Microlecture 011: How To Recruit Multi-Ethnic Patients Into Clinical Research

When you look at most large research studies, you will often find a common trend– most of the study participants are mainstream patients. Few ethnic patients enroll in research studies. The reasons for this are many and complex.

There are certainly implicit biases on the part of all stakeholders. The researchers may feel that ethnic patients are unlikely to enroll in their study and so do not want to spend a lot of time recruiting them. Ethnic patients may feel that researchers are not to be trusted and may worry that they are being experimented upon.

In thinking about this issue, I feel that most large studies are publicly funded i.e. funded by NIH from our tax dollars. If we do not participate in the studies, then the results may be less relevant in the future for our specific ethnic group or population– or we may be in the dark about specific effects and side effects of common medications and important interventions in certain groups.

There is just one way for all cultural groups to shape research and to reap the full benefits of research findings and that is if we participate in the research protocols to the extent we can.

Watch the video to learn more about this topic.
VJ Periyakoil, MD, Stanford University School of Medicine.

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Microlecture 012: How To Introduce Interpreter Services

Who should introduce the interpreter and how should this be done? It is important to clarify the role of the MI and explain who the interpreter is there to serve. The MI is there to help both the doctor and the patient. Even if the family wants to interpret for the patient, the MI still needs to be there to interpret for the clinician.
If the MI arrives before the clinician, should the MI strike a conversation with the patient?

I prefer that the clinician and the MI spend tow minutes doing a brief, pre-meeting huddle about the proposed interaction and the goals to be accomplished during the encounter. Then both can enter the patient’s room together, start with brief introductions and proceed with the meeting.

Watch the microlecture for a sample pitch to the patient and family about the need for an MI.

VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator

Microlecture 013: Ethics Of Selective Interpreting

Medical interpretation ethics behooves the interpreter to adhere to their professional code of conduct at all times. This means that the MI is going to interpret everything said in the clinical encounter with the patient, including any differences of opinion, conflicts or unpleasant interactions that happen during that encounter. The MI is not there as to sensor the conversation or interpret selectively.
VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator

Microlecture 014: Should We Think of the Interpreter as an Invisible Person?

“The best thing to do from a medical providers perspective to help the MI is to act as if the MI is invisible” says Maria Reira. Ms. Reira is an expert medical interpreter (MI) who interprets in  Spanish, Catalan and German.

Should we behave like the MI is an invisible person,  ‘body-less’ voice if you will? This is to say that even if a MI is there in person, treat them like they are a telephone interpreter. Well, I am not sure. The MI is incredibly helpful in a clinical encounter and I will lose a lot of valuable data if I reduced their role to a mere voice. If I have an MI in my clinical encounter, I am going to look to her/him to interpret the verbal and non-verbal aspects of patient communication. Do you agree? What would you recommend?

VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator


Microlecture 015: What are the 2 Things a Medical Interpreter Needs to Know Before the Clinical Encounter

In any clinical encounter involving a patient with Limited English Proficiency, both the clinician and the medical interpreter need to prepare for the encounter.

The MI needs to know two things:

a. Standard logistics issue: which venue, which patient and what is the subspecialty so they can come prepared to interpret the medical terms..
b. Context of the encounter and the goals and agenda. 

The question is this: whose job is it to give all this information to the MI? Are there some aspects they can get before the clinician gets there or is it the job of the clinician to tell them everything? Watch the video to learn more.

VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator

Microlecture 016: How To Make The Medical Interpreter Feel Respected and Engaged

How can we make the MI feel more included in the clinical encounter?

Lot of times, the medical interpreter is walking into a sensitive situation and they can be caught off guard and feel disconnected from the encounter.

So, how should we brief them about the context so they can be better prepared? More importantly, are their specific challenges the MI can help with? For e.g. how to handle the loving but forceful daughter who will not let the patient (her mother) have a voice in her care?

VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator

Microlecture 017: Role Of Therapeutic Touch

What is the need to do a physical exam in a clinical encounter? For the most part, we get so much information about the patient from lab work, the imaging studies and other tests and reports that one can argue that the physical exam plays a minor part in the clinical encounter.  

I firmly believe that the physical exam forms the bedrock of the doctor-patient relationship. Firstly, if we did a focused physical exam, we might not need to subject the patient to so many lab tests and procedures.

My colleague, Prof. Abraham Verghese,  (a big proponent of the physical exam) jokingly told me once that the modern-day doctor needs an X-ray to diagnose an amputation!  

In addition to the obvious diagnostic value of the physical exam, it has a more subtle and deeper therapeutic significance. A careful physical examination, done respectfully, strengthens the doctor-patient bond and improves patient engagement with their own wellness and health.  

VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator

Microlecture 018: Should We Sugarcoat Bad News?

There is a lot of debate about how to give bad news to a patient in a culturally effective manner. Some cultures value direct communication without any frills. Other cultures prefer to be more subtle. In certain cultures, the family will not want the patient to ever know bad news about their condition.

What are the pros and cons of giving bad news in a subtle and oblique manner? Is there a benefit to being subtle and shielding the patient?

VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator

Microlecture 019: What is the Difference Between Social Touch and Therapeutic Touch?

Culture governs how we interpret many things including acceptable norms for touch.In many cultures, it is not acceptable to do prolonged social eye contact ( seen as a forward gesture) and it is not appropriate to touch a person, especially a person from the opposite gender.

In medicine, touch  (or “haptics“) is a vital part of the care we provide patients.  In fact, doctors do comprehensive medical exams of all patients irrespective of age, gender, ethnicity of the patient. So, what are the differences between social touch and therapeutic touch?  Are they governed by the same rules? How can you make therapeutic touch less intrusive and more respectful to patients?

Microlecture 020: Should Clinicians Engage in Small Talk with Patients?

Should we do small-talk with patients to set them at ease? This may be a standard expectation in some cultures. In fact, by making patients comfortable, we can expect them to engage more meaningfully and be willing to participate and take an active role in their care. Having said that, is small talk the best use of the 10-20 min of face time we have in a typical clinical encounter? It is precious time and we want to use every drop of it to improve the health and well being of patients. Given that time is limited, what are some simple strategies to connect with the patient, set them at ease while still being mindful of limited time?