I was assigned to complete my family medicine clerkship at Sanitas Medical Center, a primary and urgent care site in Miami, Florida that serves a large and diverse population. Most patients are elderly, Spanish speaking immigrants from Latin American countries such as Cuba, Venezuela and Colombia. Others come from Haiti, Jamaica and Barbados. Each patient brings with them their own culture, beliefs, customs and language that influence the way they interact with the healthcare system. These factors are often reflected in the medical problems we seek to treat. In these settings, communication, understanding and building trust is essential to providing quality medical care. What is the best way to do this? By listening.
It was a busy Tuesday morning at Sanitas when my preceptor and I entered Room Five to attend to our next patient. The room was cold and engulfed by ambient sounds that played from the overheard speakers. The patient, a small, elderly woman with short, caramel colored hair sat on a chair by the corner of the room. Invisible were the thought bubbles that swarmed above her head, subtle was the gleam in her eyes, but the message was there. Experienced and astute, my preceptor picked up on her body language and kindly questioned the patient about her mood. Upon further investigation, the patient erupted into tears and took a deep breath before disclosing the reasons for her sorrow. In a downhearted Spanish tongue, she uttered, “my daughter barely speaks to me. She says she is too busy and does not have time to talk or come see me. I have not seen my grandchildren in months. Everything is so different now and I do not understand.” My preceptor quickly closed her laptop and faced the patient. She was all ears.
For the next 30 minutes, we allowed the patient to pour out her feelings and discovered that she and her family had recently immigrated from Venezuela. It was apparent that she was depressed and having difficulties adjusting to life in the United States. My preceptor communicated empathy by holding her hand, and I by offering her a tissue. Coming from the same culture, we understood how easily the fast-paced American life could disintegrate the social bonds and family cohesion important in Latin culture. My preceptor crafted her words thoughtfully to validate her emotions and offered her reassurance: “I recognize it is difficult to adapt to an unfamiliar environment and routine. I am here to support you and help you as best as I can. There are resources I can offer you and professionals I can refer you to that can help you in managing your feelings and guide your spirits up.” As the conversation carried on, I saw the thought bubbles that once swarmed above her fade away. The tension in the patient’s face dissolved. She appeared more relaxed. Poles apart from the beginning of the visit, she now communicated comfort and strength: “I see now that my worries are valid and that I have the tools to conquer them. You did not disregard me. You truly understand.” The patient agreed to be enrolled into a mental health program and follow-up in a few weeks. At the conclusion of the visit, the patient expressed she was grateful we took the time to listen to her concerns and understand her situation: “Thank you, doctor. Thank you for taking the time to listen to me. Thank you for your patience.”
Throughout the visit, I felt at ease and sympathized with the patient. I was glad we were able to recognize her depression and create a fruitful experience for her. Despite knowing we could not dissipate her worries, I believe our communication with the patient was both helpful and rewarding. I learned the importance of observation and reading subtle signs that could shed light on the patients’ troubles. As I progress in my medical career, I wish to further develop this awareness and improve my communication skills to better understand and assist my patients. Above all, I confirmed that simply listening to patients is the best form of communication.