Language Barriers

I recently treated a patient on a gen med ward whom had been admitted after fainting at home. This particular patient, although still living ‘independently’ at home, was cared for predominantly by their partner. Despite no diagnosed condition this patient’s partner undertook all cleaning, cooking, washing, shopping etc duties, while the patient spent a large percentage of their day watching television. Unfortunately the patient’s partner became unwell, and not long after the patient developed a chest infection eventually causing them to faint at home and be brought to hospital. The first point mentioned in this patients’ notes was that they spoke English as a second language, but that this wasn’t a major problem and had been living in the country for over a decade.

My supervisor asked me and another student to see the patient to assist in clearing their secretions, mobilise them and provide some general education. We found the patient SOOB in their chair staring out the window and introduced ourselves. No comment by the patient. We then simply explained what we were going to do with them that day and again received no acknowledgement that they had heard our comments. While we knew the patient had mild hearing loss and did not speak English as their first language they were clearly ignoring us. We attempted to communicate again and this time the patient just shook their head. Again we explained fairly loudly and extremely simply that we were there to help them, but again all we received was a shake of the head. Frustrated one of us sought out the patients nurse for some assistance, who simply told us that this was just the way he was. Any attempt to assist the patient to STS or take deep breaths was met by the patient blankly looking away or worse going ‘floppy’. This behaviour continued for the next few treatment sessions and each time was documented in the notes. Despite liasing with nursing staff and the patients doctors ( note that the patient had no history of a neurological event and on occasion did speak to the staff) the patient s behaviour remained consistent. Another physio who had managed to mobilise the patient on another day (only because the patient had to have a shower and use the bathroom) said that the patient had replied to them that they didn’t want to comply with physio and walk because at home ‘they wouldn’t have too’ and therefore ‘didn’t want to walk here’.

Both myself and the other student found this patient extremely frustrating. It was clear that they could understand us, therefore must have understood the reasons for treatment and the risk of developing a severe chest infection if they did not comply. It didn’t seem to matter what we did or said the only way to mobilise this patient was to either get them to walk back to bed or to the bathroom, with no treatment specifically aimed at their chest and clearing secretions. Perhaps the patient did not want to return home especially after fainting or maybe was depressed or for some other reason did not want to get better and return home and this was why they acted in such a manner. This doesn’t change the fact that it was and is very difficult when patients ignore all your advice and recommendations when you know the negative implications that this may have on their health. Luckily for this patient they have not got any worse – in saying this they are not any better either. In some cases such as this patient, particularly with their history at home, I think that sometimes all you can do as a physio is provide the patient with the best treatment options and continue to provide them with the opportunities to comply. With this particular patient each day we try to involve them in treatment, with the assistance and support of the nursing staff, but unfortunately they aren’t interested. Thus while language barriers can be a problem usually there is an attempt to communicate via gestures, facial expressions etc. In this case an unresponsive patient (with no pathological basis) who ignores both yourself and refuses to comply with treatment can be extremely difficult to provide a duty of care to. If anyone has had a similar experience or has some suggestions as to how to get this patient to comply with treatment I would be very grateful, as this particular patient is still on the ward!