Learning a language is a life-long
process and for me, it means daily ups and downs. In writing blog entries documenting my experiences
working in a Spanish language patient environment, I always try to remain
positive for my readers, regarding my struggles speaking and understanding
medical Spanish and I reflect on my occasional vocabulary faux pas. Importantly, I attempt to center my focus on
how I try and overcome these challenges. My hope is that someone out there may
read my musings say, “Yes! I’ve been there too!” and perhaps gain something
from my perspective, if only the comfort
of a shared experience with another medical professional.
There are times, however, when I’m
having a particularly “bad” or “off” day in the language, when using Spanish
with my patients leaves me feeling frustrated. Consider this: I know that if I
was at native-speaking level, most of my frustrations would be moot. This is because if I was at native-level,
then speaking Spanish, or listening to it spoken, would not require any
additional effort or thought on my part. And, as such, I could get on with the
medical exam focusing only on the details of that, and not how those details are communicated.
But, the reality is that I am not at
native level, and there are days when I really have to work hard to put
together exactly what I want to say and how I want to say it in Spanish. Even at the professional level of fluency
I’ve achieved at this point in my career, there are still days when I have
trouble understanding a patient when he talks – either because of his accent –
how he pronounces certain words, or because he’s talking too fast, or because
he’s using slang or Spanish colloquial phrases I’m not familiar with.
It’s on these days in particular,
that I sometimes become agitated when I realize my office schedule is
predominantly filled with Spanish-only speaking patients. Now understand this, my anxiety comes from my
own frustrations with myself and my abilities in the language, not with the
patients themselves. When I must conduct
everything in Spanish, I know that I won’t be able to walk into an exam room
and feel completely confident, like I want to feel when greeting a patient –
because I go into translation mode, not speaking mode. I feel
a certain sense of anxiety because, though I can express myself well in Spanish
and begin my exam projecting confidence in this way, I worry that at any moment
the patient may ask me a question I won’t completely understand, for whatever
reason. It’s at that point that I will
have to let down my guard, my confidence, my pride, whatever you want to call
it, and tell the patient I didn’t
completely understand what was said, and could he please repeat it for me: “Lo
siento. No le entiendo – por favor repítalo, y un poco más despacio.” It could
be when some of you are reading this, you’re saying to yourselves, “So? You ask
them to repeat and then get on with it.” True. But I think every doctor wants
to project confidence to a patient – and this is done with medical knowledge
and communication ability. Some missteps
in communication may leave the patient feeling like he’s not being completely
heard.
If you can’t already tell, I put an
enormous amount of pressure on myself to improve my Spanish to a high degree. I
feel that is a part of me being the best doctor I can be to my Spanish speaking
patients. There are on-going discussions in the medical community regarding
whether all United States physicians should learn to speak Spanish to meet the
growing demand of patients with limited English proficiency. Some argue that
the patient needs to have enough information about his condition to make
informed decisions, and he won’t be able to if he doesn’t understand the
language the doctor is speaking. Further, medical mistakes can happen through a
misunderstanding of the patient’s true symptoms, duration, medical history, if
the physician has a limited ability to comprehend or speak Spanish.
Others argue that it shouldn’t be up
to the physician to learn Spanish, rather it should be the patient’s
responsibility to take charge of his own health care and learn to communicate
his needs to the doctor in order to get that accomplished. Though Spanish is a very close second to
English in the United States, English is still the primary spoken language, and
it can’t be expected (or even be possible) that doctors become fluent in every
language that is spoken in the country. And it’s not always convenient or
financially reasonable to require translation services at all medical
practices.
I remember one time in residency
when I was talking to a patient in her late twenties, I was using my medical/conversational
Spanish which, though it wasn’t as good at the time as it is now, was good
enough to be understood and convey meaning.
Or so I thought. At one point the
patient said to me in non-proficient English, “can we get someone else here who
speaks better Spanish?”. I remember
feeling so angry and embarrassed. I
thought to myself, ‘look, I’m making an effort at communication here, and doing
fairly well at it. Where’s your effort?’ Shouldn’t the patient make
an effort to be understood and to understand too? Am I expecting too much?
If I prescribe a medication and I
instruct a patient on how to take it, and I explain in depth that without it,
the patient can and will lose her vision, but she does not take it and hence
loses vision, whose fault is that? Is it mine? What more could/can I do? Isn’t
there a point where a patient has to take responsibility for her own health
care? Shouldn’t that involve the communication to receiving good health care as
well?
So, what is the answer?
I notice that there is an inverse
proportion between my insecurities with my Spanish speaking encounters and my
level of knowledge and experience in the language. As I have gotten more and more proficient in
medical Spanish, my insecurities and frustrations have equally decreased. My
goal in the language is that one day, it will come as naturally to me as
examining a retinal fundus with a 78 Diopter lens. I do believe that day will
come, but it is not here yet. Until then, I have to accept that there will be frustrations when attempting
perfection in a language non-native to me, and that patients can’t and
shouldn’t be passive regarding their own health care. They, too, should take an
active role in learning how to express their needs so they will be understood and understand. If doctor and patient
work together to bridge the communication gap, they’ll soon find that all
along, they’ve been speaking the same language.
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| Preko, Croatia |
