I was listening to a fellow student take a history from a local (Dominican) patient a few weeks ago. The student (who was American) was trying to ascertain how long ago the patient’s last menstrual cycle occurred. The patient thought that the student was asking her how long her menstruation lasts, so she responded “3 to 5 days.” Without verifying what the patient actually said, the student wrote down that the patient’s last menstrual cycle was 3 to 5 days ago. It turned out that the patient actually had not menstruated for over 3 months, which was an extremely important detail that the student missed.
Incidents like this happen all the time. Unfortunately, when it happens in medicine it can make the difference between life and death. It’s easy to assume that just because you are speaking the same language, that there is comprehension on both sides. In Dominica, where I live, the national language is English. Most of the students come here from the United States and Canada, where the national languages are also English (and French in Canada). However, the English that is spoken by Dominicans can be very different than what is spoken elsewhere. For example, in Dominica, alcohol is frequently considered synonymous with rum. So, if you ask a patient if they drink alcohol, they may honestly tell you “no.” However, they could be drinking 30 beers a day. Another example is that when they use the word “foot,” they frequently mean their entire leg. So, if you don’t ask them to specifically point to the pain, you might end up with an entirely different diagnosis.
These types of errors in communication aren’t restricted to differences in culture. There can be vastly different ways of communicating within the same culture but between different age groups. A teenager will likely describe their symptoms with different words than an elderly person. And the list goes on and on. There are so many subtleties involved in accurate communication and history taking that it’s no surprise that many patients end up not being treated properly due to poor doctor-patient communication.
I think that physicians should be particularly sensitive to the subtleties involved in talking to their patients. Just as a surgeon’s delicate use of a scalpel is an art, so is proper history taking and communication with patients. As with many forms of art, there is always an element of natural ability combined with practice and dedication. Even if you do have a natural ability to communicate well with patients, you should never forget that it is still an art, and as such should be continually practiced and adapted.