The Thinker

Sometimes when I’m speaking to a patient in Spanish, I’ll think of something that I want to say to him that I could easily say in English, but I do not know exactly how to convey in Spanish. Especially if it’s a colloquialism, there is usually not a direct English to Spanish translation. You simply have to know the Spanish language-way to express it. In these instances,  I have to make a quick decision: either abandon the phrase altogether or attempt my own Spanish version.  The latter may result in a complete butchering of the language—oftentimes, it does! So, after the patient leaves, I typically write these phrases down on paper and save them for investigation later.  By the end of the week, I’m left with random phrases on little pieces of paper that add up to quite a collection. For this blog entry, I’m going to list some of these phrases below, translate them the way I would if I had a patient in front of me, but then research to see how the phrase really should be expressed by a native Spanish-speaker for comparison. Here we go!

“The disease has to run its course.”

My translation:  Esta enfermedad requiere más tiempo para curar.

Actual: Esta enfermedad tiene que seguir su curso.

             Esta enfermedad debe tener su curso.

             Esta enfermedad tiene que completar su evolución.

“When your medication runs low, please call the office.”

My translation:  Cuando casi ha acabado los medicamentos, por favor, llame la oficina.

Actual: Cuando quedan pocos los medicamentos, por favor, llame la oficina.

             Por favor, llame la oficina antes de se terminen los medicamentos.

“When you hit your eye, what were your symptoms?”

My translation: Cuando le golpeó el ojo, ¿qué fueron los síntomas?

Actual: Cuando le ha dado un golpeo al ojo, ¿qué fueron los síntomas?

             Cuando se golpeó el ojo,...

             Cuando se ha golpeado el ojo,...

“It is important that you keep your follow-ups with your doctor, so that he monitors for any changes in blood pressure.”

My translation: Es importante que mantenga usted las citas de seguimiento con su médico, por eso, él le pueda vigilar para cambios en la presión de la sangre.

Actual: Es importante que cumpla con sus citas médicas, para que el médico mantenga una observación de los cambios en la presión de la sangre.

             Es importante que asista a sus citas médicas, para que el médico pueda averiguar para cambios en la presión arterial.

             Es importante que usted vaya a la cita de seguimiento, para que el médico pueda vigilar para cambios en la presión sanguínea.

“He thought that you had these symptoms for many years.”

My translation: Él pensó de que tuviera usted los síntomas para muchos años.

Actual: Él pensaba que usted hubiera tenido los síntomas por muchos años.

 Él pensaba que usted tuviera los síntomas durante muchos años.

“Let’s say, for example, the test was normal. I would not start those drops you are using.”

My translation: Vamos a decir, por ejemplo, que el examen fuera normal. Yo no empezaría los colirios que está utilizando.

Actual: Se podría decir, por ejemplo, que fuera* normal la prueba. Yo no tendría que empezar los colirios que está utilizando.

            Digamos, por ejemplo, si la prueba fuera normal. Yo no habría empezado las gotas que utiliza usted.

            Pongamos en caso, que el examen fuera normal. Yo no iniciaría las gotas que utiliza usted.

(*Even with my research, I am still not fully clear on the proper expression of this sentence. To me, by beginning the phrase with, “let’s say, for example”, I’m creating a hypothetical situation that is uncertain.  Therefore, any uncertainty is expressed in subjunctive. If you use subjunctive, ie fuera, then you follow it with the conditional tense, tendría.)

“It depends on the insurance. They dictate where you have to go (for the treatment).”

My translation: Depende del seguro. El seguro dirige a donde tiene que ir (para el tratamiento).

Actual: Depende de la compañía aseguradora. El seguro le indicará donde tiene que ir.

             Depende del seguro médico. El seguro le exige donde va usted.

             Depende del seguro médico. El seguro le aconseja donde puede ir usted.

There are many ways to express any one particular thought in a language. As you can clearly see, some of my translations above came very close to what I found in parallel texts (aka Spanish reference texts) online. Others deviated from the Spanish “norm”.  However, the question remains, will the patient understand me, even if I don’t say my phrases according to the RAE (Real Academía Española- the governing body for all things Spanish language-related)? The answer is yes.

Think about it, when a non-native English speaker has said something to you in an “unnatural” aka "non-native" way, you can still understand him. You still get the gist of what is being said. Why? Well, we don’t need precisely correct grammar to convey understanding. Ideally we strive for correct grammar, but it is not always necessary to get the point across. My advice is to keep practicing. When a phrase pops into your head that you want to try to express in your non-native language, go for it! But write these phrases down for later investigation, to see how close you are to what a native speaker would say to convey the same idea. In this way, your command of any language will continue to improve day by day.

References

Phrases. 2017. In Linguee.es. Retrieved July 25, 2017, from http://www.linguee.es/  

The Thinker, The Gates of Hell, Musée Rodin

Trata

“Usted habla el español bien.”

“Bueno, gracias, tengo más practica para hacer, para mejorarme...y tengo—“

“Pues, trata.”

                                                                   *

For anyone who has been reading my blog entries regarding my experiences using Spanish, my second language, throughout my medical career, you will note that they follow a sinusoidal-shaped curve of emotion. There are very positive entries, which focus on powerful learning moments, both linguistically and culturally.

Then there are the frustrations that I feel when I am racing to perform an exam (because of minimal time allotted me) and diagnose a patient and explain all this in detail to the patient in a language that is not my native one. Today’s entry represents another such frustrating dip in the curve. However, I remind myself and my readers that the point of my blog is to show the experience of practicing medicine in a non-native language in its entirety: the good and the bad.  I hope my readers can understand that even in my moments of anger or frustration or exhaustion, I always work to provide the best experience possible for my patients.

I was examining a patient recently. He only spoke Spanish, so I performed the exam in Spanish. As I was finishing up my notes and printing his eyeglass prescription at the conclusion of the exam, he took a moment to compliment me, telling me that I speak Spanish well. This is not unusual, and I’ve mentioned many times before in this blog, that the majority of my Spanish-speaking patients are grateful that I conduct the eye exam in their language. Because they are grateful, most will overlook the occasional grammar mistakes that I inevitably make: the wrong verb, the wrong conjugation. Incorrect use of subjunctive. Wrong choice of the verb “to be”. 

Because I’ve become accustomed to hearing these compliments, I lapsed into my usual response in Spanish, “Thank you, yes, of course I have much more practice to do if I want to improve...”, or something to this effect. But this time it was different. The patient interrupted me with a curt, “Well, you’re trying,” in Spanish.

You’re trying.

And suddenly in my mind, the compliment ceased to be a compliment, and transformed into a criticism instead.  And listen, maybe he really  did mean it as a compliment. But I see it from a different perspective. Think about it:  when you tell someone “they’re trying” at something, what you are saying is that, although they are making a good effort, and you applaud that effort, the end result is poor. Through that one word, trata, this patient touched a nerve within me because I don’t think most patients – make that, I don’t think most people—realize the amount of work that goes into conducting a medical exam in a non-native language. And then, having to do it under a time constraint makes the situation even more stressful.

Of course, I didn’t show him how I felt. I finished my notes and handed him the prescription, and wished him well and told him that he should return for a complete eye exam again in one year. It was business as usual. However, when something someone says bothers us, we have to ask ourselves why that person’s words hit a trigger point. I don’t have to think very long or hard to know why his trata bothered me. I’m sure there are individuals out there, maybe even readers of this blog, who wouldn’t think twice about it! But the root of my frustration comes from the following:

When I was interviewing for the ophthalmology position in the practice where I work, of course I talked about my ability to conduct an eye exam in Spanish and regarded it as a selling point. Why not? I had worked over a 15-year period to build a professional fluency. And I knew that the area where this office is situated has a fairly large Spanish-speaking population. I thought to myself,  I’m being hired as an ophthalmologist, but if I can use my language skills here and there for the patients that need it, all the better. This, in my mind, would make me a better fit for the practice and would also render me an invaluable team member.

However, within the first few years of working there, the office manager began swiftly altering my patient schedule, very rapidly replacing all my English-speaking patients with Spanish-only speaking patients. The English –speakers were moved to the schedules of the other doctors in the practice. These doctors are all monolingual. This means the majority of time I spend in that office, I am only speaking Spanish from the moment I walk in the door at 8:30am until I leave at 7pm at night. That’s anywhere from 30-40 patients a day with whom I am speaking only in Spanish. This is a very different work scenario than that which was posed to me by the practice owners when I was initially interviewed. I was hired to be an ophthalmologist first and foremost.  I was hired for my medical skills, not my linguistic ones.

For anyone performing her job in more than one language, there is no denying that the work load is greater. This is because it takes tremendously more mental effort to express things clearly in another language, in addition to addressing cultural issues which also affect the interaction. I recently had to perform risk management training with my malpractice carrier, PRI. The training course, entitled Clinical Reasoning, Resilience and Teamwork, addressed this issue of speaking non-native languages in the medical setting:

                ...language barriers may create a time burden for physicians...physicians felt

            that they had spent more time with non-English-speaking patients, the actual

            duration of the encounters was no different from those with English speakers.

            The study concluded that the physicians’ perceptions that encounters with non-

            English-speaking patients were longer may have been due to the increased

            effort involved in overcoming language and cultural barriers.

After doing some additional online research, I discovered that the medical industry is not the only one where people with bilingual or multilingual skills are taken advantage of in the work setting.  Nurses, customer service representatives, administrative assistants, etc. have had similar experiences of being hired to perform a certain job task, but later told they had to do that job task in two (or more) languages, just because they have the ability to do so. These people, like me, have become very frustrated, working twice as hard as fellow monolingual coworkers, and for the same pay scale.  And the worst part is, legally, employers have the right to exploit their workers like this.  If employees are being overworked and not compensated appropriately, their only recourse is to quit.

Going back to the patient that started this conversation, the one who told me (while I was working in two languages under a time constraint)  I was only trying, am I angry at him? No. Do I think he said something offensive? No. But his words brought to the fore an injustice I have been struggling with working at this practice. It's a struggle that affects many, and if not addressed appropriately, will have a negative impact on workplace morale and employee well-being.

"When the well runs dry, we shall know the value of water." -Benjamin Franklin

Benjamin Franklin oil painting, Michael J Deas

Una conversación con un paciente

Doctora: Leí la información de la enfermera...se dice aquí que tiene usted síntomas de “destellos de luces” en la vista periférica?

Paciente: Sí. Para arriba, en este rincón de la vista (me muestra con movimientos de la mano) veo destellos, como un relámpago, de vez en cuando, y, como moscas que vuelan.

D: ¿Sabe usted en qué lado están los destellos- el ojo derecho o el ojo izquierdo?

P: Cuando me lo cubro, el ojo izquierdo, no los veo. Pero, cuando cubro el derecho, sí, veo los destellos.

D: ¿Desde cuando, más o menos, tiene usted los síntomas?

P: Hace un año, tal vez diez meses, ahora.

D: OK. Usted sabe que se le dilataron los ojos. Voy a examinar la retina—

P: Está bien.

(algunos minutos más tarde)

D: Pues, hay una explicación por qué tiene los síntomas visuales que describe.  Usted tiene en la retina periférica del ojo izquierdo un desprendimiento superficial de la retina. Está ubicado en la retina inferior, al lado nasal. Gracias a Dios, porque está ubicado en la retina inferior, usted no tiene un desprendimiento de la macula, o la retina central. Con un desprendimiento de la macula, se vuelve ciego.

P: Yo sabía que algo estaba mal. Antes de vine aquí, les he consultado con muchos otros médicos. Todo me dijo que no tenía yo problemas con la retina. Me dijeron los médicos que los síntomas indicaban solo sequedad, y que yo necesitaba las gotas artificiales para resolver el problema. Entonces, ¿qué es lo que tenemos que hacer ahora?

D: Va a necesitar un especialista de la retina, para reparar el desgarro en la retina, y para aplanar el tejido retinal.

P: Está bien. ¿A dónde voy?

D: (le doy un pedazo de papel) Aquí he escrito el apellido de un especialista de la retina con una oficina local. La dirección está ahí también.

P: ¿Él acepta el seguro que tengo?

D: Sí. Voy a decirle a la secretaria a llamar la oficina para informarle al médico que viene usted ahora mismo.  No coma ni beba nada después se va de aquí. Es posible que el médico tenga que hacer cirugía, y necesita usted dejar de comer y beber para esto.

P: (al irse) Gracias otra vez, Doctora. Como le dije antes, yo sabía que algo estaba mal. Estoy aliviado a saber la respuesta que estaba buscando.

D: De nada. Me alegra que haya venido aquí. Pase un buen día.

P: Dios le bendiga.

D: Igual.

                                                                        *

D: I read the information from the nurse...it says here that you have symptoms of  “light flashes” in your peripheral vision?

P: Yes. Above, in this corner of my vision (he shows me with hand motions) I see flashes, like lightening, once in a while, and like bugs flying.

D: Do you know which side the flashes are coming from? –the right eye or the left eye?

P: When I cover my left eye, I don’t see them. But when I cover the right, yes, I see the flashes.

D: Since when, more or less, do you have these symptoms?

P: It’s been a year, maybe ten months now.

D: OK. You know that your eyes are dilated. I’m going to examine your retina.

P: It’s OK.

(some minutes later)

D: Well, there is an explanation why you have these visual symptoms.  You have in the peripheral retina of the left eye a shallow retinal detachment.  It’s located in the inferior retina, on the nasal side.  Thank God –because it is located in the inferior retina, you do not have a detachment of the macula, or the central retina. With this, you become blind.

P: I knew something was wrong. I have consulted many other doctors before you. Everyone told me that I didn’t have retinal problems. They told me that my symptoms indicated dry eye, and that I needed artificial tears to resolve the problem.  Then, what is it that we have to do now?

D: You are going to need a retinal specialist, to repair the tear in the retina and flatten the retinal tissue.

P: OK, where do I go?

D: (I give him a piece of paper) Here I have written the last name of a retinal specialist with a local office. The address is there, too.

P: Does he accept my medical insurance?

D: Yes. I’m going to tell my secretary to call his office and let the doctor know you’re coming now. Don’t eat or drink anything after you leave here. He may need to do surgery, and you have to fast for this.

P: (upon leaving) Thank you again, doctor. Like I told you before, I knew something was wrong. I am relieved to know the answer for which I was looking.

D: You are welcome. I’m glad that you came here. Have a good day.

P: God bless you.

D: And you as well.

Una conversación. Courtesy: ClipArt Panda