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Health communication is perhaps one of the most influential and controversial aspects of the health care system today. A multitude of influences can affect the ultimate success or failure of collaborative communication between patient and caregiver, which may result in mutual frustration and a lack of effectiveness towards the healing process. Though the remedy of it is not yet a top priority for organizational culture improvements, low health literacy is one of the biggest problems affecting patients and caregivers in the United States. Patients who do not understand their diagnosis, treatment or self-care instructions are at a greater risk for an increase in episode and length of hospitalization. In some hospitals knowledge coupling is one way medical staff is attempting to remedy the lack of collaborative communication between doctor and patient by using thorough questionnaires to address more fully the patient's individualized self and needs. In addition, utilization of the biopsychosocial model of care giving seems to enhance all aspects of communication, thereby insuring greater success in the treatment, diagnoses, and healing process, as well as the satisfaction of the patient and care giver. This is especially helpful when working with and around the cultural views of marginalized patient populations.
In the first scenario, Lena awakens in the emergency room after fainting in school, feeling confused and upset. The person who brought her there, her best friend Susie, is still present and Lena yells at her that she should know better than to bring her to a hospital for treatment. Lena is from Southeast Asia and has only been in the United States for approximately ten years. She was raised and adheres to the traditional ideas of medicine and health maintenance that are popular in her culture. When she tries to leave the emergency room upon awakening, Susie summons a medical assistant who attempts to restrain her, telling Lena insensitively that she does not have time to deal with her lack of cooperation, insisting that she is sick and must stay in the hospital to get better. Suddenly a doctor appears and dismisses the medical assistant. The doctor then tries calmly explaining her condition to Lena and asking questions about her symptoms. Lena is uncooperative, perspiring g heavily and refusing to respond. The doctor then states he has patients to attend to who actually want to get better and leaves the room.
Lena's role as patient in this situation is obviously very difficult for her for many reasons. Being part of a marginalized population, she seems to assume, perhaps correctly, that the physician assigned to her, as well as any of the other medical staff involved, is almost sure to be unaware or even indifferent to Lena's attitudes and beliefs regarding her health and the best ways of maintaining it that she has utilized, successfully or not, her entire life. She is also now painfully aware of the fact that her best friend Susie also has no understanding or faith in the power of these traditional methods, or rather in Lena herself as a means of addressing and treating Lena's possible illness. Lena in fact seems to have been socialized to feel that western methods of healthcare are counter-effective, even enemy like, and she is absolutely close minded to the idea that her participation in this system would provide her any short or long term relief from what may be causing her symptoms. As Lena's best friend, Susie is ultimately showing only concern for Lena's best interests, and was, more than likely only adhering to what she herself was socialized to believe. To whatever degree she was or was not unaware of Leans personal beliefs and preferences, Susie is exhibiting and projecting through Leans situation, two distinct dimensions of a fairly common reliance on healthcare providers in this country: Reliance on the healthcare provider for decision making, mostly, but also perhaps the reliance on a health care provider to stay healthy. The medical assistant in this scenario seems to be stretched thin and frustrated by the amount of work that already needs to be done without being summoned to restrain a patient who, for whatever reason, obviously does not want to be there. Between issues of time availability and workload responsibilities, the medical assistant is left with no real choice but to be short forceful with anyone who is not exhibiting full cooperation while at the hospital. It is highly likely that her frustration is greatly increased by the knowledge that both time and other responsibilities waiting, simply do not allow her the opportunity to be as caring and compassionate as it would take to make an improvement on the situation. She is expected to get the job done, quickly and efficiently. The physician too is under extreme pressure from both time and workload. Aside from the almost certain presence of stress and burnout as an explanation for the caregivers lack of patience with Lena, the socialization of doctors in this country creates the feeling that their time, opinions, and job responsibilities ultimately take precedence over those of the patient or a lower ranking worker within the organization. The doctors response and perspective towards Lena once he realizes that she is not immediately willing to participate with him in finding a speedy diagnoses for her condition, seems to be exasperation and a lack of desire toward discovering the source and possible importance of Lena's behavior. The doctor is consciously or unconsciously disregarding the fact that finding out more about Lena herself could be detrimental in understanding the cause of her fainting spell, the reason for her reaction to waking up in the hospital, the possible solutions that she would be most likely to participate with and understand, and maybe even the gateway for adjusting some of Lena's more negative views of western healthcare closer toward the positive.
Lena's physician seems to be operating under the biomedical model of healthcare. He asks focused and specific questions, requiring only brief, often yes or no answers that leave the patient feeling like a faulty machine that needs fixing, rather than a living, breathing individual with unique thoughts experiences. It is possible he is of the mindset that providing individualized care and attention to the patient is in the hands of the friend or relative who is in the room with them, and his only responsibility should be to diagnose and prescribe treatment. Had he not made that assumption and instead utilized a more biopsychosocial perspective to even a small degree, he may have been able to engage Lena in open communication, leading to a more timely and accurate diagnoses. Understanding more about Leans views and concerns, he could then make suggestions for treatments that might help her and also find out about the traditional medicines she is likely to use from her own culture, both educating himself and making forewarning available to Lena about any possible danger in mixing medicines, herbs and treatments, as well as which combinations could provide her extra relief. The downside of this of course is the speculation that this approach takes up far too much of the doctors time, while on the other hand it is clear that a great deal more could be accomplished, with less chance of mistakes, than with the purely physical, more specifically organic biomedical approach, which got both patient and caregiver nowhere closer to closing the case and in fact ended with the doctor simply walking out. This reaction to the situation will more than likely make his next attempt at helping Lena even more difficult and time consuming. Research has proven however that doctor, nurses and other caregivers in the organization report much greater job satisfaction when they are able to spend more time and attention on the patient. It is unfortunate to know that in the case of both physician and medical assistant in Leans scenario, the option to take this meager yet detrimental bit of extra time with the patient may not even be available, indeed in some hospitals may even be dissuaded by the rules and guidelines put in place by higher ranking authorities within the system. Had Leans cultural stigmas and beliefs not been so deeply ingrained, she may have, at the very least, been willing to respond to the doctors questions and cooperate just enough to wrap up the experience quickly, enabling her to go back to her life and more traditional methods of handling her health, perhaps with a broader awareness and perspective of western tools of treatment which she might choose to couple with the medicines and remedies commonly used in her culture. The medical assistant is likely being pressured by most of the same things as the doctor, though to a different degree and different reasons. The physician's tasks during the day are more or less spelled out. See a patient, gather information, review it and make a diagnoses and method of treatment. The medical assistant however is assigned to take care of most anything detail that may come up throughout the day which needs attention. This can be running errands for, or getting things ready for the doctors, helping patients or situations involving patients and their friends and family, organizing and cataloging information and everything in between. They also have to take orders from people within the organization who are of a higher rank than them and this can also involve having to deal with that person's aggressive behavior when they are under stresses of their own. All of these influences can make it seem acceptable, even necessary for the medical assistant to depersonalize the patient in an attempt to make interacting with them as streamlined as possible. Susie's apparent assumption that, despite her beliefs, Lena would be unable to take care of herself and her health symptoms in her own cultures way, probably created a feeling of betrayal and anger in Lena, making her even more stubborn against cooperating with the western roles of patient as a collection of organic parts and symptoms, and the physician as decision maker and provider of the tools and treatments necessary for the return back to health. Through his inability (due to boundaries job parameters) or lack of desire to find out about Leans individualized beliefs and experiences, other than the physical symptoms related to her fainting, the doctor only served to solidify the stigmas of the patient and set up a roadblock against his ability to provide her with any short or long term relief in this situation.
It is clear that for health communication in this country the time has come for organizational culture improvements that would redefine the way hospitals typically process and deal with individuals and the many facets of their health concerns. It seems to have become the norm for the treatment of patients to become a sort of trial and error which takes far more time in the long run, and due to issues like low health literacy, can even threaten patients health. Medical reform efforts that promote teamwork between nurses, doctors, medical assistants and other hospital staff by perhaps redefining their job parameters so that nurses and medical assistants can ask questions and gather information in a calming way, paving the way for physicians to more quickly and efficiently make decisions regarding diagnosis and treatment without leaving the patients feeling like their personal thoughts and opinions were overlooked or disregarded. This will ultimately create greater job satisfaction for all the health care workers involved, making their jobs smoother and the diagnoses of the patient more accurate. Knowledge Coupling would be an excellent tool to incorporate in this strategy. If Susie, Lena's best friend had tried talking to Lena about her fears and concerns that led to her decision to bring Lena to the emergency room, instead of immediately summoning a medical assistant to restrain her, there is a greater chance that Lena would have been calmer and more willing to engage in open communication with the people involved, even if only to reiterate her despise for the western methods of treatment. Susie's lack of compassion and understanding towards Lena, considering she was the only person in the situation who knew Lena well enough to give it, was in fact the catalyst to the actual end result, a stalemate. If Susie, the medical assistant and the doctor had all shown more care towards Lena's distress through their tone of voice (not to mention choice of words), body language and facial expressions, it would have been the first successful steps towards engaging her in open discussion, enabling them to actually provide help instead of possibly exacerbating her condition and causing her to shut down emotionally. Lena herself would do well to contact a social support group for people of a marginalized population where she can learn possible strategies for getting the most out of the American Healthcare System, and even how to couple it with their own traditional methods and medicines. Knowledge Coupling, invented by Dr. Larry Weed, is one of the more recent health communication technologies available to help both doctors and patients feel like they are giving and receiving all of the information possible to reach a diagnoses quickly and efficiently. While some experts worry that Knowledge Coupling "takes the responsibility away from the patient and decision making", it would seem that being provided almost all the relevant facts ahead of time, and in one collected, easy to access place, would make not only diagnosis easier for the physician, but also help inform him in regards to the best follow up questions to ask when speaking with the patient directly. Whether it is the workload of the medical assistant, or their socialization to feel like "low man on the totem pole" which leaves them struggling always to get their jobs done quickly and efficiently without mistakes, it would help everyone in the situation if the medical assistant was perhaps instructed by the physician to address Lena's distress with care and concern, attempt to calm her with understanding and compassion, and gain insight into the situation. This would strengthen the teamwork aspects between all parties, make the physician's job easier and give Lena the impression that the people in charge of her care were genuinely there to help, making her more likely to cooperate and communicate openly.
My finally thoughts, Lena has been living in the United States for more than a decade who was deeply rooted in her culture and heritage and that was why she did not want to listen to the doctor and conform to the modern medicine, due to the fact that she was used to using archaic medicine practices. The miscommunication between her and the doctor was a major road block that should have been overcome by both and both where at fault, however more so on the doctors behalf because it was unprofessional to just walk out on a patient like that. I believe that everyone should be treated the same no matter where it might be because if we are all Americans then we are all covered by the declaration of independences.
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