Stories from a Multi-Cultural Practice

by Kayla Hatchell, MD

Salt Lake City, despite its location in a land-locked state, draws a larger international population than I expected. It could be the international airport, the lure of outdoor activities, or another factor I have not discovered yet. As patients pass through or have relocated from across the world, we see plenty of distinct cultural backgrounds which enrich our practice. I can recall two particular patients who taught me several joys and challenges of a multi-cultural practice.

The first patient, from Southeast Asia, was passing through for a conference when he developed crushing chest pain and presented to our emergency room. He was admitted for a cardiac arrest, far from home, in a country where he did understand the language but was not familiar with the medical system. The thought of having a medical emergency in a foreign country is stressful for many of us, but our patient was accepting of our care and often expressed his gratitude. We often stopped by his room to check in and explain the frequent monitoring that was needed due to his condition. Multiple residents in our program cared for this patient due to his long admission in our hospital. The patient’s wife and brother travelled to be by his bedside, and the team updated them frequently on his progress. We felt a strong desire to ensure he was getting the highest quality care we could provide as a way to honor him and his family. When his progress halted and it appeared he may die within a few days, our care managers researched any way that we could transport him to his home country as he wished. Unfortunately, given his critical condition this could not be arranged. Though my team was saddened that our patient’s wishes could not be carried out, we continued to do what we could to make our patient’s remaining time comfortable. Showing compassion to patients from across the city or across the world is a privilege I am grateful for.

The second patient saw me in our primary care clinic and quickly became one of my favorite patients. She was from Europe and had lived in the U.S. for the past few years. She was transferring care from another health system, and we had plenty to catch up on. Using a translator in the first visit allowed us to cover a range of topics including her diabetes, hypertension, and her insomnia. She agreed to come back in one month for follow up. At the second visit, she declined the translator and said she preferred to speak with me directly and was excited to practice her English. She told me about her sleep apnea and struggles with her CPAP machine. Then she said she would like to see a cardiologist. I reviewed her history again, and besides hypertension that was well-controlled with her current medications, I could see no other cardiovascular problems. She confirmed that she did not have any known heart problems but restated she would like to see a cardiologist. I explained that we do not refer patients who have no heart problems and proceeded to ask about chest pain and related symptoms. The patient then shared that, yes, she had “needles” in her chest when she walked which resolved when she rested. I was alarmed by these symptoms ordered a stress test for further evaluation. In reflecting on this encounter, I was disappointed in how close I had come to missing her key symptoms if I had not decided to ask further. The roundabout way we discussed her concerns, starting with the referral without mention of symptoms, was not the way I was accustomed to hearing a history. Even with a translator, I could have passed by her concerns thinking I had reassured her that she did not need to see a specialist. My encounter with this patient taught me the importance of casting a wider net in my questions and being on the lookout for concerns which could be voiced in different ways.

Kayla is from West Richland in beautiful Washington State. She attended college at Rice University and headed to the east coast for her medical degree at the Dartmouth Geisel School of Medicine. Her medical interests include primary care, preventive medicine, behavioral health, and women’s reproductive health. Her research interests include screening and interventions for the social determinants of health in primary care, and how primary care can best partner with and support vulnerable populations. Kayla loves a variety of outdoor activities (downhill and cross-country skiing, mountain biking, and trail running, to name a few) and spending time with her fiancé and cat. She is thrilled to relocate to Utah and join the University of Utah community for family medicine and the Utah StARR research program. Kayla chose the University of Utah because of the opportunities for community engagement, strong outpatient and inpatient training, focus on wellness, vibrant culture, easy access to the outdoors, and the chance to pursue training in primary care research.

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