Communications

Back at work for the last two days with presentations and working on the special projects. The weather has broken some and the heat is not that bad. In fact yesterday it was raining pretty hard in the morning and the cab ride was longer than I would have expected. The fellows have been presenting their special projects and this has been very stimulating and I am very impressed by the quality of the talks.

Yesterday one of the topics led to a very animated discussion of the issue of non-disclosure of diagnosis and prognosis to patients. Although the cultural norm is to not disclose illness severity to patients but to discuss with family there is now some doubt among the group that this is still or is really true. Dr. Thuy from Hia Phong told us that she had been very struck by the way I spoke with one of the patients at 09 Center and how this had been helpful to him and not upsetting. She said she had never talked to a patient like this and that she had asked perhaps 20 people over the weekend if they would want the doctor to talk to them honestly about their illness if they had a severe illness, and everyone had said yes.

Cuong then told us about his experience when he was on call and he had used some of his new communications skill and that this had been very helpful and that nurses and other doctors had noticed the difference and had commented on it. I think that it is clear that both of them will have a change in their practice related to communication.

We also discussed Kubler-Ross and I suggested that they should do some survey work regarding this issue of disclosure of illness because the preferences for discussion may be changing and that I thought it would be important to document this in Viet Nam, since it could effect communications education in medical school and residences.

I have been working on my Vietnamese and I am really enjoying trying to learn more. The more I learn about Vietnamese and the culture the more I think I can understand culture. However, it would take years to truly have a good insight and understanding. I think that there are aspects of the culture that are just not understandable by the Westerner. I think that the Vietnamese have and are doing a much better job of understanding the culture of other places in the world. I think that the USA in general has not done a good job of trying to understand the multiple points of view.

I been looking for festival flags as something to take home as a gift for the unit but I haven’t been able to find any. Cuong said he would help me with this and the told me the character in the middle means unity or solidarity. I think that that is a wonderful sentiment for Palliative Care.