Saturday, December 30, 2017

Listen First, Read Later: Back at the Beginning

It’s hard to speak fluently if you spend all your time reading in silence.
                                                                                                            -Denis Ivanov

When you’re first learning a language, it is better to hear it first before you see it in written form. You want to be able to associate the objects in your environment with the sounds that represent them. Otherwise, when you see something around you or hear something,  you will first have to think of the word in your mind, then you must translate it, then lastly you think of the object being referenced.

Did that make sense?! Let me explain...

To give you an example, I’ll start with my own experience. My primary language is English. When I started learning Spanish at age eleven in school, I learned the Spanish words that coincided with English words, usually presented in long vocabulary lists like this:

the table=la mesa

the couch=el sofá

the chair=la silla

and so on and so forth.

I read the words in a vocabulary book. And, yes, we (the other students and I) read them aloud, too, but seeing the lists was the first introduction to these words. It’s not as if the teacher pointed to a chair and said simply, “silla”. We didn’t look at a chair and see in our mind’s eye “silla” and hear in our inner ear “silla”.  Instead this is what we saw:

silla ---> chair

I’m thinking back to some of the first English words I remember learning as a young child. No, it wasn’t “mom”, or “dad”, or a color of the rainbow, or a barnyard animal. It was “George Washington”!

I mentioned early on in this blog (see the entry Beginnings)  that I grew up in a two-family home with my parents and my grandparents (maternal). When I was a preschool-age baby, my parents and grandmother were working full-time, but my grandfather was retired. He was home and took care of me until my mother got home from work. My grandparents were very big on colonial America. They had some form of yester-year memorabilia in every square inch of their house: a Paul Revere statue, a Thomas Jefferson decanter, a replica of the Liberty Bell, and, of course, a rather large wall plaque of George Washington. My grandfather carried me on his shoulders, pointed to the objects and said their names. “George Washington. George Washington.” But remember, every time he said those words, I wasn’t seeing the actual words “George Washington”. I saw this:



 
The fact of the matter is, when we are exposed to language before we start school, we never see the words we learn. We learn the sounds that describe the things in our environment. We hear a sound and we know instinctively and immediately what it is. We can see the object, and practically taste and feel the object. That’s language. That’s communication.

But later on in school, we see what these sounds look like on paper and we learn to read and write. And we continue to read and we continue to pick up new vocabulary this way.

The problem is, this is not true language communication. This is why it is so hard for students learning a second or third language in school to communicate with native speakers of that language – even after years of school-based study.

Donovan Nagel, creator of The Mezzofanti Guild, a website dedicated to linguistics and language learning, explains this concept more in-depth in his blog article, “How important is reading for learning to speak a language? Not very. Here’s why...”. He states that, “Language is 100% spoken. What we read...on paper is a representation of those sounds.” As a result of this, he goes on to say that simply reading words will not make you a fluent speaker (and I’m adding here, will not make you a good listener, either).

Mr. Nagel continues in the article, encouraging language-learners to practice a skill known as “chunking”.  This means, listening to audio conversations in the target language repeatedly (without reading!) and trying to use what you hear before you even understand the grammar or every vocabulary word. He insists people would have much more success on the road to fluency using this method instead of reading and memorizing the written word.

What Mr. Nagel has to say in this article rings very true to me, and I’ll explain why. As I said, I started my Spanish studies at about age 10 or 11. I learned vocabulary by reading long lists of words written in Spanish, along with their English counterpart. My studies continued that way- all with written text in Spanish- throughout junior high, high school and college.  I had memorized quite a bit of vocabulary and felt that I really knew the language well. But the moment people started speaking Spanish, I could barely understand them. Instead of understanding the foreign sounds coming out of their mouths, I saw a few words here and there that I could pick out. Words that I had to first translate in my head into English before I could understand. Said a different way, the sounds had no meaning to me, even though I knew what the words meant. This is because my language education focused too much on what was written down, and not enough on oral expression.

Frustrated, I often thought to myself, “When will I reach a point when I won’t have to think so hard when I’m having a conversation in Spanish? When will I understand naturally? When will I respond only with my thoughts and feelings and not have to think about the words and the sentence structure?” Well, after reading Mr. Nagel’s article and reflecting on my own experiences,  I finally have the answer to those queries: never.

...at least not until I let go of what is written down and instead simply listen to what is being said.

This is truly a eureka moment for me! In essence, I’ve been studying Spanish (written, written, written) for 31 years and though I communicate better now in my 31st year than in my 1st year, I still feel at a loss in some spoken conversations. I always felt more comfortable reading and writing the language, which is why I feel much more competent as a Spanish translator rather than a Spanish interpreter. And I spent years thinking it was because my brain was wired to understand written language better. I blamed a genetic flaw. A genetic tendency.  (There were for a time –now disproven- education theories that stated that some people learn better by reading/writing vs. speaking/listening. No study has ever proven this to be true. Now we know the reason.).

Granted, during our first few years of life, ie. birth through 3 yrs of age or so, our brain is pruning away unnecessary connections, removing redundancies and leaving behind neuron connections that serve in our survival. When we grow up around one language, our brain maintains neurological connections to understanding the sounds involved in communicating in that language, and eliminates foreign sound connections. This is the reason why learning a language after this neurological “plastic” period – as older children or adults – is difficult to become accustomed to hearing new and different sounds and conversation flow of a foreign language. But this can be overcome, simply by doing more listening and more familiarizing oneself with these new and different sounds. It is not the primary reason why communicating in a non-native language is difficult. The real reason is: we must associate objects with sound first before we associate them with their written representations.

It is now the end of 2017, a time when we make our new year’s resolutions. In 2018, I am going to resolve to do much more listening and speaking to increase my communication skills in Spanish and the other languages I want to learn. It is my hope to add French to that list, as well as Croatian, the language of my husband and his family.  Linguistically, I am going to turn back the hands of time and be a child again, doing the only thing a child can do in an effort to interact with her environment: hear, listen, mimic and speak.


What are your language goals for 2018?  


References

Ivanov, D. (2015, July 9). 9 beliefs 99 percent unsuccessful language learners have. [Web log post]. Retrieved December 30, 2017, from http://www.learningtoknowrussian.com/2015/06/9-beliefs-learning-russian-marathon.html

Nagel, D. (2015, July 2). How important is reading for learning to speak a language? Not very. Here’s why... [Web log post]. Retrieved December 30, 2017, from https://www.mezzoguild.com/reading/#

Tuesday, December 12, 2017

Patient Correspondence Letter 2

This is an example of a letter I wrote on behalf of a fellow general ophthalmologist, my practice colleague, for his patient. The patient, a young woman, was found to have papilledema during a routine eye exam.  For any non-MD readers of my blog, papilledema describes a condition of bilateral swollen optic nerves as a result of increased intracranial pressure. This is a dangerous condition that if left untreated has very negative implications on not only the patient’s sight but on the patient’s life. As a result of this finding, she was promptly referred to a neurologist for the appropriate testing and management. Unfortunately, the patient never kept the neurology appointment and the administrative staff  made the referring ophthalmologist aware of this.

In these cases, it is very important to reach out to the patient and explain, once again, the importance of following up with the treatment and management of such conditions. The patient here needed to understand that her eyes—and her health—were at grave risk.

When sending such correspondence letters, the communication should be done in a language the patient understands. As this patient was Spanish-speaking with limited English proficiency, this letter was written in Spanish plain language (aka non-technical Spanish language).  For purposes of this blog entry, I have provided a translation of the letter in English as well.

*names have been changed for privacy purposes

Estimada Sra. Méndez*:

Recibí recientemente un informe de la Dra. Smith*, la neuróloga.  La carta me informó que usted se suponía tener una cita de revisión con ella después del examen conmigo, pero le faltó la cita.  Usted recuerda nuestra conversación durante su examen aquí, cuando le dije que usted tiene nervios ópticos bien inflamados y hinchados.  Esto significa que usted tiene alta presión dentro del cráneo y necesita más pruebas por la neuróloga (incluye una punción lumbar) y medicamentos para tratar y curar esta condición.

También, la Dra. Smith me dijo que usted no ha recogido de la farmacia las pastillas que ella le recetó. Ella me dijo que ella ha tratado llamarla muchas veces, pero no podía contactar a usted.
Esta presión que tiene en el cerebro es muy peligrosa para su salud y la salud de sus nervios ópticos.  Si no recibe el tratamiento para bajar la presión del cráneo, puede quedar ciega por esta condición.  Por favor, le ruego que llame usted la oficina de la neuróloga inmediatamente cuando recibe esta carta, para hacer el examen de la espina y la punción lumbar y también, le solicito que recoja los medicamentos de la farmacia.

Después de que empieza usted el medicamento y tiene el examen de la espina, necesita regresar aquí por otro campo visual para hacer un examen de seguimiento de los nervios ópticos. Si tiene preguntas, llame esta oficina en cualquier momento. Si nos necesita para hacer la cita para usted con la neuróloga, nos complace hacer esto para usted.

Gracias por su paciencia y atención en este sentido. Recuerda, la salud de los ojos y del cuerpo están en juego.

Sinceramente,
Dr. Johnson  

                                                                        *


Dear Mrs. Méndez:

Recently I received a report from Dr. Smith, the neurologist.  The letter informed me that you were supposed to have a follow-up appointment with her after your exam with me, but you missed that appointment.  You remember our conversation during your exam here, when I told you that you have very inflamed and swollen optic nerves.  This means that you have elevated pressure inside your head and you need more tests by the neurologist (including a lumbar puncture) and medication to treat and correct this condition.

Also, Dr. Smith told me that you have not yet picked up the tablets from the pharmacy that she prescribed for you. She told me that she has tried many times to call you, but has been unable to contact you.

This pressure that you have inside your head is very dangerous for your health and the health of your optic nerves.  If you do not receive treatment to lower this pressure, you can become blind from this condition.  Please, I ask you to call the neurologist’s office immediately when you receive this letter, to have the spinal exam and lumbar puncture, and I ask that you also pick up the medications from your pharmacy.

After you begin the medication and you have your spinal exam, you need to return here for another visual field test to follow up on the optic nerves.  If you have questions, call this office at any time. If you need us to make the appointment with the neurologist for you, it would give us pleasure to do so.


Thank you for your patience and attention in this matter.  Remember, the health of your eyes and your body are at stake.

Sincerely,
Dr. Johnson

The Eye Exam 2017

Monday, November 27, 2017

Spanish Confetti


A man who knows two languages is worth two men.—French proverb

In keeping with my high school Spanish teacher’s, Mr. Jondee’s, advice, I continue to write down Spanish words or phrases  I come across in conversation, books, TV, etc, that I don’t know or understand. Then I look up their meaning and every now and again, I try to peruse the list to remind myself and remember.  As the years grow longer, so do the lists! Of course, as an ophthalmologist, I make sure to write down any medical expression in Spanish I’m not familiar with, but during this process I don’t limit myself to medical terms. You may be asking yourself, particularly if you are a health care provider with Spanish-speaking patients: Why should I bother learning vocabulary beyond medical terminology? What does, for example, the word columpio – a playground swing – have anything to do with heath care? Well, it doesn’t. But it may be important to know that word if a child is brought into the ophthalmologist’s office with a gash on her brow. When you ask how she got it, her mother may tell you, “Ella estaba jugando y la golpeó el columpio”.  If you have dedicated yourself to learning a language or expanding knowledge of a language due to patients you work with,  don’t limit yourself to memorizing only specialty-based vocabulary.  You need to know words of expression. You need to know words of the objects in your environment.  Particularly as a doctor, you need to move beyond the basic, “¿Qué le duele?” or  “Tome dos tabletas y llámame por la mañana.” Although this list (and it is only a fraction of the words I have written down over the years!) may seem overwhelming at first glance, don’t subscribe to the “I’ll memorize only what I need to know” mentality. Never stop learning – your patients will appreciate your efforts toward better communication.

I made a Spanish language folder on my hard drive dedicated to this vocabulary. I made a page in my iPhone notepad. Sometimes, when I don’t have access to my phone or my computer, I just scribble the words on little pieces of paper- whatever I can get my hands on at the time- so I don’t forget the word! So, my house, desk, and car all have a light layer of this “Spanish confetti” at any given time.  Sometimes I look upon this confetti as a sign of progress and think to myself: look at how much vocabulary I know! Sometimes it frustrates me: I’ve studied Spanish for 30 years and LOOK how much I don’t know! But moving forward is all we can do. In keeping with that philosophy, I’m dedicating today’s blog entry to vocabulary lists. Occasionally over the course of the blog, I will introduce new lists.  I’m thinking it may give you a head start on yours, or at least help you tackle some of your Spanish confetti. 

Me atendió la última vez.         You helped (attended to) me the last time.
Está relacionado con...             It is related to... (as in linked to or connected to)
¿Qué parentesco hay con-?      What is the relationship-? (ie blood line, genetic/family background)?
Los conservadores                   conservatives; (I have seen used for condoms, too)
Los preservativos                     preservatives, (I have seen this used for condoms as well)
El encargo                                assignment, job (alt. por encargo de – at the request of)
El expediente                           record, file (ie el expediente administrativo – administrative record)
Se le enganchó                         he was hooked (as in, captivated, interested)
*don’t confuse enganchar (to hook) with engañar (to deceive)
Deberían haberlo hecho           they should have done it
Aprobar                                   to approve
Hay que ver                             must see, should see , lit. there is to see
El tiroteo                                  gunfire; shooting
El tropiezo                               stumble; stumbling block; trip
Albergar                                   to shelter, to refuge
Los vejetales salteados             stir-fry vegetables
El jengibre                               ginger
Un ingreso fijo                         fixed income
Hablantes                                 speakers
Los encargados                        the managers
El concejo                                council
El consejo                                advice
Actuar                                      to perform
Cautela                                     caution
Los emprendedores                 the entrepreneurs
Un hallazgo                             a finding
Ronquido                                 snore (noun)
Cifra                                        number, figure
Vincular                                   to link (ie link stories or ideas)
El peor de los casos                 worse comes to worse
Tacón                                       heel (of a shoe) tacones altos-high heels
Con el dedo de pie destapado  open toe (use with zapato)
Suplicar                                   to appeal to
Aplacar                                    to appease
Tener ganas de                         to have a yearning for, desire to...
Calzado con tirantes                footwear with straps
Silvestres                                 wild
Ahondar                                  to delve (deeper)
Desdicha                                  misfortune; misery
Aplastar                                   to crush
Eje                                           axis,like visual axis
Sanidad                                    health
Vinculado                                linked
Difundir                                   to spread; disseminate
Brindar                                    to offer; provide
Encajar                                     to fit
Encajar con perfección            to fit perfectly
Zarpar                                      to set sail
Un naúfrago                            a castaway
Rehusarse                                to refuse
Desgaste                                  wear and tear
Demacración                           emaciation
Abejorro                                  bumblebee
Delito                                       crime
Conseguir                                to get, obtain
Soler                                        to usually do
Agredir                                    to insult, to attack
Entramado de alambres           mesh of wires
Prometadora                            promising
Se ha convertido                      has become
Verja                                        gate
Ordenador                               computer
Resbalar                                   to slip; to slide off
una pista                                  a clue, a track
La procedencia                        origin
Un tiro                                     shot (from a bullet)
Un balazo                                gunshot
Cefalea                                     headache
Cuando menos lo esperamos       when we least expect it
Al pasar por un período difícil     when going through a difficult period
El meollo del asunto es...             the bottom line is...
Lo que mal empieza, mala acaba  What begins badly ends badly (Euripídes)
¡Ni a palos!                               No way!
Rejilla de amsler                       Amsler grid
Perjudicado                                injured; handicapped
Holgada                                      loose
Nueces (nueces picadas)             nuts (chopped nuts)
Historial clínico; registro médico   medical record
Hoja clínica; récord médico;
Expediente médico                         medical chart
Calzar/calzando                              to wear (shoes); wearing
Obrar recíprocamente                     to interact
Entreacto                                         intermission; interval
La carpeta                                       a folder
El lista                                             a list
Juntar                                              to piece together
Pegar                                               to glue; to paste           
Conocimiento- familiaridad           knowledge- familiarity
Esperar; suponer; aguardar             to expect
Exhaustivo; a fondo                       exhaustive; in-depth
Frustrada                                        frustrated
Sonidos; ruidos                              sounds; noises
Significación; sentido                    meaning
Nunca me los han de vuelto           they never returned it to me
Cobrar                                             to charge; to recover it
Ingresar universidad                       to matriculate in university
Conseguir un trabajo                      to get a job
El primer puesto                             first prize
Logro                                              achievement
Tiza                                                 chalk
A ahora nos toca a nosotros           Now it’s our turn
Costearse                                        to afford
Labor social                                    social work
Troglodita                                       cave dweller
Un nudo en la garganta                   lump in the throat
Al borde de la muerte                     at the brink of death
Garrote                                            a club; a stick
Una bola de....                                 a bunch of...
Piscinazo                                         to take a dive (fake hurt in game)
Comprobar (compruebas)               to check (ie. checking the eye pressure)
Comprometidos                              committed (to)...
Apuntarse                                        to sign up (me apunto: I’m in!)
Dar de baja                                      unsubsribe
Montura de gafas                            eyeglass frame
Ventas                                             sales (ie. increase sales)
Remos                                       oars
Balseros                                    rafters (people who ride a raft)
Multas                                      fines; tickets (ie traffic ticket)
Ganga                                      bargain
Planta cara                               confronts
Plato; platillo                            dish(as in, a food specialty)
Sampedrana                             St. Peter (from San Pedro)
Hacerse                                    to gain; to become
Tiene que ver                           has to do with
Becas                                       scholarship
Pasantías                                  internship        
Destacar                                   to stand out; to distinguish
Lanzar                                     to spearhead; to start
Apretar (aprieta)                      to tighten (tight)
Realizar                                   to accomplish; to perform                   
Alcanzar                                  to reach; to attain
Medioambiente                       environment
No obstante                             however
Sin embargo                             however
De ninguna manera                  no way; by no means
Ceñida                                     tight; girded; clining
Hay que mirarla                       to have a look at
Volcar(se)                                to overthrow, fall over oneself
Los colirios                              eyedrops
Sobresalir                                 to excel; to shine
Pulgada de altura                     an inch high
El grosor del trazo                    stroke (as in brush stroke)
Administrar                              to manage
Creador(a)                               creator
Acobardar(se)                          to be daunted by
Borrador                                  draft
Modismo                                 idiom
Caracol                                    snail
Penumbra                                semi-darkness
Delito                                       crime
Soez                                         filthiness; badness
Abordaje                                  an approach; a collision
Te escuecen                             they sting you (eyes)
El foro                                     the forum
El liguero                                 the garter belt
desamparados                          helpless; homeless
caseta de billete(de metro)       ticket-booth
taquilla                                     ticket-booth
que hacer que                          that make; cause that
emocionante                            exciting
entregar                                    to submit; to hand in
pulir                                         to polish (as in polish up a draft)
esmerar(se)                              to strive; to do your best
notar                                        to notice; to note
el reto                                      the challenge
destrezas                                  skills; dexterity
empeño                                   determination
predicar                                   to preach
predecir                                   to predict
notablemente                           noticeably; greatly; sharply
facilidades                               ability to learn to do something; facilities; aptitude
propiedades                             properties
la policía                                  the police
sugerencia                                suggestion
impulsar                                   to drive (as in, push something/idea forward)
espesor                                     thick
llevarse a cabo                         carry out
tratar(se)                                  to try (to treat)
¿por qué hay que operar?        why operate?
constatar                                  to confirm; to verify; to prove
            

Courtesy: Inside-CRM Death of the Sticky Note

Thursday, November 9, 2017

Patient Correspondence Letter

There are times when physicians cannot rely on pre-printed translated office material. Particularly when it comes to communicating important information to patients, personalized letters tailored to the patient in question are required. Here is an example of an actual letter* directed to a patient from his general ophthalmologist. You will see the original English version first and then my translation into Spanish (*all names and locations have been changed to protect anonymity). This letter in particular was sent to the patient because he never followed up with setting up an appointment with a glaucoma specialist—something that was recommended to him during a recent office visit.


Dear Sir:

Your last visit to our office was October 21, 2015.  During that exam, I had explained to you that you have a diagnosis of advanced glaucoma and that you are going to need medication in the form of eye drops to treat it.  I also told you that you are going to need a glaucoma specialist and that you have the opportunity to see Dr. Smith, located in Springfield, or Dr. Jacobs in West County. You told me that you would make a decision as to which office to visit, and that you would call me with this information.

Since that time, I have not heard from you.  My secretaries have tried contacting you, but you have not answered.  Please remember that a diagnosis of advanced glaucoma is very serious.  In your case, eye drops are not enough to maintain a stable eye pressure—you need the help of a specialist.  If not, it is possible that you are going to lose your vision completely.

Please, when you receive this letter, call the office to schedule an appointment with the glaucoma specialist.  The number here is:

(123) 456-7890

Remember, if you do not call to make this appointment with the specialist, you are in danger of going blind.

Thank you for your time.

Sincerely,

Dr. Jones


                                                                        *


Estimado Señor,

Su última visita en nuestra oficina fue el 21 de octubre, 2015.  Durante ese examen, le expliqué a usted que tiene un diagnóstico de glaucoma bien avanzado, y que va a necesitar medicamentos en la forma de gotas para curarlo.  También, le dije a usted que necesita un especialista de glaucoma, y tiene la oportunidad de ver al Dr. Smith, ubicado en Springfield, o al Dr. Jacobs en el Condado de West.  Usted me dijo que haría una decisión cual oficina podría visitar, y que me llamaría con esta información. 

Desde ese tiempo, no he oído de usted.  Las secretarias han tratado de llamarlo, pero no nos ha contestado.  Por favor, recuerda usted que el diagnóstico de glaucoma avanzado es muy grave.  En su caso, los colirios no son bastante para mantener una presión estable del globo del ojo—necesita usted la ayuda de un especialista.  Si no, es posible que pierda la visión completamente.

Por favor, cuando recibe usted esta carta, llame la oficina aquí para hacer la cita con el especialista.  El número aquí es:

(123) 456-7890

Recuerda, si no llama para hacer esta cita con el especialista, usted está en peligro de la ceguera.

Gracias por su tiempo.

Sinceramente,

Dr. Jones
 
NYC Bird Murals 2017. Artist: Key Detail