February 6th, 2007 by Dr. Val Jones in Opinion
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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.
January 10th, 2007 by Dr. Val Jones in True Stories
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** This follows from the previous blog post**
A week later a 10 pound package came for me in the mail – it was a copy of the patient’s entire medical record. It took me almost an hour to find the part that had to do with the paralysis event, but as I read through the chart I saw my note and then gasped.
My note was simple: it documented my physical exam findings, the time I first found him paralyzed, the time I called the surgical team, the time it took them to get to the patient’s room. It was all clearly written and nicely documented. But the entry just above mine was from a nurse who had apparently turned the patient earlier that morning to wash his posterior. She noted that the patient was having some neck pain afterwards and that she had given him some Tylenol.
Then came my note.
And then came another note from the nurse, dated 3 months after the incident, and labeled “addendum:”
“Paged Dr. Jones to evaluate patient with complaint of inability to move lower extremities. Dr. Jones responded that she would examine him after rounds. I told Dr. Jones that it was an emergency but she said the patient would need to wait.”
I was horrified. That’s not at all what happened – the nurse was clearly afraid that she would be held responsible since she was the one who had moved the patient earlier that morning, possibly displacing his (recently operated upon) spine and causing a bleed. She obviously wrote the note to make it look as if the irreversible paralysis was due to the slowness of my response.
And so I felt helpless and very afraid – is this what will end my medical career? I thought about all my years of training, how careful I always tried to be, how much I cared for my patients – and would it all end with this insanity?
As it turned out, I had to prepare for a deposition. I studied every angle of the case, read every piece of the chart, sweated it out for many weeks. And then I got another call from the lawyer one day: “They’re settling out of court. You don’t have to come in. Just forget about it.”
I was relieved, but angry. I also felt very sorry for the patient. But most of all I wondered about the legalities of practicing medicine – how vulnerable we docs are, how a complication can be seen as malpractice… and how another healthcare professional can be so damaging. Sometimes practicing medicine scares me – lives are at stake, and even the best intentions can lead to life-altering events.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 9th, 2007 by Dr. Val Jones in True Stories
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An attorney from the hospital where I used to work called me out of the blue. He asked me if I remembered a Mr. So and So. “I’m not sure,” I said uneasily. “The name does sound familiar.”
Slowly the case came flooding back to me. I was on call on a weekend covering the neurosurgical step down unit. A nurse paged me to tell me that someone couldn’t move his legs. I asked if it was a new problem. “Yes, he could move them just this morning.”
I ran to the patient’s room and found an anxious appearing, young obese man lying flat in bed with a neck brace on. He had recently had a cervical laminectomy (a neck spine procedure). “I can’t move” he said, a bead of sweat trickling off his brow. “Can you feel anything?” I asked.
“Nothing below my neck.”
I took my metal tuning fork out of my coat pocket and pressed it firmly on his toe nail bed to see if he’d withdraw from pain. Not a flinch. My heart started racing. This is a surgical emergency.
I called the neurosurgery team and told them about the sudden paralysis. They arrived on the floor in under a minute, confirmed the diagnosis, grabbed the chart and took the patient to the O.R. immediately.
Hours later I heard that the man had had a rare complication of neck surgery – a small arterial hemorrhage that rapidly compressed the spinal cord. The surgeons evacuated the blood immediately – though it was anyone’s guess if the man would fully recover.
And apparently he didn’t. Four years later he was suing the hospital for malpractice, and I was named in the lawsuit.
“But I didn’t do anything wrong,” I told the attorney.
“Well, you’d better read the record,” he said ominously.
**See my next post for the end of the story!**
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 2nd, 2007 by Dr. Val Jones in News
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Many people use glucosamine and chondroitin sulfate as a natural therapy to treat their arthritis pain. This seems like a reasonable thing to do since glucosamine is a critical building block for cartilage, and chondroitin can help keep joints properly hydrated. And as we know, osteoarthritis is caused by joint wear and tear and decreased cartilage health.
Unfortunately, the research results have been fairly underwhelming.
Here is how one author* summarized the latest research:
“It seems prudent to tell our patients with symptomatic osteoarthritis of the knee that neither glucosamine hydrochloride nor chondroitin sulfate alone has been shown to be more efficacious than placebo for the treatment of knee pain. If patients choose to take dietary supplements to control their symptoms, they should be advised to take glucosamine sulfate rather than glucosamine hydrochloride and, for those with severe pain, that taking chondroitin sulfate with glucosamine sulfate may have an additive effect. Three months of treatment is a sufficient period for the evaluation of efficacy; if there is no clinically significant decrease in symptoms by this time, the supplements should be discontinued. Furthermore, there is no evidence that these agents prevent osteoarthritis in healthy persons or in persons with knee pain but normal radiographs.”
So I guess the bottom line is that these supplements are no magic cure for knee pain – they aren’t known to be harmful (except to the wallet) but they aren’t sure to be helpful either.
*Hochberg, Marc C.
Nutritional Supplements for Knee Osteoarthritis — Still No Resolution
N Engl J Med 2006 354: 858-860
Val Jones is a licensed practitioner of Rehabilitation Medicine and Senior Medical Director of Revolution Health’s portal. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Val’s and do not necessarily reflect those of Revolution Health.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 30th, 2006 by Dr. Val Jones in True Stories
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Good medical diagnosis and treatment often requires some detective work. One of my patients came to see me for foot pain recently. She described what sounded like a pretty typical case of plantar fasciitis – pain in the heel of her foot, worst with the first few steps in the morning, improving throughout the day. I recommended stretches, physical therapy, night splints, ibuprofen… but to my surprise nothing was really helping.
One wintery day she came back on a return visit and I happened to notice her footwear – boots with a very thin, flexible sole. Slowly I began to think of her tromping over ice, sand, gravel, and snow in these boots… I asked her if she could feel the ground under her feet.
“Yes, I can feel everything – I don’t like to walk around in the snow and ice because it kind of hurts to step on all the lumps and bumps. But I can’t just stay indoors all day, I have errands to run!”
I explained to my patient that I had a hunch that the rocks were bruising her plantar fascia, causing it to be inflamed and painful. I asked her to buy herself some thick soled boots – the kind where she couldn’t feel the lumps and bumps under her feet.
About a week later my patient called to tell me that her foot pain was much better. The new boots seemed to be doing the trick… “I never knew why my plantar fasciitis got worse in the winter times, doc. I thought it was the cold that made things worse.”
Well, I had learned a lot too… sometimes the best treatment option is not on the standard protocol list. The power of observation is one of a physician’s most important weapons.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
