About 6 months ago I was in the emergency department taking care of a child with seizures. I remember the frustration of trying to get a phone interpreter amidst the busy chaos of the flu season. Shortly after getting the interpreter on the line, I soon learned that the family was running low on formula and was mixing less powder in the water because they didn’t want their son to become dehydrated. They were doing the best they could to make ends meet, but at the end of the day, they could not afford to buy more formula for their youngest son if they wanted to be able to purchase food for his older siblings too. The parents were devastated when they learned that their son had seizures because his sodium was low from diluting his formula. I felt helpless and could not understand how this happened. I wondered how a family that was connected to WIC and other resources still was having problems.
Clearly there is the problem of language barriers, and maybe this was not the first time they have been seen for these issues. Maybe earlier another physician in the same place as me did not spend the time to take a full history with a phone interpreter. I will confess that I definitely thought about cutting the history short. Maybe the family felt the same frustration I was feeling about having to take the time to wait and have the same statement translated over and over again. In fact, I learned this month that Spanish-speaking patients and their families feel just as frustrated by phone interpretation, and they often leave out important details because they feel bad, like they are “wasting time”.
When I was on newborn a few months later, I learned that WIC only provides a set amount of formula, and it may not cover all of a patient’s needs, especially as they get bigger. When a family runs out of formula and it cannot be provided by WIC, it is up to them to get it on their own. Knowing that transportation is an issue for many families, it is understandable why this is difficult. And on top of that, even if they can get to their local grocery store, many stores in Hispanic neighborhoods do not even carry formula. This has really opened my eyes to the barriers that many families face, things I just take for granted and haven’t considered.
Looking back now, I know I can do better. I know I am inevitably going to be frustrated by the systems in place, but so are my patients. I am going to take the time and effort to give the best care I can. All too often I forget that the plan of care may not be feasible for the family in front of me. They may not just be facing a language barrier, but barriers in transportation, health care literacy or income. When we are rushed, we often forget to take a step back and listen. As I go on in my training, I will challenge myself to remember these few minutes can make all the difference.