En la mezcla otra vez - Vuelvo al mundo de lenguaje

I just completed my first week in a new ophthalmology practice. In addition to meeting new people, seeing new faces and remembering new names, I quickly discovered that I had three languages on which I needed to brush up:

 

1) Plain language – the ability to explain medical jargon in clear, concise, lay terms

 

2) Computer language – in order to qualify for certain incentives, more doctors’ practices are embracing the use of electronic medical records (EMR). Unfortunately, EMRs are not universal throughout the U.S. Working in a new office means learning new software. 

 

3) Spanish language – after 8 months away from a real, live Spanish-speaking patient, the task of falling back into unstrained fluency is upon me and is daunting.

 

My first two Spanish-speaking patients were booked for standard full eye exams, so, easy to perform and easy to explain in Spanish. Neither patient had any particular pathology and neither was very talkative, so I didn’t have to worry about too much small talk ‘la charla’ while typing up their medical reports.

 

But as the days progressed, patients came in with problems. Concerns. Questions, in Spanish. And they came in with their individual accents and colloquialisms. And what I thought would be easy was hard all over again.

 

One woman had a long history of accommodative esotropia, but she didn’t use bifocals. She felt “better” when she wore distance glasses, but felt a “pulling” sensation in her eyes sometimes.

 

She had mild amblyopia.  She wanted to know if surgery could be done to improve her vision.

 

One man couldn’t remember his medications or his primary care doctor’s name. He had 20/60, 20/70 vision, refused to wear glasses, and wondered why he felt dizzy most of the time.

 

Another man asked why his eyes were always tearing. He thought it was because of his cataracts. He looked at me with an expression that indicated to me that he may not be taking me seriously. 

 

As I sputtered on and tripped over my explanations,  the patients listened to me, but not fully understanding what I was saying. I realized three main points:

 

1) When faced with giving an explanation in a second language, know what you’re saying in English first.  If you don’t know that, you won’t be able to say what you want in Spanish, either.

 

            Case in point: the White Dot Syndromes. How do you explain MEWDS to a young, healthy 22-year-old? Imagine what you’d say in English first. Think about it. Think about what makes sense. Then give your most concise interpretation in Spanish.

 

2) Familiarize yourself with the right vocabulary, and say it often enough so you’ll remember it.

 

            There are many disease states in ophthalmology that we just don’t come across often enough, for example, Susac disease, or Posterior Polymorphous Dystrophy. If we learn the vocabulary to use with one patient and never use it again, we will forget it. When you come across a less common eye problem and make the effort to explain it in Spanish, it’s worth writing down and keeping for future reference. It helps to use as a refresher when another patient with Sympathetic Ophthalmia walks through your door.

 

3) Always employ the approachable “plain language”.  ‘Side vision’ is more easily understood than ‘vision in the periphery’.

 

            Every time I see a glaucoma suspect patient, I want so badly to say, “your nerves look suspicious for glaucoma..”in Spanish, but I always forget the word for “suspicious” (sospechoso, incidentally, but after this I’ll forget if I don't use it), I lose confidence in my pronunciation of the word for ‘look’ (which translated would be the word “appear” or “aparece”). In the end, I find myself breaking the sentence down to the simplest explanation: “One optic nerve looks bigger than the other. This could be normal. This could be glaucoma.”   So choppy. So not me linguistically, at least in English. But just as the poet John Stone so eloquently put in his poem “He Makes a House Call”, medicine is what works. And so dialogue in a patient’s first language and a doctor’s second must do the same thing: what works. 

 

These are many concepts I’ve wanted to explain in Spanish, but struggled to do so clearly and concisely:

 

“It’s difficult to explain this, but the fact that your vision isn’t “crystal clear” is not all related to strabismus or the fact that you are hyperopic.  Since you have a fair amount of far-sightedness and astigmatism, and you had to start wearing glasses since 5 years of age and you admit that you did not wear them consistently, only “once in a while”, I suspect you have a level of amblyopia.  Amblyopia means that during the formative years, the visual part of the brain did not receive a clear image from each eye. This part of the brain stops forming when we are around 10 years of age.  After that, there is no surgery or eyeglass that can “force” the brain to see 20/20, when the best it can see is 20/30 or 20/40.  But  you are fortunate, because your amblyopia is mild. To be able to see 20/30 is great. Some patients with amblyopia can’t even see 20/400, which is equivalent to the big “E” on the chart.”

 

Is this plain language? Actually, no, it isn't. So why am I tripping myself up making it more difficult for myself and the patient? Maybe I should have thought about saying:

 

“Surgery cannot make your eyes see better. You did not wear your eyeglasses regularly as a child, and now the eye is lazy- it cannot see 20/20. But, your vision is still very good with your glasses. We can make the glasses a little bit stronger.”

 

“Cirugía no va a corregir la visión.  No se vestía los lentes regularmente cuando era niña, y por eso el ojo es un poco ‘perezoso’- Usted no ve 20/20. Pero, la visión es todavía muy buena con los lentes que tiene.  Podemos hacer los lentes un poco más fuerte.”

 

 

Or how about when I tried explaining why a patient’s eyes were tearing? I wanted to say:

 

“Your eyes are tearing because they are dry. I know this sounds strange (I know this is an oxymoron), but eyes tear as a reflex response to not having enough basal tears to cover and protect the cornea. I have to examine your tear film first to see for sure, but if this is the case, then likely you will need to use artificial tears regularly.”

 

But maybe I should have simply said:

 

“Your eyes are dry. They tear because they are irritated, but this is not normal tearing. You have to start using artificial tears regularly.  If you put a drop in each eye 2-3 x a day regularly, especially when you are reading, watching TV, using the computer, sewing, then the tearing will stop.”

 

“Los ojos son secos.  Están lagrimeando porque tienen molestia, pero no es lagrimeo normal.  Tiene que usar lágrimas artificiales regularmente.  Si ponga una gota en cada ojo 2-3 veces al día regularmente, especialmente cuando lee, mira la television, usa la computadora, cose, el lagrimeo va a parar.”

 

Better. I still want to use the word ‘oxymoron’ (el oxímoron, incidentally.  That can’t be too difficult to remember!)

 

Of course, the International Classification of Disease, Ninth Revision, prefers doctors speak in this type of language:

 

“You have 375.15, 365.0 and a touch of 368.03.” 

 

Statistical. Universal. Alas, impersonal.

The bottom line is that practicing medicine today is about more than simply practicing medicine.  It's about being fluent in, at minimum, three languages: the language of your patient, plain language and the software language to document the visit.  Maintaining fluency requires constant use. Language growth requires the patient encounter.

Adirondacks, NY