Language Barriers, Racial Bias, and Patient Care

The following scenario illustrates how language barriers and racial bias can have a direct effect on patient care and influence clinical outcome. The scenario is based on a story told by Art Chen, a physician working in the San Francisco Bay Area.

My patient was a seventy-two-year-old Chinese gentleman whom I had admitted the night before for urosepsis. Early the following morning, I received a call from the nurse on the floor informing me that the patient had become "combative, confused, and, now, on top of everything else, he was incontinent of urine." The nurse explained that the staff was having a very difficult time controlling the patient and wanted to restrain him. I asked the nurse, "Who is talking to the patient?" reminding her that the patient was Chinese and didn't speak English. She told me there was no one on the floor that could speak Chinese. I decided not to approve the order for restraints but instead I offered to come and evaluate the patient as soon as possible. The nurse and her staff were quite upset with me. Later they told me they had agreed at the time that I was just another doctor who had no clue how to deal with nursing issues on the medical floor.

As soon as I arrived in the patient's room, he looked at me and he asked me why I had detained him in his bed. He asked me why the large, strong male nurses wouldn't let him go to the restroom. He was very lucid and cooperative. He explained that he had needed to go to the restroom to urinate and when he was detained, he had pushed back trying to get to the restroom to relieve himself. Ultimately, he had become incontinent in his bed.

I'd love to say that reporting and reviewing this incident caused immediate and significant changes in the hospital, but that was not the case. However, working with the staff, I was able to get the hospital to approve funds for translators and to prepare, print, and distribute cards with common patient requests in different languages that the nurses could use to ask patients about pain, thirst, eating, urinating, etc. In addition, the hospital developed a plan for providing translation services by telephone and educating staff on how to use this service.

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