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Originally published: Common Sense
Several weeks ago, I finished my first year of medical school and began the arborous drive from Kansas City, Missouri, to California for a summer research position. When I was just six minutes away from my destination, my car of 21 years decided to break down. It is important to note that I am studying in the United States as an international student from Canada, and despite growing up as a neighbor from the north, much of the U.S. and its various systems are foreign to me.
As midnight approached and the smoke started billowing out of the front bonnet, I found myself pulling off to the side of the road in a city unfamiliar to myself. I quickly took all the essential paperwork from my vehicle – F1-student visa, passport, insurance papers – and found a rock a safe distance away, where I proceeded to call my parents and quickly realized how clueless I was in navigating what to do next.
The following day, in the early hours of the morning, a tow truck transported my car to the nearest dealership, where the diagnosis was made that I had injured the radiator driving through an extreme heatwave. The vehicle's internal damage wasn't worth the cost of repairs, and so began the days of paperwork and arduous tasks to find a new car. Much of this headache included learning about the processes trying to purchase a vehicle as an international student, surrender my Canadian license plate, change insurance companies, and finding a way to scrap an unwanted foreign car with an odometer tainted in kilometers rather than miles.
What is considered common sense to someone from the United States is not what is considered to be general knowledge to someone international. Having to explain why I did not have a social security number and uncovering the process to obtain one proved to require more effort than some of my classes in medical school. I had to do the research not only for myself but also for those attempting to help me. In uncharted territory, stuck in an endless feedback loop of frustrating conversations, I couldn't help but think of the ironic similarity to the U.S. healthcare system.
If I had an accident and end up in the emergency room, I wouldn't even know what would be considered good practice. Do I have to pay before you treat me? Yes, I have insurance, but what does that mean? Am I supposed to learn about this in medical school, or does it come naturally over the years as you spend time in a hospital? When do these essential details become common sense as I continue on the trajectory from student to doctor?
As I advance in my medical training, I have good faith that I will slowly learn these various processes; however, I often question how disorientating this might seem to a patient unfamiliar with a country's medical system. How often do they experience distress and uncertainty due to a lack of knowledge that others have subconsciously acquired by growing up within the U.S.? It was reported in 2018 that more than 44.7 million immigrants lived in the United States.1 Although I am not an immigrant per se, I would speculate that this would indicate that there is a sizable population just as lost and confused as myself when it comes to navigating these systems both within and outside of healthcare. My car experience taught me that despite English being my first language, being well educated, and growing up in a country that is arguably culturally similar to the United States, I still had an element of vulnerability. Most of the newly-discovered tasks I encountered seemed like a different language and left me feeling like I didn't have full control of my situation. Taking into consideration a patient's perspective, I can only begin to imagine how troubling this must be, especially when we start to consider differences in language, cultural, and past experience regarding medical care.
We are taught as medical students not to use medical jargon when communicating with standardized patients. This rule is implemented so that we don't overwhelm the patient with words that they may not understand; however, I never considered that even if everything was explained in lay terminology, the process may still not be intuitive. As physicians, we need to consider this as a part of our efforts better to improve immigrant status as a social determinant of health. It has long been established that immigrants have higher morbidity and mortality rates than their non-immigrant counterparts. These poorer health outcomes can be attributed to various factors such as lower English proficiency, socioeconomic status, marginalization, and inferior treatment on behalf of the practicing healthcare personnel.2
It is often overlooked that navigating a system unfamiliar to oneself can be intimidating, and this can be a deterrent when seeking treatment, leading to less access to care. This experience has taught me the need to be respectful, patient, and empathetic with our communication as a healthcare team because what may be common knowledge to one person isn't necessarily common knowledge to another.
- Batalova J, Blizzard B, Bolter J. Frequently Requested Statistics on Immigrants and Immigration in the United States [Internet]. The Online Journal of the Migration Policy Institute. 2020. Available from: https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states
- Derose KP, Escarce JJ, Lurie N. Immigrants And Health Care: Sources Of Vulnerability. Health Aff (Millwood). 2007 Sep;26(5):1258–68.