We had a patient in the ward recently. I won’t say exactly where she came from, but suffice it to say, she originated in one of the Baltic states – that is, a country neighbouring the Baltic Sea.
I have always found the Baltic the funniest sea, mainly because of its use in Glasgow slang… ‘It’s Baltic’ meaning, ‘It is absolutely freezing’ (usually said by someone standing outside a pub in February, wearing a T-Shirt)
The patient had a very poor command of English. It is always difficult to determine how much a person understands as very rarely does anyone have absolutely no knowledge – hello, good and Rambo being fairly international;
Often when people say they don’t understand it is because they are not confident enough to speak in a certain language.
One of my colleagues had commented – ‘Patient doesn’t speak English, needs a CT scan then anticoagulation if appropriate and home.’ (Patsient ei räägi inglise keelt, vajab arvutikontrolli, vajadusel antikoagulatsiooni ja kodust) (Latvian) This was, suggesting, that there was an understanding her symptoms of chest pain might have mimicked a blood clot, with the standard investigation being the CT and in the case of a positive result, treatment with medicine to thin the blood and discharge home so as not to take-up an unnecessary hospital bed.
We took a more pragmatic approach and wheeled our computer over to her bedside and using Google Translate engaged in what was perhaps not as meaningful a conversation as she would have wished, but something more approximating a standard clinical encounter – ‘Hello, nice to meet you, we are the doctors, how are you feeling?’ (Labdien, patīkami tikties ar tevi, mēs esam ārsti, kā tu jūties?) (Estonian) and, so on.
Investigations were delayed as one of the departments refused to accept our use of technology – preferring to wait for a registered translator to arrive and communicate risk factors, etc.
We are taught not to use relatives (and, now it seems Google), to act as translators as they can potentially misrepresent what a patient is saying and even disrupt the confidentiality of the encounter.
Silly, I know, but that is the way it is these days.
We explained to the patient, we’ll call her Helga (not her name), who shrugged with us and accepted the inevitable delay to tests and her remaining in hospital unnecessarily for another day.
Ultimately, I don’t know if the departmental delay issue was a thing or – mythology; the mistaken belief in the existence of rules or regulations that aren’t real.
Here are some other examples…
Visiting times – hospital have the right to restrict visitors
Medical notes – belong to the hospital
Doctor, the patient will see you now
Protected mealtimes – relatives can help patients eat
No watches – bare below the elbow was a discredited political manoeuvre introduced by Mr Blair back in the day
I can’t think of others at the moment, although they are out there, hiding round every clinical corner. Waiting to delay, impede or impair good practice… You can’t do that because… Permission must be sought… It’s more than my job’s…
I didn’t fight the myth that time because I had other things to do;
It strikes me how similar the situation between someone who is not a native English speaker not wanting to demonstrate their lack of fluency and the mis-held belief that x or y or z must be done before a and b and c because, well, because that is the way we have always done it round here. Nothing to do with science or evidence base, just tradition.
This I think is another reason for my starting this blog with one of the Yiddish phrases I carry with me… Vos machst du? How are you? What’s with you today?
Not only thinking about the Shtetl life I was describing a few weeks ago, but, the centrality of tradition to the life of folk back then, before the war, when Tevye would drive his milk wagon through the streets of Anatevka rushing home before the sunset.
We are all victims of tradition.
Sometimes it helps more than hinders, frequently the other way around.
Tradition, superstition, the Ides of March, let us take a chance.