Reflective Case Study in Radiography Work Integrated Learning

E.M. is a 55-year-old retired Japanese woman who has been referred to the medical imaging centre for ultrasound and X-ray assessment. Her multiple medical conditions include pain in bilateral knee for over three months, especially on the sites of bilateral ligaments and back of knee. Pain in the right knee is worse with burning, throbbing, and aching. Pain on climbing stairs and squatting is most severe. Her GP also queries osteoarthritis and Baker’s cyst.

The radiographic projections required according to the protocol for Osteoarthritis knee series in the practice are bilateral AP weight bearing, PA Rosenberg, lateral, and skyline views.

Dauer et al. (2013) mentioned that a patient’s perceptions and decision making regarding to the X-ray examination could be affected by the way the radiographer communicates the benefits and risks with the patient. In other words, it can be suggested that the radiographers’ responsibility to clearly deliver correct information about medical radiation as well as associated benefits and risks consequences plays an important role in performing the X-ray examination. Furthermore, the relationship between patients and radiographers can be strengthened, and imaging outcomes improved resulting from appropriate and effective communication. Effective communication in this case include various aspects, for example, the display of professional conduct, respectful attitude toward patients, taking patient clinical histories, symptoms, and conditions, giving understandable instructions when positioning patients, and explaining post examination care or providing other suggestions if necessary.

To build up a trusting and friendly relationship with patients and their family, it is necessary that the radiographers provide the best possible patient care and inform patients about the exam details and what the exam entails, and most importantly, to ease patients’ and their family’s concerns. This can be done properly by answering questions from patients promptly and completely (Ugwu, 2018). With an open and honest communication, it is easier to achieve the purpose of successful imaging interactions.

Most patients come to the medical imaging centre with little conception about the exam they are having, thus the complete information given from radiographers in this stage becomes extremely critical to them. Although the referral from doctors/specialists clearly determine the clinical history and necessity for the patients to have certain examinations, it is still a must for medical imaging technologists to discuss the reasons why the patients have been referred to do the X-ray examination. Obtaining enough clinical information from patients helps determine the most appropriate types of imaging examinations and accurate imaging projections to better perform the exam more efficiently and safely.

Since E.M. is a non-English-speaking background patient and has mild age-related hearing loss, the communication barriers are encountered between her and other health professionals when the X-ray examination is in process. These difficulties met as a result of language difference and partial hearing loss. Most of the time she could not fully understand our instructions and was confused about how to follow our instructions, which made her feel anxious and impatient during the whole examination.

In the beginning, E.M. appeared very apprehensive when slowly walking into the examination room and had little eye contact with us because of nervousness. It was a bit hard to confirm the personal details with her as she only understood little English and could not hear us properly. We tried writing the details down and presented to her to see if it’s all correct. Fortunately, this method worked to her. However, the most difficult part was to let her be in the correct position in every different projection. The obvious communication barrier between E.M. and us became one of the factors that she did not even try to cooperate with us, and ended up avoiding any eye contact with us. We’ve implemented multiple strategies to effectively communicate with E.M. Firstly, through using simple language and breaking sentences into individual words which might be easier for her to understand; secondly, speaking every word clearly with gentle voice and slower speed; thirdly, directly demonstrated what exactly we needed her to do. However, the outcome was not that ideal. To deal with this intractable situation, one of the senior radiographers then went positioning E.M. straightway, but gently, without giving her too many instructions. Besides, we have spent much more time than normal positioning her in each projection.

Bal (1981) states that an overall understanding of how much English does the patient know will help medical professionals adapt language accordingly. There are some aspects which are applicable when talking to non-native English speaking patients:

1. Speak slowly and clearly with normal volume.
2. Repeat the ‘same’ sentence/words again when the patient does not fully understand since changing into other words may confuse the patient.
3. Giving instructions in a clear and logical sequence
4. Try to avoid using medical jargon as these are not commonly used in daily life thus have higher possibility that patients could not understand.
5. Better to not condense the content of what you are saying as longer explanation is usually easier to be accepted.
6. Do not give too much information in one session, because this may negatively affect the memory while concentrating to understand.
7. Ensuring patients have full understanding of instructions and given information after every conversation.

Depending on the situation, sometimes an interpreter is required to assist the process of examination. It is often to have a member of the patient’s family, a friend, or another same-language-speaking radiographer to be the interpreter. The following points should be checked when having an interpreter during the examination

1. The interpreter should be fluent in both English and the language the patient speaks.
2. The accuracy and sensitivity of the translation is satisfactory and with respect.
3. Trusting relationship must be built between the patient and the interpreter hence the patient would be willing to communicate personal or intimate information to the interpreter.
4. Always showing patience to the patient and interpreter when having conversation although the translation process might take longer time than normal.

According to Frank (2000), the lack of English vocabulary required to express the medical symptoms or problems is the obstacle that is very difficult for those who are non-native English speaking patients to overcome. He points out that these patients usually are unsure when and how to ask questions, either afraid of indicating that they need more time to communicate because of the busy medical setting. Sometimes, the specific cultural difference in the background between the patient and health professionals can cause communication problems. The existing of different culturally learned assumptions and expectations might be ignored or unware but can still attribute to conversational breakdowns. Therefore, the inappropriate or no response then given by the patient can be a reveal in failed understanding. Despite language difference, the partial hearing loss of E.M. resulting in another source badly affecting effective communication. Ciorba, Bianchini, Pelucchi, & Pastore (2012) comment that hearing loss is the most common sensory deficit in the elderly. This is further supported by Barnett (2002), who highlights that communication difficulties are reported by patients with hearing loss and their physicians, and the prevalence of people with hearing loss is increasing worldwide nowadays. Hence, the importance of enhancing skills to facilitate communication when hearing loss is involved should be emphasised. People with hearing loss can be divided into three categories (Barnett, 2002):

1)     Hard-of-hearing people

2)     Deaf people who communicate orally

3)     Deaf people who communicate primarily sing languages

In this case, E.M fell into the first category. More specifically, she can still derive some linguistically information from conversations. The key element to communicate successfully with this type of patients is to adapt the need of the situation, which mainly depending on the patient’s background and the suggestions given by the patients on how to best communicate with them.

There are some of suggestions provided by Australian Government Department of Health (2017) to enhance communication quality with a person who suffers from hearing loss:

1. Face the patient—This provides extra clues such as facial expressions for the person to have better understanding of what the speaker is saying.
2. Rephrase the sentence—Saying the same thing in different ways may help the patient to easier understand what the speaker is trying to say when the speaker is not understood initially.
3. Speak clearly but don’t shout—The voice might be distorted when shouting, thus speak clearly and slightly slower than normal if necessary.
4. Reduce background noise—This help the patient have higher concentration about what the speaker is talking about.
5. Reduce the distance between the speaker and the patient—The ideal listening distance for a hearing-impaired patient is less than two meters from the speaker.

In conclusion, it is essential for health professionals to improve communication skills with patients in daily medical practice. The range of the influence from the clinical communication can be extremely broad depending on different scenarios. Diverse cultural backgrounds and various physical conditions of each patient need to be considered seriously and respectfully. In this case, we have discussed several feasible approaches about how to develop effective communications with the patient who has partial hearing impairment and the patient who is not a native English speaker. In my future clinical practice, I would take into account all variations from individual patient and adapt specific techniques to meet the patient’s need in order to achieve the goal of building trusting relationship with patients, forming affective communications, safely and efficiently performing X-ray examinations, and finally obtaining diagnostic radiographic images.

Reference

• Australian Government (Department of Health). (2017, September 5). Australian Government Department of Health. Retrieved from Communication strategies for people affected by hearing loss: http://www.hearingservices.gov.au/wps/portal/hso/site/eligibility/abouthearing/communication_hearing_loss/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfGjzOK9A03NDD0NjLwtwvzdDBwd_UJ9vNxMjAwcDfULsh0VAav0Y6c!/
• Bal, P. (1981, August). Communicating with non-English-speaking patients. British Medical Journal, 283, 368.
• Barnett, S. (2002, July). Communication with Deaf and Hard-of-hearing People: A Guide for Medical Education. Academic Medicine, 77(7), 694-700.
• Ciorba, A., Bianchini, C., Pelucchi, S., & Pastore, A. (2012). The impact of hearing loss on the quality of life of elderly adults. Clinical Interventions in Aging, 159–163.
• Dauer, L., Thornton, R., Hay, J., Balter, R., Williamson, M., & Germain, J. (2011, April). Fears, Feelings, and Facts: Interactively Communicating Benefits and Risks of Medical Radiation With Patients . American Journal of Roentgenology, 196, 756-761.
• Frank, R. (2000, March). Medical communication: non-native English speaking patients and native English speaking professionals. English for Specific Purposes, 31-62.
• Ugwu, A. (2018, January 29). Afribary.com. Retrieved from RADIOGRAPHERS AND PATIENTS, INFLUENCE ON SERVICE DELIVERY: https://afribary.com/works/effective-verbal-communication-between-radiographers-and-patients-influence-on-service-delivery-6117#overview