The following is a recent submission I made to the 2015 Medical Economics Physician Writing Contest. It is a medley of concepts that I addressed in previous blog entries, regarding my personal experiences learning and using Spanish language with my patients. I personally believe that physicians in the U.S. are very divided on this topic - whether or not they should learn a non-native language to communicate with patients. The fact remains that while doctors debate what language they should be speaking in, a large and growing faction of patients need medical care now, and only have their language to communicate in. That being said, efforts need to be made by medical professionals to work with patients to meet this need. In my opinion, nothing achieves this more effectively and personally than conversing with and treating a patient in his native tongue.
“I can talk to you.
You understand me. For me, this
is the most important thing.”
There is the old adage, that when making a first
impression we should put our best foot forward.
As a physician, I want to put my best words forward as well. How we speak and communicate with patients
makes all the difference in their understanding of their diagnosis and treatment. It encourages compliance with the treatment
because good communication inspires patient confidence, both in the plan of
action and importantly, in the doctor.
Sometimes, we take this communication ability and
the importance of it for granted, until we’re faced with having to speak and
examine a patient in a language non-native to our own. Today I can say that I am bilingual, but this
wasn’t always the case. I grew up in an
English-speaking household and did not begin studying my second language of Spanish
until my early high school years. This
journey, from basic conversational vocabulary to medical terminology and
ultimately, conducting full ophthalmology exams in Spanish, has not come
without great effort and difficulty, satisfaction and frustration, on my
part. In my own experience I have found
that it is not enough to simply know the medical words and translations. It’s not always what you say, but how you say
it. In Spanish, I can get my point across
to the patient, but exactly how am I doing it?
Is my word choice poor? Is my sentence structure sloppy? Am I speaking more like an automaton and less
like a human being? It is this finesse, this articulation, that makes
confidence exude from our words, and we take this for granted in our primary
language. In Spanish, how do I know with
certainty that I’m “saying it right” and how do I know for sure that the
patient hears what I say?
I recently examined a patient in my office whose chief
complaint was irritation in both eyes.
The exam revealed an aqueous deficient dry eye, the diagnosis and
treatment of which I thoroughly explained to him, in Spanish. He asked questions, I answered. Then he said:
Patient: “Your Spanish is good. Were you born here?”
Me: “Yes, here, I was born in New York. Thank
you. But it’s not perfect, I have to practice more.”
Patient: “Yes, well, your Spanish is good. For me,
English is very difficult.”
Me: “It can be difficult, learning another language.
Particularly because the true learning comes from using the language regularly,
every day, as part of your daily life.”
Patient: “There was a time, when I was working as a
painter, when I knew more English than I do now. But at home I never used it,
and now, so many years after retirement, I have forgotten most of it. I am
almost afraid to speak it, because I don’t want to sound foolish. It is this
fear that really holds me back.”
Our conversation had me thinking that, whenever I go
through something difficult or challenging in my life, it has always been
helpful to know these facts:
1) I am not alone in the struggle—someone else is going
through it as well and
2) other people
have risen above the same challenges and succeeded.
I really appreciate my patient taking the time to
tell me about his own struggle: learning English vocabulary, using it and then
forgetting it. Learning the language as it pertained to his work. But
especially, his fears of sounding foolish when speaking it. This fear he admitted is so powerful that it
has kept him from even trying to use English. Sometimes, I think, pushing past this fear is more difficult than
the language learning itself.
I completely understand this, because I have felt
this way many times. There have been many days in the course of my Spanish
learning that I have felt tongue-tied and frustrated. There have been times
when I felt embarrassed, not wanting to look or sound foolish when speaking to
a patient. As a physician, my personal challenge every day is mustering up the
confidence to speak in a language when I know I will make grammatical mistakes.
To know I can’t wear my words like I do my crisp white and neatly pressed coat.
My words will expose flaws, and the fear that my patient may equate flaws in
speech with flaws in my knowledge and therefore, treatment of her disease looms
always present in my mind. It is
daunting to be different. To be thinking
in one language, and yet speaking another.
To sound different. To know that even if I use every word correctly, my
accent and mannerisms expose something that I’d rather not:
That I’m not a native speaker. That I will make
mistakes. That I will sound strange, maybe even a bit foolish. But it’s helpful
to know I’m not alone in this struggle. And I know that my effort is not in
vain. Knowing my patients go through the same challenges too, well, this
reassures me. It makes me want to try
harder, and it makes me want to encourage others when learning a language to
try harder, too.
These sentiments remind me of a conversation I had with a patient years ago in practice:
Patient: “I came here for an eye exam because my friend – she’s a patient here – she told me she had a good experience during her exam with you. She told me, ‘you will like this doctor’. After meeting you, I now understand what she was saying.”
Me: “Thank you, and how is that?”
Patient: “Well, she told me you speak Spanish. That is very important to me. I like being able to talk about my medical problems in my language, and know that you’ll understand me.”
Me: “That’s fine. I know that my Spanish isn’t perfect. I am not a native speaker...”
Patient: “It doesn’t matter. I can talk to you.
You understand me. For me, this
is the most important thing. I am glad that you are here.”
And with that, all of my fears about expressing myself appropriately in Spanish- how I sound, the words I use, the way in which I speak, the literary pomp- it all simply melted away. Understanding—in any language, there is more than one way to convey it. For all of us, it is the most important thing.
Wooded trail, Adirondacks, NY
