Cultural Barriers in Urology: How Dr. Weiser Navigates Sensitive Conversations Across Languages

Eyal Heldenberg (00:10) everyone, welcome to Care Culture Talks. I'm Eyal Heldenberg, the CEO of No Barrier, AI medical interpreter for healthcare providers. Today I have a special guest with me, Dr. Adam Weiser, and we're to talk about cultural language access and learn from your experience. So welcome, Dr. Weiser, to Care Culture Talks.

Adam Weiser (00:32) Thank you very much. I look forward to our talk.

Eyal Heldenberg (00:36) Perfect. So maybe we'll start with kind of a brief introduction of yourself and kind of your journey in medicine.

Adam Weiser (00:45) So as I said, my name is Adam Weiser. I'm a practicing urologist in Columbus, Ohio, United States, 15th largest city in America and growing. which is amazing. I trained at Northwestern University.

I then went to New York for a two-year fellowship in pediatric urology and then came to this practice in Columbus, Ohio because it afforded me the opportunity to do both adults and pediatrics. As time has gone by, I've decided to do more and more adult work and less and less pediatric work. And the adult work that I enjoy is both rewarding to me as well as I hope rewarding to the patients.

I specialize in stone disease and urinary infections and dealing with voiding dysfunction, particularly benign prostate conditions in men, and relish the opportunity every day to make the lives of my patients better.

Eyal Heldenberg (01:51) Amazing, perfect. So we take this opportunity to talk with different healthcare professionals about cultural considerations with patients. And I think in your specialty, it's even more even sensitive. maybe we could start with what are the cultural considerations when discussing those kind of issues with patients?

Adam Weiser (02:20) Well, Columbus, Ohio is different in that we are still somewhat not an enormous city, but we're not small. And like the rest of the United States, we have been embracing different people from different backgrounds from throughout the world.

and they've come to Columbus to make lives better for themselves. And these men and these women come from all over God's planet. They come from Africa, they come from Asia, they come from South America. These men and women who come often have completely different cultural backgrounds, whether they be religious, whether they be ethnic.

whether they be language oriented or gender oriented, than what would be considered middle American. And when you combine this with what I do, which is very often talking about very sensitive parts of the body, we're talking about organs of the urinary system and sexual organs. When you combine all of these things, it really keeps one on his or her toes.

to make sure that your patients are best served in a respectful manner and that there is an understanding to the considerations that are different in different cultures.

Eyal Heldenberg (03:54) Yeah, yeah, yeah. combining those two, right, this diverse population on one hand and taking a very sensitive topic, like I wonder if you have like specific categories of communities, like how different cultures or regions, of different peoples look on those subjects.

Adam Weiser (04:19) Yeah, so it's absolutely fascinating. I go, for example, dealing with men who are older. Let us for argument's sake define older as 65 and above. Many of those men, for example, that are from the United States that speak English, that come from smaller communities, they won't even say the names of the sexual organs. They refer to them.

Eyal Heldenberg (04:46)

Adam Weiser (04:48) very obliquely, they'll point, they'll sometimes use a slang word, they get very flustered and won't say anything and you have to push it or pull it out of them. And then you have patients that come from backgrounds, for example, from the Middle East or from Asia that, again, they are very reluctant to talk about these organs in the same way. When it comes to women who come from backgrounds, for example,

in the Middle East or South America, they will refer to things very differently. They won't talk about their sexual organs directly, but rather very obliquely. And it can be really challenging to learn how best to communicate with these groups of people.

Eyal Heldenberg (05:43) Yeah. So in those kinds of conversations, like you as the provider kind of help them to find the words, like point to the right, like how do you do it in the room?

Adam Weiser (05:53) Yeah,

it can be very difficult and it may take more than frankly one visit to come up with what's really wrong with the person. What I've learned about this and it's difficult to do in practice, but you need to have patience with these patients because their needs are no less or greater than anyone else's, but their ability to communicate sometimes stymies their

Eyal Heldenberg (06:00)

Adam Weiser (06:23) ability to be cured or to be healed and they can get frustrated. There are so many of these men and women that can be exceedingly bright and are hampered by their inability to communicate and you just need to slow down and try to do the best that you can to get them to a point where they feel comfortable and confident enough that they can communicate with you.

Eyal Heldenberg (06:49) Yeah. this is a great advice. It comes with some time element, right? You have another patient waiting outside, but you want to invest in kind of this situation. wonder like, how do you handle this tension?

Adam Weiser (07:07) So sometimes I can't handle that tension and what I have to do is actually cut the encounter short and reschedule the patient for the next day or sometime else in the week, whatever is appropriate. But what I will do with my staff is I will come in either early or go in and put them in the first patient in the morning or the last patient of the day so that there's no barrier and so that I don't feel that pressure.

And I found that this can be rather helpful when again, it comes to these complex patients that come from different backgrounds and have an inability to communicate as effectively as they would like or I would like.

Eyal Heldenberg (07:50) This is a great, another great advice. Basically you say if, you know, if it's an outpatient clinic settings and if you already know that the patient has, you know, different needs, so try to make the schedule more aligned with the patient needs either in the beginning of the day or the end of the day. This is a great insight. You mentioned that gender wise, like sensitivity. I wonder if you also saw like age related.

sensitivities across different cultures when it comes to your speciality.

Adam Weiser (08:24) Yeah, I've noticed, for example, we obviously chaperone, anytime we do have a chaperone, anytime we have an examination with a female. But depending on the age, some of the patients will frankly refuse for me to examine them because I'm a male and will only want a female to do this. it's sometimes again that requires

moving around and finding one of my partners who is female to come into the room and do this. And you again need to be respectful because you want to help the patient and you want to make sure that he or she has a good experience.

Eyal Heldenberg (09:09) Yeah, yeah. So, you know, using other medical staff that are, you know, more gender appropriate or relevant to the situation is another, I wouldn't say burden, but another complexity in the workflow, but you feel you need to do it in order to get the patient the degree of, you know, the level of care you want, right?

Adam Weiser (09:29) I believe that you do. The expression is, is when in Rome you should act like being like the Romans. But let's face it, that's impossible to happen overnight. We're all different. And slowly over time, we hope that our cultures assimilate and we learn and take best practices from every culture. But there are some things that are distinct and I try to remain very respectful when it comes to acknowledging those differences.

Eyal Heldenberg (09:58) Yeah, totally. All right, perfect. So let's go into the room, into the medical encounter, right? You know, different providers use medical translators or other. I wonder if you could guide us through different resources that you used or using in your career to navigate those language barriers.

Adam Weiser (10:25) So I've used a few different ones depending on the set the site of service. So it used to be at least where I was practicing most of the patients you needed to speak Spanish and there were some exceptions. And what started is when you needed a translator you would find someone on the staff of the hospital that spoke that language. That evolved to having a more professional cadre of having

language interpreters, but the problem became we were more and more diverse. So not everybody spoke Spanish that came in. Not everybody spoke Mandarin Chinese. And over time, the ability to staff this with people who could speak the language appropriately became limited. So someone very cleverly came up with something called a language line.

And the language line was exceedingly cumbersome because in the beginning at our hospital, before cell phones, you would have to literally get a special phone that had two receivers and they would plug it into the patient's bed or plug it into the clinic room and you would communicate. There wouldn't be a wall between you and the patient, but you were speaking through a headset like a phone.

into a machine and there was another person on the other end and then that other person would eventually talk and there was no ability to use any sort of visual cues because that other person couldn't see what you were doing they couldn't see if that person was tense that you were talking to and so it was difficult the body language that was problematic then we had an explosion in technology Apple came out with an iPhone and

all of a sudden the world changed in a very positive way. And after the iPhone, the iPad became ubiquitous. And through those things, we had interpreting services where you would use an iPad, for example, and you would find a translator from a particular country or particular language, or you would do this over the iPhone. When that couldn't be reached, when you could not do that, they didn't have

a person who spoke Nepali, for example, we would go to use Google Translate. And Google Translate is miraculous, except it's not trained in medicine. It's exceedingly clumsy, and it was very difficult to communicate effectively. And so consequently, we would have a lot of problems with communication. And I don't think that we've yet hit on that

perfect solution yet for these conversations with patients. But these conversations are not going away, they're increasing, and we need to have a better means of communicating.

Eyal Heldenberg (13:30) So basically you say technology has progressed, there are more solutions, but providers sometimes find themselves navigating, especially on the long-tail languages, maybe off-hours, but there is no 360 solution that you feel is in place right now, but hopefully most of it has some kind of solution.

Adam Weiser (14:01) Absolutely, I think that the technology is breathtaking and we've only begun to harness all of the wonderful things and changes that are going to come from the technology. It's going to help us a lot, we're not, at least to what I've had to use, we're not there yet.

Eyal Heldenberg (14:13) Yeah, yeah, yeah.

Got you. Yeah, totally. What about a kind of, I would say, patients where you need to explain, because in your specialty, there are many body parts and very complicated systems. I wonder if you have something around this educational part.

Adam Weiser (14:33) Yeah.

So, I personally feel that verbal communication is not enough in what we do. Most of us, frankly, whether you're educated in the US and speak English, or whether you are someone who comes from Denmark and speaks Danish, or you're someone who comes from Somalia and speaks Somali, most people are not educated in the human body, in anatomy and in physiology.

And most people when confronted with anatomy and physiology, especially of the genital and the urinary system, they become embarrassed, they become reclusive. And I try to use drawings, visual illustrations to explain things. And I try to work and to draw pictures and allow the patients to see what it is that I'm trying to see.

I try to use CT scans and MRIs and try to explain these things. And that can sometimes be a challenge again when you're communicating with someone who doesn't necessarily speak English or understand the human body very well.

Eyal Heldenberg (15:53) Yeah, it's even complex in English, right? Like it's complex in English. So now add another obstacle and it's getting even more complicated. yeah, so I guess visual aids and any kind of visual resource that could help to educate a patient is a general good advice. All right, perfect. So I wonder if we can discuss a bit about

cultural competency of the providers, like how can we improve? I know that we have, you know, sometimes a training and, you know, courses around that. So I wonder like, what's your take on the general cultural competency providers should have?

Adam Weiser (16:42) Yeah, my personal bias in terms of cultural competency is that when physicians and other providers are given mandatory cultural competency, many, if not all, roll their eyes and say, my gosh, this again. What I think the message that needs to be distilled down is that we need to understand that we come

from a very, very diverse part of the world now because the world has shrunk and that people are coming from all different corners of the world. They don't necessarily speak English. They don't necessarily have the same religion. They don't have the same politics that we have, but what we need to do is be respectful. We need to take the time to learn about other cultures. We need to be open-minded and...

I don't think that any class can teach you those things. You need to have it in your heart to do those things. And when you start to encounter these patients, you need to be able to just keep that in mind, take your time, and learn. And I've learned many things from these patients, and I hope that they've learned from me in their journeys to get well.

Eyal Heldenberg (18:02) Yeah, I would say that maybe another motivation around it is maybe it's kind of a soft skill, but it can be that you would have a better care for the patient, right? kind of the patients that you get the time that you take and kind of so it's kind of everything kind of goes to a better, a better care, a better kind of a better standard of care.

in a sense. it's coming from the soft area, soft skills, but should

Adam Weiser (18:35) I think when you have things, for example, someone who needs imminent surgery or someone that has a difficult problem, let's say cancer, something that's life-threatening.

They're scared and it's worse when you can't communicate because you don't speak the same language. And when they see that I've made the effort, when they see that I am trying, I really believe that it is a soft skill. Those patients trust more and they believe more and they get better because they feel that the person that is working with them and working on their behalf

Eyal Heldenberg (18:59)

Adam Weiser (19:16) cares about them and doesn't look at it as, ugh, this is just another notch in my belt, but rather someone that really is respectful and embraces the differences and wants to, in spite of those differences, make this person well. So I think it's invaluable to do it.

Eyal Heldenberg (19:37) Yeah, you hit a very good point. It boils down to trust, right? If you don't have it, we cannot ensure anything basically around the treatment. If you do the effort as a provider, most likely, or there is a good chance that you bring trust to the table, like the patient would see the effort and would...

be more open and more sharing and more willing to collaborate with the provider.

Adam Weiser (20:12) Yes, I agree.

Eyal Heldenberg (20:14) All right, perfect. So maybe kind of more on the stories from the frontline. I wonder if you have any kind of a miscommunication story, cultural misunderstanding, something that you remember from your career.

Adam Weiser (20:30) Yeah, I had a woman who unfortunately had a surgery. The surgery went wrong. Another provider had done it and there was her ureter, which is the tube that drains the kidney to the bladder, was transected and this was found after the operation. So she had been admitted to the hospital. She wasn't doing well.

She was awake, she was conversant, and the diagnosis was made and I was called as a consultant and I'm going to have to operate on this woman. Problem is that the woman only speaks Aramaic. My Aramaic is not very good, in fact it's in fact it's non-existent. So I go and I bring, diligently bring the iPad and I connect to the service and ask for an Aramaic interpreter.

and I get the Aramaic interpreter and I introduce myself and we start to speak I to the interpreter, she to the interpreter and then the woman looks at me and she knows enough English to say to me “I do not know what he is speaking. It is not Aramaic. You should not pay him.”

And that is what she said. And so we ended up having to find someone else that was able to actually speak Aramaic so that I could explain, your ureter is transected. We're going to need surgery to reimplant your ureter. You're going to have a stent. And once I had this person with the drawings and with a family member who spoke English as well as Aramaic, all of those things together, we were able to...

get the job done and everything worked out beautifully and she healed fine. But it was rather funny when she said this to me. I was amazed.

Eyal Heldenberg (22:39) Yeah, this is fun. wonder like, when like, the interpreter should like, should he kind of said, hey, I don't know what's going on, but at least the patient was had enough.

Adam Weiser (22:53) Yeah, it was to me one of the funnier experiences I've ever had with this.

Eyal Heldenberg (23:01) All right, perfect. So I think there were great tips Kind of wrapping up, what do you think, like, what's the vision? Like, how can we improve the language access and cultural communication in your special care and maybe in general, like your final kind of thoughts around that?

Adam Weiser (23:24) Again, my final kind of thoughts are that the world has gotten smaller. We have people from all over and we need to take the time to really be able to communicate effectively and to break down barriers. And we need effective tools in order to help us to understand their problems and understand the complexities of their issues in light of

having a different background than perhaps that I have. What I feel with all of this is you need to be patient, you need to be open-minded, and you need to understand that you may not necessarily get the answer the first time, just be persistent.

Eyal Heldenberg (24:10) Yeah, Great advice and great takeaways. So thank you very much, Dr. Weiser, for participating in Care Culture Talks and see you all in the next episode. Thank you.