Preferred language

Yesterday, before I called a patient into my office to begin the eye exam, I looked over the intake forms he filled out. Under the section where it said “preferred language”, he had checked “Spanish”. So, when I went to collect him from the waiting area, I greeted  him in Spanish. I brought him to the exam room and had him sit down. I started my usual Spanish dialogue of, “Está aquí por un examen completo de los ojos. La enfermera escribió aquí que necesita usted lentes nuevos, particularmente para leer, y también que tiene un diagnóstico de la diabetes, y necesita un examen de la retina,” and so on and so on. He answered me in English, “Yeah, my glasses are two years old and I need new ones. My doctor wanted an exam of the eyes because of the diabetes.”

His English was good and he continued speaking it, so I changed to English and onward the exam went. But I wondered, why did he start speaking English at all? Especially when he had checked off that his preferred language was Spanish? It’s not like he spoke in English to everyone else in the office. After I finished the exam and he brought the coding sheet out to the front desk to schedule his next appointment, I could hear him talking and joking in Spanish to the front office staff, who happen to be Latinas from the Dominican Republic.

This situation has been happening more often lately, and it just has me thinking, why? Is it because I’m a doctor, and these patients want to show someone who they perceive to be an authority figure that they are capable of conversing in either language?

Is it because they see me, a non-Latino person, speaking very good but not perfect Spanish, and would rather communicate with me in what they assume is my native English?

Is it due to the recent political climate--the random deportations of illegal immigrants--creating a fear in these patients that they feel the need to show that they do speak English well, and are a permanent part of American society?

Is it simply that they want to flex their English-speaking muscles, while I flex mine in Spanish?

I turned to a simple, but sometimes vacuous source for more information: Google. I searched, “Spanish-speaking patients who feel the need to speak English at the doctor’s office”, or something along those lines. Not many relevant hits came up.  The closest situation was one where a man, who was learning Spanish, described his frustration that every time he would try and practice his Spanish with Latino restaurant workers, they always answered him in English. Someone angrily answered his query, saying that it’s rude and racist to assume that just because someone is Latino, that he automatically should speak and be spoken to in Spanish. Well, I can just as quickly say, don’t assume just because someone is non-Latino that he doesn’t speak Spanish. You may find out quite readily that he does, if you give him a chance to speak.

I grew up in the 1980s. Back then, you could honestly and innocently do something or say something, without the observer or listener automatically assuming that you had racist or malintent.  What is so wrong with encountering a person, hearing that she has a heavy Spanish accent, and trying to converse in Spanish with that person? Is that racist?

 Nelson Mandela once said, “If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart.”

Therefore, can’t it simply be that you are trying to make a more personal connection with that individual, by speaking in his native language? In my particular situation, I work as an ophthalmologist in an office in the northeastern United States. It happens to be situated in a community of mostly Spanish-speaking people, many of whom who only emigrated to the US within the last few years. That being said, I do not go out into the waiting area and start speaking Spanish when I see a Latino patient. At the same time, there have been many Latino patients I approach greeting them in English, and they give me the look of any person who does not understand spoken English: one of confusion, dismay, even fear. I don’t want dismay and fear to be the first impressions that a patient has when coming to my office. I don’t want the patients to think that they will have a language barrier with their doctor, and therefore will not get the help they came to receive.

So, I look to the intake forms. If someone marks off Spanish as preferred language, I greet her in Spanish. I allow the patient to choose to either continue in Spanish or not. If she continues in English, then I will follow her lead. If I happen to greet a patient in English who indicates preferred language as English, but I see right away that he is having trouble understanding and/or communicating with me, I’ll ask,

“¿Qué es lo que prefiere usted—inglés o español?

and if he says,

“Prefiero español, gracias.”, then so be it, and onward the conversation takes place.

I’m very flexible as far as the way I run my practice. The goal of any doctor –patient dialogue is clear communication. The language choice is simply a means to an end, and shouldn’t mark the end of meaningful conversation.

Death Valley National Park 2016