First Impressions

Brian: Hola, me llamo es Brian,...oh, God, let’s see, uh..Nosotros queremos ir con ustedes.

Traveler: That was pretty good. But actually when you said, ‘me llamo es Brian’, you don’t need the ‘es’. Just, ‘me llamo Brian’.

Brian: Oh, you speak English.

Traveler: No, just that first speech and this one explaining it.

Brian: You, you’re kidding, right?

Traveler: ¿Qué?

“Road to Rhode Island.”Family Guy. Fox. 30 May 2000. Television.

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In my opinion, what makes good comedy really good comedy is how closely it reflects what happens in everyday life. The more realistic it is, the more one can say, ‘yeah, that happened to me, once!’, and the more personal and funny the joke becomes.

In this short conversation taken from Family Guy, the dog, Brian, is talking with a Mexican migrant worker. Brian doesn’t speak Spanish well, but he’s trying to communicate and he does pretty well. The man he’s speaking with responds to him in perfect English (and though it’s not evident from the written dialogue, it is an easy-flowing, natural-sounding English when the dialogue is spoken). Because this man speaks so well, Brian assumes that he is fluent in English. However, the man says no, indicates it’s limited only to the English spoken in this particular conversation, and when Brian tries to talk in English with him further, the man does not understand.

A little bit exaggerated for emphasis and humor, but honestly, in my personal experience, this is very close to what I encounter every day in the office with some of my Spanish-speaking patients.  There have been numerous times when I’ve gone out to the waiting area to call a patient back to start the exam, and the patient answers so naturally in English, I assume that he is bilingual and has no problem conversing in either English or Spanish. However, a trip back to the exam room quickly reveals that the patient’s English is limited. Here’s an example of such an encounter: *names of patients have been changed to protect identity

Me: Mr. Gonzalez*? Hi, I’m Dr. Hromin- it’s nice to meet you. Please come with me, we can start the eye exam now.

Mr. G: Hi, how are you? It’s nice to meet you too. OK. Can I leave my things here? (motions to jacket and hat)

Me: It’s better to take them with you, we won’t be coming back to this area after the exam.

Mr. G: OK

(entering exam room)

Me: You can have a seat in the grey exam chair.

Mr. G: Thank you very much.

Me: Ok, so I was reading some of the information written by the technician, it says here since the last visit you’ve noticed a change in your distance vision. In your own words, tell me-

Mr. G: Uh, I don’t speak English well. They tell me you speak Spanish?

Me: Oh, sí, está bien, perdóname, pero usted habla inglés muy bien, pensé que fuera bilingüe.

Mr. G: Gracias, pero para mí, el español es mejor.

Me: Está bien. Entonces, se dice aquí que....

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In this blog, I often reiterate how my goal is to make the patient comfortable. I’ve said many times before, that I don’t want to walk into the waiting room starting in Spanish, and have the patient feel offended in thinking that I assume they don’t speak English. At the same time, I don’t want to start in English, and have the patient who only speaks Spanish feel confused and nervous that they have a doctor who won’t understand them. I check the chart to see if there are clues from the last exam (assuming this isn’t a first-time visit to the office) as to what language they prefer, and I’ll begin in that language. But in the end, if there is no previous visit to review, and the patient hasn’t indicated a language preference on the in-take forms, then I’ll default to English and change if necessary.

Some may think I’m over-analyzing, but this is really something to think about. Imagine if you made an appointment with a primary care doctor who you’ll be seeing for the first time. You check in, you fill out the papers. You are called to the exam room. You’re sitting on the exam table, and your doctor walks in. The doctor smiles and starts speaking to you, in Japanese!(insert here any language you do not know) You interrupt her and say in English you don’t understand, and she smiles and switches to English, which is pretty good but it is not native fluency, and you feel a little uneasy. Will she really be able to understand everything I’m telling her? Would I get a better exam if I spoke Japanese? How can I make a personal connection with my doctor when we don’t speak the same language? Does my doctor think less of me that I can’t speak Japanese? etc etc. I think about all of these things during such an exam. Here is how I have come to handle it over the years:

Mientras hablo con el paciente en inglés, él parece confuso.

Me: Señor, ¿cuál es mejor para usted, (o ¿qué prefiere usted?) inglés o español?

Paciente: Sé poco inglés, para mí es mejor en español.

Me: Está bien. El idioma no me importa a mí. Ok, se dice aquí que usted quiere lentes solo para leer?

Paciente: Sí, pero a veces cuando manejo por la noche, es difícil ver los letreros de la calle en la distancia. Pienso que yo necesite lentes permanentes...

 y el examen continua...

Translation of the above dialogue:

While speaking with the patient in English, he appears confused.

Me: Sir, What is better for you (or, which do you prefer?) English or Spanish?

Patient: I know a little English, but for me Spanish is better.

Me: That’s fine. The language isn’t important to me. Ok, it says here that you want glasses only to read?

Patient: Yes, but sometimes when I drive at night, it is difficult to see the street signs in the distance.  I think that I need glasses all the time.

and the exam continues.

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I think it’s important to address the subject of language right away, so you can get the full details of the history and do a complete exam. I feel that letting the patient know it doesn’t matter which language you both speak in sets the patient at ease.  He knows he’s being heard, he can express everything he feels, and he doesn’t feel judged for not knowing how to communicate in English. You win the confidence and trust of your patient. And at the end of the day, that’s what any good doctor wants.

Greetings.   Courtesy:Amanda Johns Vaden