Language discordance and levels of satisfaction between doctors and patients in a medical encounter

Abstract

This study was necessitated by a paucity of research into the communication that takes place in doctor-patient interactions in Zambia; noting that patients have in the past complained that doctors communicate with them in a language they do not understand very well or at all and so were dissatisfied with the consultation. The study sought to answer the following research questions: 1. What languages are commonly spoken and understood by patients and doctors? 2. To what extent are patients satisfied with doctor-patient communication in terms of the language used? 3. To what extent are doctors satisfied with doctor-patient communication in terms of the language used? 4. What strategies can be used to mitigate barriers to doctor-patient communication? Methods: A cross sectional, mixed study design involving 139 patients and 68 doctors who were randomly selected formed part of this study. Two structured questionnaires, two focus groups and fifteen in depth interviews were used to collect the data. Quantitative data and qualitative data were analysed using two computer programs SPSS version 14 and N vivo version 2.2 respectively. Results: The findings showed that: (i) Patients most of the times communicated to their doctors not in English which is the official language but in any of the local languages suitable to the situation. They preferred to communicate in Chinyanja most of the time though Chibemba was rapidly becoming the language of choice. However, most of the patients understood Chinyanja, Chibemba and English very well. As for doctors, they had a preference to speak in English and Chibemba to their patients rather than any other language and yet they understood Chinyanja more than Chibemba. Patients and doctors were satisfied with their understanding of what was communicated in a language they were able to understand, (iii) Both doctors and patients saw the need to mitigate barriers in doctor patient communication but doctors were rather uncomfortable when it came to strategies to empower patients. Doctors seemed to be uncomfortable for instance allowing patients to be provided with videotapes to view as a way of educating themselves on some topics. Conclusions and recommendations'. This study has concluded that small-scale satisfaction surveys like this one do not measure the desired satisfaction adequately in a scientific sense, and cannot be used as robust and reliable measure for service evaluation. But when used as formative case studies they can identify problems in service provision that may require remedial action. Clinicians and managers should avoid interpreting these findings as 'league table' results but use them to demonstrate that they are working collaboratively to respond to the communication concerns of patients and doctors alike.