Dealing with patients who can't speak english

While on my cardiopulmonary placement I was asked to treat John*, a patient with tuberculosis who could only speak a couple of words of English (a translator was not available until the following week). John was put in a vacuum sealed isolation room, anyone entering the room had to wear a mask, gown and gloves, as well as washing any equipment used. I was asked to assess John’s respiratory system and exercise tolerance and give him some exercises to prevent muscle wasting and maintain cardiovascular fitness. Initially I was overwhelmed by this as John wasn’t allowed to go outside his room and limited equipped was allowed to be brought into the room. Added to this was the fact that John didn’t speak much English, so the exercises had to be fairly simple and explained well with pictures so that John could perform them independently, due to the fact that I was instructed to limit unnecessary contact with John to limit exposure.

At first I didn’t quite know how to explain things to John I was using asking him lots of questions (some of which he could answer mostly he would look at me blankly) and then I started using both hand gestures as well as words to describe what I was saying, and this seemed to work a lot better. I would demonstrate to John each exercise I wanted him to perform, as well as showing him the pictures I had drawn of the exercise so that he could associate them and perform them correctly. To test if John understood how to perform each of the exercises I would ask him to show me at subsequent visits. The next hurdle to overcome with John was figuring out a way to tell him how many reps of each exercise he should perform, luckily John had an understanding of numbers and after counting out loud with John a couple of times he could understand how many reps he was supposed to perform of each exercise.

Reflecting back on this situation it wasn’t as difficult as I thought it might be to deal with a person with language difficulties. If I had to deal with this situation again I wouldn’t be as anxious and would probably respond in a similar way but by using more hand gestures and demonstrating exercises instead of relying on verbal means so that a patient can understand. This situation has helped me to understand the significance of demonstrating exercises to not only patients who have language difficulties but all patients as sometimes it is hard for patients to understand the smaller but very significant subtleties of exercises, and by asking the patient to perform the exercise and prompting them it leads to a greater understanding of the exercise itself and how it is meant to be performed to gain the most benefit.

*Fictitious names used