Introducing MediComms

Imagine this: you’re getting wheeled into the emergency room in a foreign country with a life-threatening medical condition, but as soon as you see your physician, you hesitate to get your words out to him/her. You desperately gesture to where it hurts, but the doctor has no idea what you’re saying. You two speak completely different languages. This is your worst nightmare: not being able to communicate when you most need it. So, what do you do?

Image courtesy of Healthline.

Every day, non-native speakers encounter this situation in which they aren’t able to effectively communicate with their medical provider, both in the emergency room and in a routine medical checkups. At times, these individuals resort to in-hospital or familial translators to convey their medical problems in their clinical visits but at times, meaning is lost in translation. For example, doctors may not fully understand and could even misdiagnose a patient without his or her proper family history. On the other hand, patients may not be as compliant with treatment without truly understanding why they are undergoing such a remedy. So what exactly can we do in a situation like this, in which language is so integral in ensuring the right treatment plan for the patient?

Our inspiration came from the fact that we all have to go see a medical practitioner at one point or another. How can you ever avoid seeing the doctor, especially if you need to go to your yearly check up? Along the same line, if you don’t speak the native language well, how easy would it be to communicate complications that arise as part of your medical treatment? So, most people have experienced miscommunication or misinterpretation at one point or another when attending a check up. Our goal is to mitigate or even prevent this issue from arising in the future, and even make healthcare more streamlined and efficient for future doctors working with individuals who may not be native to a certain country that they live in.

To begin researching how we could potentially help individuals who might encounter miscommunication issues in the doctor’s office, we began with two different research methods: interview questions and fly-on-the-wall observations. We wanted to see what issues each and/or medical provider might find when communicating with each other. However, we realized that for fly-on-the-wall, there were potential issues with HIPAA regulations that may restrict us from getting information from doctor’s visits, since using the research method fly-on-the-wall would have required us to sit in any individual’s medical appointment and potentially listen to confidential data. So, early on in the research process, we dropped the idea of using the fly-on-the-wall research method.

On the other hand, interviews were extremely effective for gathering data on one-on-one interactions between patients and their doctors; patients and doctors were the two most involved groups in the problem we were researching. While we were not necessarily focusing on the University of Washington population, our sample population was limited to that area. Also, while we were focusing on non-English speaking patients, it was hard to find that subset of the population. But while going to the University of Washington, we knew that a large number of international students frequented the school. So naturally, our first intention was to interview some students who had a similar background. We interviewed medical practitioners around the university. We also interviewed a mixture of students (who doubled up as patients) who spoke English fluently and also did not, and asked about miscommunication issues in the doctor’s office. For future research, we would definitely like to expand past the population of just the university and into Seattle and the surrounding areas.

The University of Washington — Image courtesy of Millicent Li.

Patients and their families are the biggest stakeholders of our research. If anything unexpected occurs as a result of any miscommunication issue, the patient is most at risk. Given we have scoped a medical problem, any potential mishap could cost the patient’s life. Consequently, the patient’s family would also be affected from any suffering the patient endures. Indirectly, doctors and hospitals could also be at stake. Given a worse case scenario, doctors and hospitals could be sued and lose credibility for providing acceptable medical services. Multiple stakeholder groups is another reason why we have chosen to focus our design research on alleviating any issues that may come up from communication issues between the patient and medical provider.

We focused on two interview groups, the patient and the medical provider.

Patient group:

● Eliza: Eliza is a student at the UW who was born and raised in Washington, specifically Everett, where the population is fairly diverse. Her parents are from Taiwan and Thailand, so she has a multicultural background.

● Uyen: Uyen is an international student from Vietnam who has experience with a wide array of medical providers due to having moved to the United States in her teen years.

● Jack: Jack is a white male who participates as a board member of the Interfraternity Council. He has made multiple visits to the UW clinic here on campus near the HUB.

Healthcare provider group:

● Jenny: Jenny is a nursing student at the UW who was born in China but raised in the United States. She’s familiar with working in retirement homes in the Seattle area, working with elderly individuals of a wide range of backgrounds. Also, since ten years old, she’s supported her parents in taking them to and translating for their medical appointments.

● Ray: Ray is a third year medical student at the UW who is native to the United States. He has significant clinical experience from premed and medical school at the local UW Medicine clinic.

● Amy: Amy is a second year nursing student at the UW who was born in Korea and lived in central Washington for a majority of her life. She has worked with in-patient clinics in Ellensburg, WA at KVH Family Medicine.

We focused on finding a wide array of individuals to interview since we wanted a wide array of opinions on how communication is facilitated in a medical appointment, and we also felt that this would help us determine the central issue regarding what makes communication less understandable, both for individuals who may not be native speakers and also for individuals who may be native speakers.

When starting our design research, we wanted to focus on language as a tool between two different parties and how this tool could be used to facilitate communication.

In our design research, we discovered that both medical professionals and non-English speakers knew that there were differences in understanding each other, but these differences were difficult to fix. While simple things such as booking an appointment weren’t deemed difficult by our results, medical appointments are considered a challenge between both parties partially due to cultural bias, which we ultimately sought to address when beginning this design research.

Cultural bias, according to Wikipedia, is the phenomenon of interpreting and judging phenomena by standards inherent to one’s own culture. This bias can lead to doctors misdiagnosing patients or patients not understanding their treatment plan. For example, if the provider is a cisgender, middle-aged white man, he may not understand what health problems might plague a minority who is, say, has African roots, since minorities (including individuals with African roots) tend to have a higher chance of heart disease due to their background.

Confused? We are too. Image courtesy of Isha Sadhguru

In addition, the confusion seems to be centered around confusing medical terms and a language barrier (translation) between both parties. Throughout our research, we’ve seen patients be non-compliant with medical instruction as a result of either misunderstanding the treatment lingually or culturally. To get around this barrier, we’ve also seen patients use non-verbal cues (hand gestures or pointing to body parts, doctors using alternative language, etc.) or having an English-speaking family member around to translate being common.

We’ve noticed that these non-verbal methods for communication work well enough to convey a general understanding, but past a general understanding, language is far more necessary than not. From a language standpoint, individuals seem to find the most confusion through terminology that’s fairly niche. For example, who really knows what hypoplasia or neurofibromatosis might be in Spanish?

In order to address both cultural bias and this confusing medical term barrier, we tried multiple prototypes. Our original design focused on two aspects of the patient to medical provider relationship: translation and cultural bias. However, we found that covering these two different areas would be too spread out, and difficult to fully cover. We realized that our focus should be on the bigger picture of communication issues between two parties. So, our proposed design focused on helping to alleviate translation and miscommunication issues.

Tactile and pictorial channels — Image courtesy of msjbutterfly

First, we looked to engage with other solutions that were non-verbal. The ideas we came up with came from two different channels: either tactile, or pictorial. These two ways mingled with communication differently than what we’d seen in our interviews with both patients and medical providers. For example, in pictorial representations, patients could point to specific drawings and it would be fully understandable. With respect to tactile representations, touch could be interpreted in many ways, for example through braille.

However, we later thought that, if we didn’t find ways to suppose traditional translation, how could we possibly design for a population that relies mostly on peer-to-peer translation? In addition, how could a pictorial and/or tactile technology option cover all confusions a patient may have, including specific medical terminology? So, we opted to focus on a more robust and multifaceted design for translation and communication.

Our Final Design

Our new proposed solution focuses on the practical issues that may come up during an actual visit at the doctor’s office. Firstly, we know that there is usually a large amount of preparation between the patient entering his/her/their appointment and then the actual appointment at hand. A lot of translation required for this part. For example, a nurse initially gathers the patient information at the beginning of an appointment, so there would need to be a way to quickly do so in every doctor’s appointment. We thought that such a solution should be static in any number of appointments and relatively easy to explain to the user. We started with a few scrapped designs, those of which are listed here:

Automated Appointment Scheduling Prototype
Remote Vitals Monitor Prototype

However, these designs were a bit too specific to a certain action and the technologies used may be too unfamiliar to the user. We then pivoted. We sought to use technologies that individuals were already familiar with, and so we immediately thought of some form of a web application. However, we needed a way to display whatever application we chose to use in a larger screen than just a computer screen. So, we opted for a relatively common option: an application with a projector. Our storyboard notes our design here:

MediComms storyboard

Our design would project an application onto a blank screen in the doctor’s office. Then, we could show English and the patient’s language they’re familiar with, along with a vocabulary bank that could highlight unfamiliar medical terminology. This way, we would be able to incorporate both a pictorial and translational representation in the final design. Firstly, both the medical provider can show the text that he/she is saying, in addition to pointing to the image of the words. In addition, the patient and/or medical provider can also read the translation in real time if there isn’t a full understanding from either party. This solution would be simple to use and intuitive for both the medical provider and patient to communicate between each other. With this technology, we’re hoping to alleviate any struggles that might come up between patient the doctor and to facilitate medical treatments more easily.

There’s so many more issues to address in the sphere of translation and mitigating misunderstanding in the medical area. Hopefully, our goal is to continue facilitating this design to hopefully bring our ideas to life, eventually. One step at a time, we’ll make it through.

Thanks to all who’ve supported us this far, and hopefully, we’ll continue getting more support along the way to complete our design journey.

Designed by Khai Tran, Kevin Te, Millicent Li, and Mark Mirador, who are all HCI designers

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CSE 440 Staff

University of Washington Computer Science, Intro to Human Computer Interaction