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Should US physicians learn Spanish?

Last night I was having dinner at Charlie Palmer Steak and entered into a conversation (in Spanish) with one of the wait staff. He was surprised when I ordered in Spanish and we had a friendly conversation about the merits of whole grain bread. He asked me why I spoke Spanish. I answered simply, “porque soy doctora” – because I’m a doctor.

Dr. Richard Reece’s recent blog post tackles the issue of language barriers in the healthcare system. He gives some good advice for cross-cultural communications, reminds us that 25% of US physicians are foreign born, and quotes the inscription on the statue of liberty as the reason why Americans should remember to welcome foreigners. However, he also encourages immigrants to learn English and frowns upon illegal immigration.

As for me, I learned Spanish because I was worried that I’d harm a patient by misunderstanding what they were trying to communicate. Of course we try to have an interpreter at the bedside at all times, but in reality it just doesn’t happen consistently. Learning Spanish was my way of practicing safer medicine.

Now it is frustrating that some patients (at least in NYC) seem to feel as if their doctor is obliged to learn Spanish. They sometimes have an attitude of entitlement that I find hard to swallow. I try to put myself in their shoes, but honestly if I were ill in a foreign country I wouldn’t assume that it was my right to receive care in English.

Still, for me, learning Spanish was a wonderful thing. There is a certain caring that I can communicate, and a certain warmth and appreciation that I feel from my patients as they encourage me – that even though I make mistakes with my grammar, they can still understand my meaning quite well. We laugh a lot at the words I find to describe things – and it generally provides a lighter tone to the interaction. Laughter is good medicine, and if my version of Spanish brings laughter to others – then so much the better!

Do you think US healthcare professionals should make an effort to learn Spanish?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Nurses escape death penalty

Makes being a nurse in the US seem like a cake walk, right?

“The son of Libyan leader Moammar Gadaffi said five Bulgarian nurses and a Palestinian doctor condemned to death by a Libyan court had received unjust verdicts and that they would not be executed, a Bulgarian newspaper reported on Monday.

A Libyan court last month convicted the five Bulgarian nurses and a Palestinian doctor of intentionally infecting more than 400 Libyan children with HIV, despite scientific evidence that the youngsters had the virus before the medical workers arrived in Libya. It sentenced all the medical personnel to death.

‘The original files were manipulated and there were many mistakes, but it was the fault of the police officers and investigators who handled the case at the initial stage.’”

As I was thinking about how these relief workers were “ambushed” I imagined that the parents of the HIV positive children were looking for a scapegoat – there is a lot of stigma associated with HIV, and in a country where mere finger pointing can result in the death penalty… taking care of those infected with the virus can be more deadly than the virus itself.

The article also hinted that if it weren’t for the Bulgarian embassy publicizing the unjust executions, they would have occurred without a second thought.

Let’s hear it for the healthcare workers out there who put their lives in harms way to treat the innocent and helpless.  Do you know of other examples?


This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Mice take one for the human team… again

Gone are the days of Beaver Cleaver – and apparently the days of Mickey & Minnie mouse are numbered as well.

In this new study, humans give LSD to the little rodents:

“Of course, we don’t know what the mice experience when they are treated with these drugs,” Sealfon said. “But we do know that there is a head twitch response in the mice that provides a good correlation with drugs that are known to be hallucinogenic in humans.”

So um… why are we doing this?

The Onion spoofed animal research very nicely, picturing an obesity study lab rat nestled among snickers bars and M&Ms.

And in another recent study, we gave mad cow disease to our furry friends:

“As expected… at 9 weeks of age they developed sponginess in the brain tissue, all the mice developed behavior and memory problems, for example they stopped burrowing.”

Hey, I have an idea for a new study – let’s see what mice infected with mad cow disease do if we also give them LSD?

I feel a bit sad for the tiny critters, don’t you?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Wrong diagnosis: physician instinct may harm or help?

A member of our editorial team kindly brought me some blog fodder last week – a recent article from the New Yorker. It was an inflammatory piece, describing four types of errors that doctors make in diagnosing patients:

  1. Representativeness error – when a physician fails to consider diagnoses that contradict their mental templates of a disease. E.g. thin, fit, young male with chest pain – unlikely to have heart attack, but did have one.
  2. Availability error – the tendency to judge the likelihood of an event by the ease with which relevant examples come to mind. E.g. a patient coming to the ER in the middle of a flu epidemic, with flu-like symptoms was diagnosed with flu but actually had aspirin poisoning.
  3. Confirmation bias – confirming what one expects to find by selectively accepting or ignoring information. E.g. “sub-clinical pneumonia” diagnosis given even though lungs are clear.
  4. Affective error – the tendency to make decisions based on what physicians wish were true. E.g. nice young patient has mild fever – physician presumes it’s a typical post-op fever rather than early sepsis.

Although these biases (I wouldn’t really call them “errors”) are indeed real, I thought the author went a little too far, finishing his article with a scathing quote from a Canadian physician:

“The implicit assumption in medicine is that we know how to think. But we don’t.”

Ouch.

I have mixed feelings about this – for as many examples they can think of that demonstrate how physicians got the wrong diagnosis, I can also think of examples of physicians getting the right diagnosis against all odds.

Consider the middle aged woman who came to the ER with a headache – one sharp physician had a “gut feeling” that this headache was not typical, and resisted the protocol to do a head CT to rule out a sub-arachnoid hemorrhage and send her home. Instead he got blood tests that revealed the underlying diagnosis: advanced leukemia. Her blood was so thick with dividing leukemia cells that it was causing her to have a headache. She underwent immediate dialysis and survived what could have killed her.

Or what about the man who complained of chronic sinusitis? Instead of giving him an antibiotic with outpatient follow up, one physician took a detailed history and realized that this man had been having sinus pain since a recent fall from a ladder (while using a nail gun) at a construction site. The doc got a head X-ray and found a nail lodged in his sinus! During the fall the nail gun had shot a nail into the corner of his eye, leaving no entrance wound. Because of the jarring nature of the fall, the man didn’t even realize he had been shot. The man had an ENT surgeon remove the nail, and she also cleaned out what could have become a life threatening abscess.

The truth is that doctors (like anyone else) are vulnerable to making false assumptions about people – and that we would all benefit from using a software program that would automatically generate a large differential diagnosis to consider each time we see a patient (just to keep other possibilities in the forefront of our minds). However, if you ask patients if they’d rather be treated by a machine or a human being – I’m sure the majority would choose the latter. I think we can all agree that instinct and judgment still have value in this information age. The trick is to marry accurate information with good instincts without ordering every single test in the book to rule out rare diagnoses on everyone! That’s a tough balance to achieve.

Do you know of any examples of a physician making an unexpected diagnosis based on gut instincts?  I’d love to hear about it.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Does good research get buried?

We had a problem in our pregnancy forum today – there were so many forum posts submitted so quickly that people didn’t get the chance to answer a post before it was buried underneath an avalanche of other questions. This left the people asking the questions quite frustrated.

A few hours later I was peer reviewing an article for the AJNR. I did a Medline search as part of a background check for my review. I found 30 pages of research articles. I was reading through their titles when, glazing over on page 28, I realized that a very similar study had already been conducted… in 1979.

It suddenly occurred to me that good questions (and good answers) can be buried by time. They say that history is doomed to repeat itself… the Internet is beginning to help me understand why that’s so.

What do you think?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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