Reshaping Bedside Manner in a Diverse World

The collaborative's biggest success, the Pan Asian Volunteer Health Clinic, operates every Tuesday evening in a county building in Silver Spring. Virtually every person who signs in is Chinese born or raised, as are the volunteer doctors and assistants. Their shared backgrounds mean easier communication when patients describe symptoms or the herbal remedies they have tried.

"Everybody speaks the same language," said M.K. Lee, deputy director of the Chinese Culture and Community Service Center, the partner that helps MobileMed recruit staff. If a patient complains that "I've got fire in my mouth," the staff immediately figures: fever. "Every Chinese physician knows what that means," Lee said.

Contrast that with the confusion that can arise in other settings.

"It's harder to describe what you feel," said an older woman named Qi Chen. In Beijing, Chen was a university professor. She lives in Potomac with her daughter and baby-sits her 9-month-old granddaughter. Both were with her recently at the clinic as Chen waited to see a doctor about pain in her elbow. Someone had told her it probably was tennis elbow. "But I don't play tennis," she replied.

An article last year in the Journal of the American Medical Association cited "the need for significant improvement" in physician training. It detailed a survey in which a quarter of more than 2,000 final-year medical residents said they were insufficiently prepared to deliver care to new immigrants or those with beliefs not in line with Western medicine.

"You make assumptions about patients based on how they look, how they speak, the clothes they have on, and, truth to tell, patients make assumptions, too," said Yolanda Haywood, an assistant dean at George Washington University medical school. In keeping with national accreditation standards passed in 2001, the school incorporates cultural questions into a required four-year course, the Practice of Medicine.

Dealing with varied backgrounds and beliefs takes time, which the pressures of managed care do not easily accommodate.

"You have to first have this little chat," Director Mary Jelacic said of her African patients at the Pregnancy Aid Center. Then the doctor or nurse moves on to the actual health issue, which may be tucked within a meandering, lyrical narrative.

"It's like peeling an onion," she said. "It takes a long time to get to why the person is here."