Two tongues

It’s not unusual to have multiple family members in the room when I’m examining a patient.  Sometimes a grandmother will be accompanied by her daughter and grandchild.  Sometimes a husband brings his wife.  Sometimes, a mother comes with her child and her sister.  But multiple family can be multilingual.  Some may speak Spanish while others know only English or are fluent in both languages.  This can present a special challenge to the health care worker—who to address? –and how?

A woman brought her 10 year old daughter in to see me at the advice of her daughter’s pediatrician.  The young girl had been rubbing her eyes at night when watching TV.  In addition, evaluation of her vision at the pediatrician’s office revealed poorer vision right eye vs. left.

I could hear the technician getting the patient’s medical history and checking her vision in the next room and she was talking to the mother in Spanish and the daughter in English.  I find these situations sometimes awkward, because I am not always sure how I should introduce myself and address the patient and family for the entirety of the exam. 

Do I walk in speaking Spanish?   “Hola, Soy Dra. --. Voy a examinar su hija hoy.”

Do I then conduct the whole exam, including diagnosis and explanation, in Spanish?

Do I walk in speaking English?  “Hi, I’m Dr. --, I’m going to examine your daughter today.”

Do I then conduct the whole exam in English?

Do I address the daughter and the mother in two languages, English for daughter, Spanish for mother?

I use the word “awkward” because my goal is always to make the patient and family feel comfortable.  People feel comfortable with their doctor when they can understand their doctor, and when they know their concerns are being heard (and understood) as well.

In this particular case involving a minor, even if one doesn’t factor in languages, I prefer to address the parent/guardian involved, at least initially.  Usually the child will know the parent’s tongue and be able to follow along, but this is not always the case. Here, when I addressed both of them in Spanish, I could tell there was some vocabulary the daughter didn’t understand, and further, she did not know the letters on the Snellen chart in Spanish.  So I actually used a little bit of both:

Me: Hi, I’m Dr.--, (smiling at child and mother), which is better for you—English or Spanish?

Mother: Para mi, español, pero para ella, inglés o español. Ella sabe las letras en inglés.

Me: Está bien. (addressing both child and parent) ¿Entiendo Uds. están aquí porque el pediatra les dijo la visión es borrosa?

Mother: ¿Borrosa? No—por la noche cuando ella mira la televisión, está frotando los ojos constantemente.

Me: Ahh, (turning to the daughter) ¿cuando miras la televisión, tienes picazón en el ojo?

Daughter (to mom): ¿Qué?

Mother:  ¿Tienes picazón? ¿Alergias en el ojo?

Daughter (shakes head no)

Me: ¿Te arden los ojos?

Daughter: No.

Me: (to daughter) ¿Los ojos están lagrimeando? (to mother): ¿Ve Ud. que sus ojos están lagrimeando?

Mother & Daughter: No.

Me: (To mother): ¿Ella no está tomando medicamentos y no usa gotas para los ojos?

Mother: No.

Me: OK, vamos a ver…(some minutes later). Bueno, ella tiene ojos saludables. El nervio óptico, la retina, el lente—todo está bien. Pero, es posible que, cuando mira ella la televisión, el ojo se seca, y es por eso ella está tocando los ojos.

Mother: OK.

Me: Me gustaría darle a ella lubricantes—gotas artificiales los que puede poner en sus ojos cuando ella mira la televisión. Y, otra cosa, la visión está bien. Con los dos ojos, ella ve 20/20, pero el ojo derecho es un poco mas débil comparado con el otro. Es porque el ojo tiene poco miopía. Ahora, no significa nada y no necesita lentes. Pero en mi opinión, ella debe regresar aquí cada ano por un examen de los ojos a determinar si ella necesita lentes o no.

Mother: Está bien. Gracias.

And the exam went well, the conclusion here being that in situations where the patient and family may not be on the same page linguistically, the best thing to do at the onset is to ask what they prefer and tailor the visit to those particular language needs.

One recurring theme you will find in this blog is the fear of looking or sounding foolish when trying to communicate in a non-native language.  I am always thinking in the back of my mind when I talk with  patients in Spanish, Did I say that right? Did I conjugate wrong? Am I verbally butchering my assessment and plan??.  I worry so much about how I sound, that I don’t stop to think about how tough it must be for the mother in the above scenario.  Here,  her daughter is easily conversing with a doctor in a language non-native to her.  Though the mother may know basic English, she doesn’t use it because she may also be anxious about appearing foolish. As in, how can she know less than what her young daughter knows? Being sensitive to these issues is equally as important as diagnosing and treating the medical condition at hand—and your patients will truly appreciate you for it!

Courtesy: D.Hromin