I spoke with a friend this week who felt like a stranger in a strange land. She’s recently moved to a community with almost no experience with Muslims, people from West Africa, or with those with chronic pain from a genetic disease. Every encounter presents challenges drawing on her charisma, empathy, dignity and ability to adapt and educate – sometimes during the crisis of severe pain. During my friend’s medical encounters she does not face a health literacy dilemma. She is usually more expert about her culture and her health challenges than the medical professionals she meets. She faces a life literacy dilemma. In my life as a patient and career as a clinician, I face an infinite variety of people, cultures, and situations different from my own or my comfort. I am often at a loss at how to engage this range of clinicians (as a patient) and people (as a clinician). How can we proactively prepare for so much unknown and unfamiliar?
Let’s look at this from the view of the people who feel like a stranger in a strange medical land and then from the view of medical communities and teams facing unfamiliar individuals and communities. First, a crisis is no time to educate and build bridges. After all, it’s a crisis. My friend will be going back to her new clinics and emergency department to proactively introduce herself, her family, and her health challenges. She will present the protocols developed with her previous health team that work for her with contact information back to those specialists. Second, we clinicians, clinics, and facilities know the cultures and situations that challenge us the most – maybe homeless, disabled, cognitively different, refugee, addicted… We can proactively reach out to educate ourselves and introduce ourselves to community resources and plan practical means of communication. What about the completely unexpected, such as my friend in a new community? I learned the most about reading an unfamiliar room and responding with empathy from the Big Apple Circus, the troupe of clowns working with frightened children from hundreds of countries and cultures when I worked @BostonChildrens. I also read an article this week, “Medical Improv: A Novel Approach to Teaching Communication and Professionalism Skills.” Watson K, Fu B. Medical Improv: A Novel Approach to Teaching Communication and Professionalism Skills. Ann Intern Med. 2016;165:591-592. doi: 10.7326/M15-2239. Two residents are speaking to each other in gibberish, and 2 others are struggling to translate this exchange into English—which is wonderful, because it means that they are successfully doing an improvisational theater exercise called “Foreign Movie.” The constraints of this exercise focus the gibberish-speaking trainees on what they can “say” through body language and vocal inflection and focus the translators on what they can “hear” through nonverbal communication. If you don’t understand, what can you understand? Improvise. Brilliant.
It’s a two-way street – the stranger and the strange land.