Assignment:
IMPACT OF PHYSICIAN ATTITUDES ON PATIENT BEHAVIOR: A TRUE STORY
Carmen was a sixty-one-year-old Spanish woman visiting her relatives in the United States.
(The name of the patient and some other facts have been changed to protect the patient'sand physicians' privacy.) During her trip, she was hospitalized for emergency spine surgery.She had been suffering from excruciating back pain that her physicians in Spain had misdiagnosed.While in the United States, her pain had worsened, and it turned out that athe ma jo r infe ction had al most destroyed two of her vertebrae and was threatening her abilityto walk.
The surgery was successful. However, Carmen felt isolated in a foreign hospital where sheco uld not communicate with physicians and nurses. She spoke no English. Her relatives visitedhe r as often as they could, but they also needed to deal with work and family obligations. Theyhired an interpreter for a few hours each day so Carmen could communicate with the hospitalstaff and perhaps feel a little less lonely.
Approximately fifteen days after the surgery, one of Carmen's physicians recommendedthat she try to stand up and sit on a chair. When he went to visit Carmen, he did not speak toher through the interpreter. He just instructed the nurse to help her and did not show muchempathy for Carmen's pain. Carmen tried to get out of bed, but her pain was really botheringher. After the first attempt, she a sked her i nterpre ter to tell the physician that she was tired; sheneeded to rest and might try later.
A few hours later, her internal medicine specialist came by. She had been alerted aboutthe earl ier events and had called Carmen's relatives to discuss how to approach this issue. Shegreeted Carmen warmly and started to speak with her through her interpreter. Carmen talkedabout her attempt to stand up. She was still in a lot of pain. Despite the words of reassuran ceby her relatives who had just telephoned her, she was not sure she wanted to try again. Afterall, in most countries, patients who have this kind of surgery, or even less invasive surgery, areconfined to bed rest for much longer. Carmen found the request unreasonable.The internist explained to Carmen that this was a common procedure in the United Statesand helped improve and accelerate a patient's rehabilitation. She highlighted the benefits ofearly ambulation. She also showed empathy for Carmen's pain. She mentioned that she wouldconsult pain specialists to see whether they could do something to redu ce her pain while shetried to regain mobility. Through the interpreter, she made sure that Carmen understood allthe information and also asked if she had additional questions.
Carmen decided to try again with the help of the nurse and her interpreter. After a fewattempts, she stood up and managed to sit on a chair. The entire team-the physician, thenurse, and the interpreter-encouraged and congratulated her for trying. She was still in a lot
of pain, but she was ha ppy about having succeeded. After all, this was a sign that things mightgo back to normal soon.
The physicians' recommendations proved to be effective. Less than a month after hersurgery, Carmen was able to walk with the aid of a cane. Without the skillful communicationinter vention of the internal medicine specialist, this story might have had a different outcome.Carmen might have taken longer to sta nd up and perhaps suffered some of the medicalconsequences of prolonged immobility.
- Discuss how the provider-patient communication affects the outcome of treatment.
- Recall from your experience a story that shows the important of this kind of communication.