Every patient is complicated: Gray
Virginia McMillanvmcmillan@clear.net.nz
News Ben
Gray
The much talked-about "difficult patient" masks the reality that
every patient is complicated.
So says Wellington GP and academic Ben Gray, who will take leave
of absence from the multicultural Newtown Union Health Service in
January.
Eighteen years at the mainly low-income, high-needs practice have
taught him the importance of not making assumptions about patients,
including ones who "look like you", Dr Gray says.
And, in a practice where most patients do not resemble the
smart-but-casually dressed, English-accented Dr Gray, he says it
has been a huge privilege to learn amid diversity.
A major lesson has been to try to apply all his skills with every
patient.
Many in the Newtown Union community are of Maori or Pacific Island
descent, or are migrants or refugees from Middle Eastern, Asian and
African nations.
"On one level, it looks hard...but everyone is complicated," Dr
Gray says.
Over the years he has found the "heart sink" patients become fewer
and fewer.
The patients many doctors describe as difficult appear to be odd
or non-compliant, or to have different worldviews and not to value
the care given, Dr Gray says.
But these are judgements clinicians make and, with them, comes a
risk of poor care.
"Best practice" also contains judgements, implying resources are
unlimited and patients will willingly follow the doctor's "correct"
advice, Dr Gray points out.
In the real world, it is not a patient's fault when they do not
see a treatment as a priority. In his view, the clinician's job is
to identify the feelings and talk them through in search of
agreement.
Dr Gray leaves the Newtown practice on 20 January 2012 to devote
himself for a year to full-time work at the Wellington School of
Medicine and Health Sciences, where he has researched and taught
part time for the past five years.
His recent research on the use of interpreters in primary care has
led to a toolkit.
In his next studies, toward a master's degree in bioethics and
health law, he will question the cultural safety of the established
principles of biomedical ethics (autonomy, justice, beneficence and
non-maleficence).
Autonomy of the individual is not given great weight in
collectivist societies such as Maori, Dr Gray points out.
Useful resources
• The 42-language Language Line offers
interpreters
in 42 languages via a large number of organisations
(including health). Visit: www.ethnicaffairs.govt.nz
(see 'Language Line').
• For the Auckland DHBs' Culturally and
Linguistically Diverse (CALD) resources, training and interpreter
services visit:
www.caldresources.org.nz
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Podcast: The risk of misunderstanding
Clinicians are putting patients at risk when language barriers are
not tackled, Dr Gray argues. His research shows New Zealand health
professionals make insufficient use of interpreters in the care of
patients with limited English (>>nzdoctor.co.nz, 'News', 9
September).
Virginia McMillan interviews Dr Gray about miscommunication,
accessing interpreters and learning to use them.
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