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• Lost in Clinical Translation: Difficult communication in futility
  Joseph Y Ting
  Published on: 19 June 2015

• Published on: 19 June 2015

  Lost in Clinical Translation: Difficult communication in futility

  • Joseph Y Ting, Clinical Senior Lecturer

  Getting your message across to a patient and their family is difficult and fraught with misunderstanding. Aside from not having enough time and patience to explain complex diagnoses and sophisticated treatment plans as well as ensuring that understanding has occurred, English may not be the patient's first language.

  As a hospital doctor, even when using non-technical terms, I wonder whether a family member or a p...

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  Getting your message across to a patient and their family is difficult and fraught with misunderstanding. Aside from not having enough time and patience to explain complex diagnoses and sophisticated treatment plans as well as ensuring that understanding has occurred, English may not be the patient's first language.

  As a hospital doctor, even when using non-technical terms, I wonder whether a family member or a professional interpreter is capably relaying acute concerns and nuances of complicated discussions to patients from a non-English speaking background. The medical team cannot be sure that questions posed by a patient in return are being faithfully rendered.

  As communication is an iterative and interactive process, far more is "lost in translation" in health care encounters when the several spoken languages are necessary. Body language can be misinterpreted, with cross- cultural diversity in health-seeking behavior and beliefs pose further obstacles to effective communication.

  There is no doubt that the ethical, moral and legal quandaries of whether to withdraw ventilator-support from a child and pregnant adult clearly dependent on machine-assisted breathing are stressful for, indeed provoke strong emotions in, families and critical care staff.

  Ongoing physiological support as decisions on treatment withdrawal are being deliberated in courts of law necessarily delay the availability of scarce intensive care beds to other seriously ill or injured patients with far better prospects of meaningful recovery. These patients cannot afford to wait for all-round resolution between families, clinicians and courts. Surely the high cost of intensive care and the diversion of hundreds of thousands of dollars from other health care programs bears serious thought even in times of immense crisis. The health system cannot afford the thousands of dollars spent each day in the support of a brain- stem damaged person for whom futility is the eventual outcome. In the unlikely event that one is weaned off the ventilator, the patient is still condemned to full nursing care for the rest of her natural life.

  I recently cared for an elderly man who had sustained a large brain hematoma. The son, who had cared for an ailing father for years, stroked his shock of white hair as he declined neurosurgical treatment on his father's behalf. As he tearfully looked upon the face of his uncomprehending father, the son was unwavering in his refusal. He believed that the great man his father had once been was no longer there. We agreed that surgery was not going to change that and they went home.

  A truthful rendition of diagnosis, treatment and prognosis, as well as ensuring that the family has understood, were necessary for my patient's son to confidently make a decision aligned to his father's wellbeing and priorities. My job was easier without the self-imposed burden of trying to dictate treatment trajectory. I was satisfied that I had not, by deception or persuasion, imposed what I believed to be in the best interest of the patient. Doctors are human after all, with even our most well-intentioned recommendations susceptible to the the beliefs and values we hold dear.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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