Overcoming the Language Barrier
For patients diagnosed with a complex medical condition, maneuvering intricate medical language and treatment options can be a daunting task. It can be even more challenging, and frightening, for patients who do not speak the same language as the medical professionals who are providing their care.
Terrie Flatt, DO, MA, a pediatric hematologist/oncologist at Children's Mercy, discovered this first hand while studying in Mexico as an undergraduate. He was visiting a rural area and became ill with a parasitic infection. As he sought treatment at a local clinic, the communication barriers he encountered created a stressful situation.
"I was just starting to learn Spanish and none of the doctors or staff spoke English," Dr. Flatt said. "They were starting IVs and giving medicine, and I didn't know what was going on. Even though it was not a serious diagnosis, I felt I was in a situation that was completely out of my control, and I didn't have the ability to say ‘yes' or ‘no' to a treatment plan. As my career in medicine has advanced, I've grown to appreciate that experience at a very different level."
The experience had such a profound effect on Dr. Flatt that when the opportunity presented itself in 2012, he developed the Children's Mercy Spanish-Speaking Hematology/Oncology Clinic. The goal of the clinic is to address the special needs of the Spanish-speaking community. Dr. Flatt draws on his medical training and background. He has a master's degree in Latin American Studies from the University of Texas, Austin and taught university-level Spanish. He also incorporates his experience from living and carrying out research in Latin America.
"The foundation of what I do is to make sure families and patients are always communicated with in a culturally appropriate way," Dr. Flatt said. "I want patients and families to feel they will always be a partner in making decisions that can be life changing. I believe the only way that can happen is by establishing a relationship with them."
Of patients attending the clinic, nearly three-fourths speak only Spanish, making Dr. Flatt their direct-care provider. As with all oncology patients, they are seen often. However, in this population, all their medical materials are bilingual. This includes medication sheets with dosage and warnings; fact sheets with contact information; diagnoses and medical information for emergency situations; plus calendars for medication, appointments and procedures.
Two additional goals for the future include the use of telemedicine to help monitor and direct treatment for long-distance patients; and second, to create a support group so Spanish-speaking families can connect for social interaction and education.
The incidence of acute lymphoblastic leukemia is approximately 15 percent higher in Hispanics than Caucasians and the overall survival rate is lower in this population. Consequently, Dr. Flatt is organizing a research project to investigate whether genetic differences in leukemic cells play a pivotal role in these statistics.
"During the last few years there's been a lot of forward thinking in terms of whether there are differences in the cytogenetics of an ethnic group's leukemia cells," Dr. Flatt added. "Our research might give us clues about ethnicity and what it means to leukemia. We could also learn if patients with certain genetic make-ups may need more intense therapy, or a new type of drug."
Children's Mercy is establishing a relationship with a pediatric hospital in Mexico where genetic samples from various tumors can be shared. Using laboratory resources here at Children's Mercy, Dr. Flatt's research collaboration will seek to understand the genetic differences among children diagnosed with leukemia.
"If we find something new, this could become part of our routine testing in the future," said Dr. Flatt. "Thirty years ago we didn't look for certain cytogenetics characteristics, and now we always run routine panels as these can guide treatment decisions. We're making amazing strides, and this could help us attain even better cure rates."
 
Terrie Flatt, DO, MA, was inspired to establish the Spanish-language Hem/Onc Clinic at Children's Mercy after he personally experienced the challenges of receiving medical treatment when a patient and provider speak different languages.
Dr. Flatt's work has been recognized with honors such as the Hyundai Hope on Wheels Pediatric Cancer Scholar Grant Award earlier this year, and he was a recipient of the CMH 2012 Kaleidoscope Diversity Award.