I’ll answer some of the questions likely to come immediately to mind. No, she didn’t bring a sign language interpreter (in spite of my requests for her to do so). No, I don’t know sign language. No, I hadn’t tried translator services through my hospital. No, she did not have any family. Essentially, we communicated with me speaking loudly (as she read lips and heard somewhat when I increase my volume) and with handwritten notes.
Through our multiple visits we’d tried padding, taping, two different OTC inserts, and new shoes. I’d advised her on accommodative and functional orthotics which she couldn’t afford.
What? You can see where this is going? Let me stop you there. She did ask for surgery, which I have not done. As honestly as I could I explained to her the added risks of surgery on someone with her disability. Can I honestly consent this patient for surgery? Will I be able to impart to her all the complexities of the intra- and postoperative time periods? What if she has complications? Will she understand my instructions without causing extra damage? Let’s move on…
I saw the second patient two weeks ago in my wound clinic. She was a recent immigrant from Cuba, speaking only Spanish, presenting with her sister (a partial English speaker), and a professional translator. She had polio as a child, underwent what she thought was an ankle fusion approximately twenty years ago (which turned out to be a pantalar fusion after reviewing her radiographs). The hardware was removed shortly after the surgery, and she was now complaining of a painless open lateral cuboid lesion for nine years. Yes, I was thinking the same thing you are now: draining sinus tract from chronic osteomyelitis.
Her first visit seemed to go well. We had a very straightforward discussion about her probably having osteo and discussed the need for radiographs and further testing as well as local wound care.
Her second visit didn’t go quite so well. She returned, this time with a new translator. After telling her about her radiographs (which did in fact show signs of osteo), we discussed the options including surgical debridement, IV antibiotics, and/or a combination of the two. She then told me she would have surgery only if I could give her a guarantee that I could cure her AND in one surgical session.
If the klaxons haven’t started ringing in your head at this comment, something’s wrong with your judgement. We proceeded to a very long discussion, during which time I related that I could not and would not give guarantees. To make matters worse the translator was not relating accurately what I was saying. I happen to know some Spanish and could tell he wasn’t being completely accurate. After this somewhat contentious discussion I offered her a second opinion. By the way, don’t be afraid of second opinions – they cover your butt from a medicolegal standpoint, and often get that unwanted patient out of your office. You’re not a bad doctor if a patient wants a second opinion.
So the patient agreed to consider my suggestions, and I haven’t seen her since. If she does come back I’ll demand a second opinion, and I have absolutely NO intentions of taking her to surgery. Could I truly communicate my reservations to her? Add a language barrier to a patient with an already unrealistic expectation and you have a lawsuit in the making.
What about my deaf patient? Well, for different reasons I unfortunately won’t be touching her with a knife either. I know my limitations and those include the inability to adequately communicate with some patients. Remember, first do no harm!
Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]
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