Two handsDate: 5|1|2024

Blair Findlay, HCCI Development Associate, rode along with Dr. Paul Chiang, HCCI’s Senior Medical and Practice Advisor and Northwestern Medicine HomeCare Physicians Medical Director, for a day of house calls. In this series, Findlay shares her experiences from that day. Read parts I and II.

In part I of this series, I mentioned how meeting patients in their homes allows house call providers to see the whole patient—not just the parts they show in the office. One patient we visited, “Quang” (the name has been changed for privacy), had just been released from the emergency room and had a serious diagnosis. Quang lived with his wife, his daughter and her husband, his son, and two children.* He was in a makeshift hospital bed behind a curtain in what was once the family’s dining room.

During Quang’s first visit with Dr. Chiang, multiple issues arose: not only was Quang’s family unaware of his diagnosis, but he was also in denial about it. After assessing the situation, Dr. Chiang decided to use a phone-based Vietnamese translator to assist. But language turned out to not be the only barrier.

Power of Attorney is a topic that frequently arises with older patients, and it can be difficult to explain, even with the aid of a translator. For example, while Quang’s son and daughter took turns bringing their father to appointments, it wasn’t clear who the decision maker was. The translator tried to convey the importance of this role and helped Dr. Chiang ask questions about Quang’s physical and mental state.

The physical state was evident based on reports from Quang’s recent hospital visit—he was in liver failure. Through the translator, Quang said he had “nothing to say” about his diagnosis. “The other doctor said I don’t have problems with my liver,” he added, via the translator.

Cultural factors came into play once Dr. Chiang broached the subject of Quang’s mental state, especially depression, which can have some stigmas. Quang refused to answer any related questions. At a standstill, Dr. Chiang thanked the translator and continued with his physical examination.

Later, after the visit, I talked with Dr. Chiang about what had happened, and he said that “although everything wasn’t resolved on that first visit, I hope we will be able to improve the patient’s issues through additional visits and building a trusting relationship with him and his family members.”

This visit showed me how important house calls are for seeing the whole patient. Culture and tradition came into play strongly during this appointment, which likely wouldn’t have been obvious in a traditional office setting. Despite the difficulties, Dr. Chiang’s respect for Quang’s culture added comfort to the visit, and in turn, demonstrated how to better care for him.

* According to the Vietnam Embassy in the U.S.: “in Vietnam’s traditional society, a typical family has three or four generations living under the same roof.” 

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