4th yr 1st rotation: topic 3 STARES: communication

Situation:
I had an 80 year old Vietnamese patient with a long history of neck and back pain. This was the first time I had seen this patient he had been seen by another student and was being transferred to me. Nothing was noted in his notes about his English or the need for a translator so I assumed his English was of a good enough quality to get through the session. However although he did have a generally good level of English his understanding when it came to more complex tasks and exercises was limited which made the session difficult.

Task:
To assess and treat this patient with a basic level of English.

Action:
I was able to get an understanding of what was causing his pain through actions, drawings and simple language in the subjective. In the objective I used simple language and watched his facial and body language to help clarify further where his pain was and what could be contributing to it. With his treatment and home exercises I made sure to clearly demonstrate and use clear single stage commands and focused on using drawings to explain the exercises. I then got him to perform the exercises to see if he understood how to do them and corrected any misunderstandings that could have been present.

Result:
The majority of the session went well, however some of what I had said was lost in translation! The patient seemed to get most of the exercises and what I did treatment wise did seem to improve some of his objective findings. He seemed to understand what I wanted him to do and he understood the drawings I gave to him for his exercises.

Evaluation:
I think I was fairly effective of getting across what I wanted him to do and what he reported to me. I think my use of simple clear to understand language and drawings were helpful in conveying his exercises and getting responses from him. Being aware of his facial expressions and his body language in response to pain was very important in making sure I found what might be causing his pain and to avoid hurting him too much. I think an interpreter would have been very beneficial though to help convey the more complex tasks I asked him to perform like deep neck flexor exercises and being able to educate him properly on his neck and back pain and what is helpful/harmful for these problems.

Strategies:
An interpreter was booked for his next session I had with this patient.
Clear, single staged commands with simple language and responses
Use of hand actions and demonstrations
Using drawings as explanations
Watching facial and body language, not just relying on what the patient is saying.