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