A
teenager and his mother come into the exam room. The teenager is my patient and
is fluent in English and Spanish. His mother only speaks Spanish:
Doctor:
(after finishing the exam) You have myopia, which means you’re near-sighted. This is why you can’t read what your teacher
is writing on the board at school. You need a prescription for glasses.
Teen:
Do I have to wear the glasses all the time?
Doctor:
Not necessarily. If you want, you can just use them in class to see the board.
But if you like your vision with the glasses on, then you can leave them on all
the time if you want. This will not harm your eyes or affect your vision
long-term.
Teen:
Can I have contact lenses? I’d prefer contacts.
Doctor:
If your mother approves, then yes, you can, but you need to learn how to take
care of them and how to put them on. The
prescription for contacts is different that that for glasses. You would need
another exam for contact lens fit. It looks like your insurance will only cover
one prescription, either for glasses or contacts. So, if you were to get
contacts, you’ll be paying out of pocket. But most important is the care for
contact lenses. If you mistreat them, or
overwear them, it can result in a serious eye infection or permanent loss of
vision.
Teen: (le mira su madre)
Mom, quiero lentes de contacto.
Mom: ¿Qué dice la doctora?
¿Son seguros utilizar? ¿El seguro, los cubre?
Teen: Sí, sí, sí. Ella dice
que sean más fáciles utilizar que lentes, y la mayoría del tiempo, el seguro
los cubre.
*
An
80-year-old grandmother comes into the office for an eye exam regarding her
declining vision over the last few years. Her 60-year-old son accompanies her.
Abuela: No sé por que, pero
hace dos años ahora que no puedo ver bien. Me gusta leer y coser, y en los
últimos meses, las dos actividades en particular son imposibles hacer.
Doctora: (después del
examen). Usted tiene ojos sanos, y otra cosa que sucede del envejecimiento del
ojo: las cataratas.
Abuela: ¿Tengo catarata en
cada ojo?
Doctora: Sí, pero lo bueno
es que, porque el ojo es sano, con cirugía para sacar la catarata y poner un
implante permanente, usted pueda ver muy claro después, y, que más, pueda
regresar a sus actividades regulares- las que siempre disfruta.
Abuela: No sé lo que hacer.
¿Es posible que yo pueda tener lentes nuevos en vez de la cirugía?
Doctora: Sí, recuerda que la
cirugía para sacar cataratas no es una emergencia. Es considerado cirugía
electiva.
Abuela: (le mira su hijo) No
sé...
El hijo: Debes tener la
cirugía. El seguro la cubre. Recuerda, papá tenía la cirugía antes de murió.
Abuela: Bueno, los lentes me
gustan...
El hijo: Estoy harto de oír
que te quejas que no pueda leer o coser. Los lentes no van a mejorar tu visión
completamente. Debes tener la cirugía.
*
A
young woman in her early twenties is the patient. She comes to the office with
her husband, who leads the way into the exam room when she is called.
Doctor:
(smiling, extending hand out to the patient) Hi, I’m Dr.-...
Husband:
She doesn’t speak any English. You’re going to have to talk to me.
Doctor: (al devolver la
sonrisa al paciente) Hola, Soy Dra. Hromin, es un placer conocerte. Sígame al
cuarto para el examen...
Husband: (surprised and somewhat
irritated) Oh, you speak Spanish.
Doctor: (le mira la esposa,
mientras le contesta al esposo) Sí, yo hablo los dos idiomas. La lengua del
examen no me importa a mí, solo la comunicación entre del paciente y mí.
(La esposa sonríe).
*
As
I have said in previous blog entries, the overwhelming majority of
Spanish-speaking patients and their families and/or friends are relieved and
grateful when they discover that I can not only speak Spanish to them, but
understand them when they express their concerns to me in their language.
However, during my 20+ years working in the medical field, I occasionally do
come across patient-family or patient-friend dynamics that are not based on
honest communication. It is during these
instances that, if I did not have a good command of the Spanish language, I
would not be able to pick up on these deceptions, and therefore would not be
able to be an advocate of truth for the patient and/or family.
For
example, the three opening scenarios depict situations where I have experienced
these interactions. The first focuses on
a very common issue. Many children and
teens come to the office as patients and they are bilingual. When a child knows
two languages and a parent only understands one of them, unfortunately, this
skews the power and control into the hands of the child. This is further
aggravated by the fact that many adult family members who don’t speak or
understand English have used their children as interpreters which again, places
a level of responsibility and power into the hands of young people who, in my
opinion, should not have it.
As
a result, children and teens who are bilingual will try to take advantage of
this ability when their parent only speaks Spanish. They speak to me in
English, listen to what I have to say, and then tell their parent something
completely different, usually to their advantage, in Spanish. In the specific interaction I’ve depicted,
the teen does not want glasses. He wants contacts, so he’s willing to say
whatever he has to in order to get his parent to agree to a contact lens
fitting, even if he must twist the truth of what I said to get what he wants.
What he doesn’t know, however, and will soon find out, is that I understand
what he’s doing, and I set the record straight:
Teen: Sí, mom, la doctora
dice que los lentes de contacto son mejores y más fácil utilizar que lentes. Y
el segur los cubre.
Doctora: (le mira la madre)
En actualidad, no. Generalmente, y depende del seguro, pero el seguro cubre
solo una opción: lentes o lentes de contacto. Si no cubre los lentes de
contacto, tiene que pagarlos del bolsillo.
También, no son “más fáciles” utilizar que lentes. Una persona tiene que
aprender como utilizarlos, cuidarlos y debe mantener un balance entre del uso
de lentes y lentes de contacto. Es porque, para ponerse los lentes de contacto
todo el tiempo no es bueno para la salud del ojo y de la córnea. La persona con
lentes de contacto tiene que ser responsable, porque el abuso de los contactos
puede resultar en infecciones de la córnea o, peor, la perdida de la visión.
Madre: (le mira el hijo, frunce
el ceño) La respuesta es no. Compramos solo lentes. Vamos.
*
The
second situation is another very common one. An elderly patient is brought to
the office by their 60 some-odd year-old son or daughter. The patient depends
on her children for transportation and care, and the child plays in fact two
roles, child and parent. In this case,
the patient is nervous about having cataract surgery, and would rather get a
prescription for a new pair of glasses, even though it has been explained that
the surgery would lead to a better visual outcome. Still, the patient requests
glasses, but her son, anticipating that his mother won’t be happy with them
which will incur another trip back to the doctor’s, tries forcing the surgery
on her. In the end, though another visit with the doctor in the future when the
patient continues to be dissatisfied with the glasses may be an inconvenience
for the patient’s son, the patient is the one who makes his / her own medical
decisions.
El hijo: Mom, la doctora le
dice que los lentes no va a servirle bien, porque tiene cataratas. Es mejor que
tenga la cirugía para sacar la catarata.
Doctora: (les mira la abuela
y su hijo) Pues, sí, pero en el fin, no podemos olvidar que el paciente tiene
que hacer su propia decisión. Especialmente en este caso, porque la cirugía
para sacar una catarata es electiva. (le mira la mujer) Mi consejo es, lleve la
receta de lentes nuevos y tómase el tiempo para hacer la decisión que es mejor
para usted.
*
The
final scenario depicts a wife and her husband. The wife is the patient, and is
only Spanish-speaking. Her husband is bilingual. He pushes his way in front of
her to greet me, physically asserting his control of the situation and what he
believes will also be full control of what is being said (and understood)
between his wife and the doctor. However, he quickly finds out that I speak and
understand Spanish. His wife and I can communicate directly, without third-party intervention. The control is taken
out of his hands and placed back where it should be, in the hands of his wife
and the doctor.
A
few final words on this particular blog entry. I do not mean to imply by my
above experiences that all bilingual teens are out to deceive their parents, or
that all children of elderly parents view their folks as a burden or that all
husbands are out to control their wives. Quite the contrary, the vast majority
of my interactions with patients and their families and friends says otherwise—that
they are there to help each other and speak up for their family member’s best
interests. However, unfortunately, I have encountered some cases like those
above. It is during those moments when I am so grateful for my knowledge of
Spanish. Knowledge is power. Knowledge of language is an extremely important tool that I
use to allow me to be a better doctor to my patients. Knowledge prevents being
lost in translation. Knowledge halts third-party intervention. Knowledge of another language takes work and
dedication, but the reward of open, honest communication between doctor and patient
make the toil and time truly worth it in the end.
 |
| Utah, Summer 2015 |
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