Introduction/ Literature Review
The research question that Parsons, Baker, Smith-Gorvie, and Hudak (2014) elaborated for the study sounds as follows: “In a situation of language discordance, do Canadian physicians prefer to manage emerging problems independently or seek help from language professionals?” Even though Parson et al. did not specifically study the issue of medical consent and limited language proficiency in radiology, the nature of the phenomenon pertains to the said field.
Given the complexity of radiological procedures and adverse outcomes, it is imperative that health practitioners adopt effective strategies to address possible misunderstandings. Parsons et al. embarked on a broad topic but examined it in a narrow context since they enrolled a small number of physicians from one hospital in Toronto, Canada.
The literature review by Parsons et al. provides a clear rationale for their research. Some studies in Canada showed that limited command of language among other factors such as gender and trust issues inhibited patient-doctor communication. While they compiled sufficient evidence from recent studies to prove the existence of the communication problem, the authors emphasized the fact that there is not enough research on how medical professionals deal with language discordance. Thus, the theory of language discordance in the medical field requires further development which makes the study by Parsons et al. justified and innovative in a way.
Methods/ Research Design
For their study, Parsons et al. employed non-randomized convenience sampling as they only interviewed 22 physicians working at the same hospital in Toronto. The number of participants and the sampling method imply certain limitations: the findings might be too subjective and difficult to extrapolate on broader social groups. However, the approach might as well be justified by the qualitative study design which is characterized by small sample size.
Parsons et al. conducted a series of in-depth interviews during which the physicians were asked to recall their encounters with limited English proficiency patients. After the data was collected, the authors carried out descriptive qualitative and inductive inferential analysis in order to categorize the participants’ experiences. The main variable was operationalized as communication strategies in the case of language discordance and was consistent with the literature review and the research question.
Overall, Parsons et al. succeeded in answering the research question. Based on the data provided, the researchers outlined two primary strategies: “getting help” and “getting by” – contacting other specialists or attempting to solve a problem independently. Further analysis showed that the choice of a strategy hinged on some factors such as the severity of a disease, time constraints, and availability of translation aids.
The participants were often confronted with the dilemma that Parsons et al. describe as “possible vs ideal,” and they overwhelmingly chose what was “possible” at a given moment. Parsons et al. presented the descriptive and inferential data in the form of a table and accompanied it with several paragraphs of explanatory text. The findings related to the previous research results as they proved the prevalence of the issue and the necessity to address communication barriers in hospital settings.
Parsons et al. reason that there are certain implications for clinical practice based on their study findings. When the physicians chose “get by” over “get help,” they often preferred to run more tests to mitigate risk. The concept of “mitigating risk” was found to be rather subjective: the hospital did not provide any guidelines for effective risk management. Moreover, the participants defined the threshold of problem complexity on their own: there was no consensus on when to abandon attempts to handle a problem and get help.
This led Parsons et al. to make a reasonable point about the dire need of practice standardization in hospitals and new policies on how to manage limited English proficiency patients. The authors address the limitations of the study and clearly state that the sample size was not sufficient to make the data inferential. As for future recommendations, Parsons et al. wish to test the effectiveness of different interpretation services in medical settings.
Parsons, J. A., Baker, N. A., Smith-Gorvie, T., & Hudak, P. L. (2014). To ‘get by’ or ‘get help’? A qualitative study of physicians’ challenges and dilemmas when patients have limited English proficiency. BMJ Open, 4(6), e004613.