Brianna is a white patient who has come for one of her routine OB visits; she is in her third trimester. You expect Brianna to be looking forward to the birth of her child, but when you ask her casual questions as you walk her back to her patient room, Brianna responds in short, quiet phrases. You notice that Brianna usually comes to her appointments with her partner or a friend, and today she is alone, so you ask whether Brianna would like to wait for them to come. Brianna says that no one could get off work to come with her.

Question

Ray and his son Laurent come for a pediatric visit. Laurent is five years old. Ray and Laurent have recently moved to the United States from the Democratic Republic of the Congo. You know from previous visits that they speak a number of languages, including French and Lingala. Laurent has been learning English in school; likewise, Ray has been learning English on the job. You speak a little French but not enough to speak fluently on medical issues.
Ashanti is a Black teenager with autism. She comes in for a routine well visit, accompanied by her mother. Ashanti shows signs of being comfortable in her mother’s presence even though she doesn’t make direct eye contact with you or her mother.
Step 2: Analyze
Each of these scenarios includes more than one communication adjustment that you need to accommodate.

In a word processing document, create three sections, one for each patient. Then, for each patient, answer the following:

Summarize the key facts about each patient that might require communication adjustments. These key facts could include information about their communication style, learning style, identification of any physical or mental disabilities, and language differences, among others.
Identify your assumptions or biases about these three patients. Remember, bias is not always negative! As part of this step, identify any categories of adjustment mentioned in the unit that this patient might represent.
Write two to three questions you can ask this patient or their guardian regarding your assumptions and the data you gathered from the scenarios to help you know what communication accommodations to make.
Consider the different patient care decisions that might need to be made in these scenarios. Explain how various multicultural values can affect patient care decisions for each of these patients.
Step 3: Reflect
After your analysis of these patients, write a reflection about this process. What parts of this process interested you most or surprised you? What did you learn about patients, communication, and assumptions and adjustments that need to be made in order to communicate well?

Answer 1

Patient Analysis

Patient 1: Brianna

Key Facts

• Demographics: Brianna is a white woman in her third trimester of pregnancy.
• Communication Style: She responds to questions in short, quiet phrases, which may indicate discomfort or anxiety.
• Support System: Typically accompanied by someone for appointments, which suggests she may rely on social support.
• Current Situation: She attended the appointment alone due to her companions being unable to take time off work, possibly impacting her emotional state.

Assumptions or Biases

• Assumption: I might assume that her quietness indicates a lack of interest or enthusiasm about her pregnancy.
• Bias: There could be a bias towards viewing routine OB appointments as positive experiences, which might not apply to every patient.
• Category of Adjustment: Emotional or psychological adjustments may be needed to support her potential anxiety or stress.

Questions

1. How has your experience been during your pregnancy so far, and is there anything specific you’d like to talk about today?
2. Would it be helpful for you to discuss any support options or resources that might assist you during this time?
3. Is there any particular information or concern you have that you would feel more comfortable discussing?

Patient Care Decisions

• Multicultural values may affect how Brianna perceives her pregnancy and the importance of support systems. Understanding her emotional state could guide decisions such as emphasizing counseling or support groups.

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Patient 2: Ray and Laurent

Key Facts

• Demographics: Ray is a parent to Laurent, a five-year-old boy. They are originally from the Democratic Republic of the Congo.
• Language Proficiency: They speak multiple languages, including French and Lingala. Laurent is learning English, and Ray is improving his English as well.
• Cultural Context: Their recent immigration may influence their experiences and perceptions of healthcare.

Assumptions or Biases

• Assumption: I may assume that Ray and Laurent are comfortable with English due to their presence in the U.S., which may not be fully true.
• Bias: There is a tendency to underestimate the impact of language barriers on communication efficiency.
• Category of Adjustment: Language adjustments are needed to ensure clear communication.

Questions

1. Would you prefer to have certain medical information explained in French or Lingala to ensure you fully understand?
2. How has Laurent been adjusting to both the language and cultural aspects of being in a new country?
3. Are there any specific health topics or concerns regarding Laurent that you think we should address today?

Patient Care Decisions

• Multicultural values can influence health beliefs and practices. Understanding their cultural background may affect decisions on treatment options or preventive care, ensuring that information is conveyed in a respectful and comprehensible manner.

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Patient 3: Ashanti

Key Facts

• Demographics: Ashanti is a Black teenager with autism, accompanied by her mother for a routine well visit.
• Communication Style: She exhibits comfort around her mother but avoids direct eye contact, which is a common trait among individuals with autism.
• Support Systems: The presence of her mother is critical, as it may make her feel more secure during the visit.

Assumptions or Biases

• Assumption: I might assume that Ashanti's lack of eye contact indicates disinterest or disengagement.
• Bias: There might be an inclination to perceive her as less capable of understanding due to her autism.
• Category of Adjustment: Adjustments in communication style may be needed, such as using clear, straightforward language and allowing additional time for responses.

Questions

1. How does Ashanti usually communicate her feelings or health concerns, and are there specific ways that make her feel most comfortable?
2. Are there any particular approaches or strategies that have worked well in the past during medical appointments?
3. Would it be helpful for Ashanti to have time to prepare questions or concerns before the visit begins?

Patient Care Decisions

• Considering Ashanti's autism, decisions may need to focus on creating a supportive environment and ensuring that explanations are clear and accessible to reduce anxiety and foster understanding.

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Reflection

This analysis process highlighted the importance of adapting communication strategies to meet individual patient needs. I was particularly surprised by how assumptions may not solely be negative—some may stem from cultural expectations or norms, yet they can misinterpret a patient's situation or perspective. I learned that clear, open questions can help eliminate biases and uncover the true needs of patients, leading to better care outcomes.

Engagement with patients of varying backgrounds underscored the necessity for cultural competence in healthcare. Each patient’s unique circumstances shape their experiences in significant ways, and recognizing this can enhance the effectiveness of communication. This approach fosters trust and builds a better patient-provider relationship, ultimately improving the overall experience for the patient and facilitating better health decisions.