Journal 07-26-2011
I have been so very spoiled by VS site where almost all patients are well educated and came in during their first trimester. So I have been experienced well structured counseling sessions. Today in HR, things were different.
The couple I saw came in at 22wk5d of pregnancy. They had no screen test. U/S showed short femur and echogenic focus in heart, indicating the baby was at higher risk for DS. My job was to taking pedigree and talk about amniocentesis in addition to age related risk.
First of all, their body languages were funny. The girl placed her chin on her shoulder bag sitting on the table. Her husband, instead, sat back and held his arms in front of him. The girl spoke in a soft voice with Southern accent so I had to lean toward her. Even so I missed the fact that she never knew who her father was. So when talking about her parents, I said “your father is still living, is he in good health?” since she told us her mother passed away. This seemed not a huge mistake. But when I asked her ethnic background, she paused and seemed confused. My first reaction was I didn’t state my question clearly enough so I rephrased my question as “what country your ancestors came from?” She said Africa. When it was her husband’s turn, I tried to make eye contact with him but he seemed no any response. Then I wanted to make my question clear and easier to understand, so I asked him “are you also from Africa?” he said yes. Then the wife said “you have Puerto Rico background.” The man seemed very upset and talked to his wife “is it because I am black so I am from Africa? I know nobody in Africa.” I didn’t remember anything else he said sort of emotionally. XXX jumped in and explained that the reason we asked the ethnic background is only from medical standpoint. He said to his wife “I know what they meant. Do you think you are from Africa? … (I don’t remember others).” He talked to his wife. But I felt he was actually blaming on me.
I felt extremely bad about the situation. I intended to make things clear but the outcome seemed I was judgmental based on his skin color. And what’s more, I put my supervisor at an uncomfortable situation. I talked to Joanne after the session. She didn’t think it was offensive but people have different preference. Some want to be called AA, some prefer black.
Later when I talked about amniocentesis, I made eye contact with him several times, he never responded. He only held his posture from beginning to the end. Obviously his wife had no idea what to do next, amnio or not. He said to his wife it was up to her. But he thought those were just risk, and numbers, which could be wrong. I felt he was strongly against amnio, especially when he knew it is a boy, given the fact they have 3 girls already. Only when the session was approaching to the end, I felt he was very aggressive and dominant. I tried to get him involved, though failed.
I think my question “are you also from Africa?” is really inappropriate. I did define his ethnicity based on his skin, although my primary purpose was to make things clear. But he could be very different from his wife. I was taken as Korean or Japanese many times. It never bothered me since I know people can’t distinguish among Asians. But this is only my thoughts. People are different. Some are more sensitive than others. As a GC who delivers service, the best way is to adjust my strategy instead of asking patients fit me. In this case, I let my own worldview block my performance.
