A case based reflection on communicating end of life information in non-English speaking patients.

Mr X was a 56year old Chinese man (non-English speaking), who presented to the emergency department with a range of non-specific symptoms. On full workup, he was diagnosed with an advanced cancer of the pancreas. It was an aggressive, highly treatment resistant cancer, with an alarmingly poor prognosis. Before the diagnosis had been made, the family had informed our team that we were not to discuss medical issues with Mr X directly, and that upon arriving on a diagnosis we were to come to them first and they would subsequently inform him. They reported that Mr X was in support of this arrangement. Eventually we told the family about Mr X's diagnosis, and they asserted their collective will to keep this information from him, reaffirming that all medical discussion go through them. However, the doctor in charge explained the diagnosis to Mr X using an interpreter while his family were away from his bed. In this discussion, I consider this case from the perspective of respecting patients' and families' preferences around medical treatment and care.