We asked trusted experts from around the world to identify some of the challenges clinicians face when treating patients from different countries and cultures. They agreed the top issues were:
- Overcoming language barriers
- Regional differences in medical best practices
- Cultural differences in person-to-person interactions and appropriate behaviors
- Ordering or refilling the appropriate medications
Our experts offer some tips and recommendations of tools to help improve those patient interactions and therapeutic outcomes.
1. Overcoming language barriers
“The biggest difficulty for clinicians dealing with patients from other countries and cultures, in my opinion, is the language problem,” says Marlies Gosejohann, a nurse based in Germany with experience in emergency room, surgery, and endoscopy. “Diagnosis is hampered when patients cannot describe symptoms correctly or when clinicians do not understand them correctly.”
She also notes that effective treatment compliance and follow-up can be jeopardized if patients do not fully understand clinical advice and treatment instructions, like dietary tips.
Clinical pharmacist Azeem Hashmi, currently practicing at Houston Medical Center, advises that healthcare organizations should ensure a certified translator is used for all patient interactions, rather than relying on a patient’s accompanying family member or friend, to make sure the clinician’s message is being delivered clearly. “This is a standard of care at any facility providing patient care, from pharmacies to hospitals, as health systems are required to provide some level of interpretation services, whether it be through a call center service or in person.”
While it is aspirational to have interpreter services at every healthcare facility, Gosejohann notes that for those that don’t have the means to provide interpreters, the task does often fall to patient companions to interpret, or attempts are made to find other staff within the facility who can understand the patient’s language to help out. However, this kind of informal backup plan is not effective in an emergency situation.
In scenarios where there are no interpreters and language barriers remain a problem, both Gosejohann and Hashmi agree that any attempts to communicate in language should still be made, even using artificial intelligence, such as translation programs on phone apps.
Safi El Baf, an international technical product manager and pharmacist based in Dubai, notes that in addition to the importance of translation tools, organizations can make strides in addressing language barriers by starting with two basic approaches:
- Hire a diverse professional team with different backgrounds speaking different languages who will be “highly appreciated” by diverse patients.
- Encourage clinicians to use “the easiest words” they can with non-native speakers.
2. Regional differences in medical best practices
Despite global goals of reducing clinical variation by aspiring toward universal standards of care, regional differences in medical practice are inevitable, which can also lead to regional differences in patient expectation and experience.
“Each clinician uses a different approach to treat patients, and they differ from country to country,” El Baf says, citing as an example, his personal experience that usage of antibiotics is “very common” in Lebanon while substantially less so in France. Not only does this create differences in some basic treatment protocols, it also makes it “weird for a patient” to find themselves in the other country treated in a way that goes against their comfort level and expectation.
There is a “two-way solution, in my opinion,” to regional differences in care standards, El Baf says. “The clinician should ask enough questions to understand the patient’s situation and clear out any misconception the patient might have. On the other hand, the patient must understand that this is a different country, and they will use a different approach. So, they should always tell the clinician about the medications they use chronically or just travel medications.”
Working as clinical pharmacist in hospitals in multiple regions, El Baf has encouraged colleagues to use solutions like UpToDate® clinical decision support and UpToDate® Lexidrug™ referential drug resource “to offer international standardized care used by high-quality caregivers around the world to ensure the patient in critical cases gets the same level of care anywhere.”
Gosejohann adds that its equally important to create consistency in patient education. “It is immensely important that patients are well informed about their disease and are actively involved in the therapy,” she says. In the cases of certain chronic diseases such as diabetes or high blood pressure, or post-surgery, patients can “decisively influence the course of the disease” through their post-discharge behavior or treatment compliance, for example, diet, completing exercises, or wearing appropriate therapeutic devices.
“Whenever the patient does not understand the healthcare professional correctly or misunderstandings occur, this can have negative consequences for the therapy and can even lead to life-threatening situations,” she says. It becomes imperative to take the time to bridge regional (and again, language) divides.
3. Cultural differences in patient and caregiver interactions
Understanding distinct cultural values, practices, and beliefs is critical to connecting with international or visiting patients and providing appropriate care, Hashmi says. That includes “being aware of differing societal and environmental factors that affect access to care.”
He notes that not every patient can be approached in the same way, or as the clinician might approach a neighbor in their own culture. “For example, some may prefer to avoid eye contact as a sign of respect,” he explains, “Or you may need to pay attention to who the family sees as the decision maker, because there may be an authority figure who is not the patient. Due to their differing spiritual and religious beliefs, some people cannot receive blood transfusions.”
When in doubt, he recommends referring to professional resources. For example, UpToDate offers a topic on “The patient’s culture and effective communication.”
4. Ordering or refilling the appropriate medications
“When patients require refills, medications can be difficult to identify due to being prescribed internationally,” says Hashmi. “Ordering the correct home medications when a patient is being admitted or discharged from the hospital can be difficult.”
“Patients come with their own bag of medications, so the clinician is expected to be familiar with these new brand names and often with molecules he has not seen since university, and that takes him into research to understand each one,” explains El Baf, noting this can lead an enormous loss of time, often when patients are waiting for answers.
While clinicians often turn to Internet searches and common info websites to quickly look up unknown medication names from other countries or alternate spellings, El Baf asks, “How reliable are those resources? These sources, in my opinion, are less trustworthy because we don't know who edited the content or how frequently it is updated.”
He concedes that common search sites can be useful and effective for quick spelling checks on unfamiliar medication names, but prefers and recommends professional, evidence-based resources like Lexidrug for mechanism of action, indications, and other safety information, as well as to match generics to varying international brand names.
Medication reconciliation is essential for visiting international patients seen in a clinic or in a hospital emergency room, says Hashmi. “When visiting from abroad or when they've recently relocated and their medication supplies are running low, they may visit clinics to establish care,” he explains. “Without being able to get in touch with the original prescriber or facility, it can be difficult to identify some of their medications and what the indications are for them. Clinicians would need to find out why the patients are taking their medications, look up the medication in a database like Lexicomp, and then order the same or an equivalent therapy regimen.”
Having an evidence-based solution in which to look up equivalent available medications helps enhance safety, he adds. “Not all international medications are unique, but if the clinician is unfamiliar with them and it makes sense given the circumstances, they will know that identifying the generic product name will be the next step.”
For the latest on multinational drug information resources, explore UpToDate Lexidrug solutions.