want to try more often is a time-limited trial of a proposed treatment option. Explain to the family, “Let’s try it for a few days or for a little while and see how it goes.” This is a really great option because it helps the patient/family feel like you are trying but it also gives them a reality check when it doesn’t work. You will want to give them specific symptoms to look for, (that they can understand), so they can see with their own eyes that the plan has failed.

After the set time expires, you can check to see if the decision is working. If it is not working, go back through the decision making process and make a better decision based on the new information about the patient’s changing condition. Don’t be stubborn and keep driving your patients in the wrong direction. Take this as an opportunity to turn around and get it right.

Have a kind and respectful day.

When your patient doesn’t speak English, you may be in more trouble than you realize.

I was talking to a professional medical interpreter at Children’s Hospital and she was telling me about the different ways a healthcare professional can get into trouble when they use the family as the interpreter. She told me that in one language, the words you might say when a patient has died, “I am so sorry your sister has died” don’t translate very well. “I’m sorry” in that language means, “I’m responsible. I killed your sister.” Oops. If you had used a professional translator in that situation, they could have stopped and asked you, “Is that what you meant to say?” And of course when you said no, you could then ask for their help in putting the words into terms that would be acceptable. The translator in this instance will tell you that you should say, “I’m so sad. Your sister has died.”

This is just one reason you should be using a professional translator. There are other reasons as well. The family may not be able to translate some of the terminology because they’re medically illiterate. Or they may have an agenda and only translate some of the information to the patient. Or they may be following their cultural rules about what can be spoken to an elder. Or there may not be a word for what you are trying to say in their language. Did you know that in one language there is not a separate word for bacteria and virus? There is only one word to describe both. How are you going to explain something when they don’t even have a word for it? Good luck without a professional interpreter.

Here are a couple tips to make working with a medical interpreter more effective:

1. If you can, arrive a few minutes early to speak with the interpreter and let them know the types of things you’ll be discussing. This way they can give you insight into the linguistic and cultural rules and how they might affect the interaction.
2. Try to not talk for more than one to two minutes. The interpreter is having to remember everything you say, and then has to translate it into culturally appropriate language. Allow the interpreter thought time.
3. Once the interpreter begins translating. Do not interrupt. Patients may think that you don’t trust the interpreter if you interrupt and the interpreter will lose face. I know this takes patience.
4. The other thing that takes patience is understanding that language doesn’t translate word for word. The English language is very direct and we are allowed to say what we need to without dancing around the subject. In other languages, language is in indirect. The only way you can say the same information is to approach it from different angles until you can finally land on the information. This will automatically take longer. It is not the fault of the interpreter if they have to say a lot to say what you have said in a few words. It is the fault of the structure of language.
5. The interpreter can also provide input on how to talk about delicate issues. We are so used to talking about body parts, diseases and personal matters that we forget how embarrassing it can be in other cultures.
6. If there isn’t an interpreter available, please use the A T and T interpreter phone line.
7. Make sure you thank the interpreter and respect that they are professionals and are there to help us, as well as the patients. They can really save you from making a terrible mistake and harming the physician/patient relationship.

Lastly, your hospital may want to consider having the interpreters round on the patients throughout the day to make sure their needs are getting met and that they feel like they have a voice in their health care. Your hospital may also think about sending interpreters into the doctor’s offices to provide interpretation services in the outpatient setting. Some hospital systems in Los Angeles have already begun doing this and it is making a difference.

Have a kind and respectful day.