Elvis Ngai Kwan hid his lung cancer symptoms from everyone
— his family, friends — even his oncologist. "I think in the old culture, the traditional Asian one, you do whatever the doctor tells you and you don’t question them," said Kwan’s daughter, Mona Jung, during a recent interview. "My father was good about going to the doctor but he didn’t communicate. That’s not right."
Mona Jung's father resisted clearly communicating with his doctors
Part of Kwan’s issue was his communication was wound up in complex cultural patterns
. He viewed the doctor-patient dynamic as one-way, so he listened intently to his doctor’s advice, but never raised important issues about how his symptoms were progressing. Jung believes her father’s disease course would have been very different had he spoken up — and that he may have lived longer.
With these concerns in mind, we developed six questions patients should ask their provider (and themselves) to improve their quality of care — and life:
1. “Do you have an interpreter?”
Not being able to clearly communicate with your physician — or not fully understanding the treatment and other options they offer you — can dramatically lower your quality of care. Ask to be assigned an interpreter who is versed in your native language. A well-trained, professional interpreter assigned to you during medical visits ensures you are getting the best possible care.
“It’s really important because it impacts the way the patient feels,” said Yanghee Woo, M.D.
, a gastric cancer
expert at City of Hope. “Patients should be made to feel like they are being very well taken care of, but if they can’t tell me how they feel, or don’t think I understand what they are saying, that must be a horrible feeling.”
2. “May I be assigned an interpreting navigator?”
Yanghee Woo, M.D.
Interpreting navigators are not just there to interpret from English to a patient’s native language, they attend appointments and procedures every time the patient comes to the hospital. If your provider offers the service, ask for an interpreting navigator to guide you through the complex maze of paperwork and processes that are part of receiving care. Comprehensive cancer centers
like City of Hope are more likely to offer these resources, and others, such as in-language clinical social workers offered through our Sheri & Les Biller Patient and Family Resource Center
3. “Does this hospital have culturally and language-diverse staff?”
Look around at the staff at the medical center you’ve chosen — not just at the physicians, but at the nurse practitioners, coordinators, patient navigators and fellows. Is there a fair representation of multicultural and multilingual staff? If so, you are likely to get more culturally sensitive care. Recruiting and staffing that represents the community being served by a medical center is a big step toward something called cultural competence — understanding and delivering health care in a manner suited to diverse cultures.
4. “Whom will I appoint to be my advocate?”
Husbands, wives, family members, friends — anyone willing to advocate on behalf of a patient — are important, especially for patients from diverse cultures. A daughter may advocate for a mother by saying, “She doesn’t speak English well.” A grandson may advocate for a grandparent by relating that the patient is in a lot of pain, or does not understand instructions about care after a procedure. Advocates also may be better positioned to push for services for patients, including interpreters.
5. “Can you write it down for me?”
If the hospital you choose does not have interpreters — or if your advocate is less than proficient in your native language — you may ask your provider to write down important information about your care. Certain questions — like, “What side effects should I expect? What should I eat and what types of activity are OK following surgery?” — are vitally important to get in writing, especially if there is a risk that your advocate will not be able to properly explain things later.
6. “Where can I find more information about help for my condition?”
Free patient and family-oriented education forums, such as a recent one held by the gastric cancer advocacy group, Debbie’s Dream Foundation
, along with City of Hope and other local cancer centers, are great places to learn more about a disease and share experiences with other patients. Other community health organizations serving minority communities, such as the AAPCHO
and the Herald Christian Health Center
, work closely with patients looking for more culturally-based resources.