By Yilu Ma, director of Interpreter Services
One afternoon in July, a request from Shapiro came in for a Chinese interpreter.
An elderly Chinese-speaking male patient had suffered a severe cardiac arrest and was in a coma. The family asked the clinical team to do everything possible to prolong his life. However, the team felt the best medical course of action for this particular patient would be to provide comfort measures. An interpreter was called to help the team and family better communicate in order to develop a meaninful plan of care.
With a culturally and linguistically diverse patient population and an increasing number of international patients seeking treatment at BWH, challenges can arise regarding communication among patients, families and providers. This is where Interpreter Services comes in, not only translating but helping care teams provide the most culturally sensitive care possible.
The essence of relationship-based care is working with patients to deliver care guided by their specific needs and those of their family. To do this, we must first and foremost understand their needs. Due to linguistic and cultural differences in beliefs, values and practices between the team and the patient (and their families), misunderstandings can occur.
For instance, in this particular situation, the family may have insisted on continuing life-sustaining support so they would not later regret that not doing enough to save their father’s life. According to Chinese tradition, families believe that adults raise children because they protect and take care of their parents when they age. This could have been this family’s way of honoring their cultural tradition.
We interpreters have seen various patient situations that contradict our own beliefs and practices: the family who wants to discharge a very sick patient against medical advice so the patient could travel back to his hometown to die; the son of a patient with cancer who will not allow the doctor to deliver bad news to the father because talking about death is taboo; a patient who asks their doctor to prescribe antibiotics when he/she is running a fever; or a patient who doesn’t show up for a routine physical because preventive medicine is not the traditional practice.
In China, doctors have absolute authority; they prescribe and tell patients what to do; whereas Chinese patients in the U.S. might get confused if they are given options from which to choose. A silent Chinese patient during the discussion might be misunderstood as confused, disinterested or even disrespectful, while in reality, it’s just the opposite: He is showing respect and deference.
All of these behaviors are guided by cultural practice. These long-held beliefs are part of Chinese culture, so it’s critical to delivering competent care that we acknowledge the differences and engage the patient and family in an open conversation, without judgment or prejudice.
In the end, with the assistance of Interpreter Services, a mutual decision was made between the family and the care team. All parties were satisfied, and the family felt understood. They knew that the patient’s — and their — best interests were central to the decision.
This patient situation reminds us that though communication challenges can occur, we can often prevent some of them by getting to know the patient and family.
At BWH, interpreters can not only ease the language and communication gap, but also the social gap, by offering information about differences in culture that stand in the way of effective communication and relationship-building. This is how Interpreter Services provides truly individualized care.
The purpose of this piece is to demonstrate the complexity of one culture and the need for clinicians to embrace culturally sensitive care. It is not meant to be inclusive of the many different cultures we serve at BWH.