On the first day of class, we talked a little bit about the relationship between a doctor and a patient who speak different languages. This article further discusses this by beginning with an experience of a young Iraqi woman. She claims that her head is in pain, and none of the medications are working. The doctor, speaking through an interpreter, advises her to go to a psychiatrist, but she refuses to because of a previous bad experience with a psychiatrist. Also, she claims that her mind is not the problem, perhaps because in Iraq, “there is a strong stigma that comes with mental illness.” Often times, when the patient and doctor must communicate through an interpreter, both become frustrated and the normal level of doctor-patient trust is not present. The article says that in cases with different languages, doctors are more likely to order more tests than are needed, the patient must stay in the hospital longer, and patients do not commit to their treatment.
The problem does not stop at mere translation. Cultural differences also come into view when the translator is trying to explain a doctor’s solution or prescription. Different cultures often do not understand the type of remedy the doctor is recommending. The article cites various cultural differences. In some cultures the men make health decisions for the women, breast cancer is looked down upon as a punishment for the patient’s actions, or patients are said to be mentally retarded when they are actually deaf.
Although hospitals and other medical facilities try to cope with different languages by hiring translators, the translators must have much more knowledge than just the vocabulary of the two languages. The training required to understand different cultures and different attitudes would be enormous, but it is something that health professionals should invest time in. No patient should continue suffering because he or she speaks a different language. Patients may believe they are receiving better treatment by going to a more advanced country, but in reality they are disadvantaged because of the language barrier. This problem brings up ethical questions as well. If patients’ cultures do not allow them to accept treatment, should doctors from a different culture force the treatment? How do doctors go about telling patients to ignore what their cultures believe? Should laws dictate how patients accept treatment? For example, in the case cited in the article about the men making decisions about women’s health. Should there be laws to counter the men’s decisions and provide health care for women of this culture?
The United States government has recognized the problem of patients and doctors speaking different languages. Title III of The American Disabilities Act includes a section that requires “Public Accommodations and Services Operated By Private Entities” to provide access for disabled people, which includes “professional office of a health care provider” and hospitals. The Act includes people who are deaf or hard of hearing, implying that sign language interpreters must be available. The case of deaf people brings up more questions that must be answered, such as when is an interpreter necessary? Can a deaf person go to a routine check-up without an interpreter or should the hospital provide one? And will deaf people feel comfortable with an interpreter or would they feel limited in what they can express to the doctor? All of these possibilities are still being considered and reform is still necessary. It is important that hospitals and medical facilities continue to better their programs for people who cannot communicate in the language of the doctors. However, the government as well as doctors are moving in the right direction.
This problem is extremely prevalent in various NGOs that provide heath care to under served areas - like Medicins Sans Frontiers. They try to counter that problem by directly hiring doctors who have some knowledge of the language with which they will be mainly working. However, this obviously still is not the only answer to this hard problem because it doesn't address the cultural aspects. Doctors should be educated on the various cultural norms in the countries that they are going to work in before they start their practice. Obviously more care and consideration should be in place especially in countries with more stringent doctor patient customs.
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