I
had often wondered how my Spanish-speaking patients feel when they go to the
doctor’s office and find out that their doctor doesn’t speak their language. I
would imagine: fearful, worried that they’ll be able to express their concerns
and that those concerns will be understood, worried that they’ll be able to
understand the doctor and his instructions in return. Perhaps they will feel
embarrassed, and even frustrated. Likely they will feel dissatisfied, knowing
they didn’t say everything they wanted to, because they trimmed their
conversation to the bare minimum – to what they thought the doctor would
comprehend. And they wouldn’t ask questions, because they didn’t want to sound
or look foolish.
Well,
I don’t have to imagine this scenario, because I experienced it first-hand
myself. It was when my husband and I went to Italy for our honeymoon. We spent
numerous days in Capri, Cinque Terre – lounging along the sun-kissed shores. But
all that lounging and strolling and shopping and sunbathing came to a halt when
one day I got sick. Fortunately, the hotel we were staying in had a doctor who
was on-call. I told the front office, “ Call the doctor immediately! I’m sick!
“, and they readily obliged. This hotel was in a popular area – heavily visited
by tourists, most if not all of which spoke English. The staff spoke English as
if it were second nature to them, so I expected the same of the doctor.
I
was lying on the bed in the hotel room. A knock sounded on the door and in
walked an older gentleman with a black leather bag in one hand. His name was
Dr. Buonocuore. Goodheart, in Italian. And he seemed to have a good heart. His
hair was white and he was portly, and he had a grandfatherly air about him
which was instantly calming. He gave me the sense that everything would be OK. I
started talking to him immediately. Being a doctor myself, I wanted to give him
all the pertinent information to make the diagnosis (I already knew my
diagnosis, but being in a foreign country, I unfortunately could not write my
own prescription there. Someone else had to do it).
I
talked about where the pain was, when the symptoms began, how they evolved and
over what period of time. I told him what I thought the diagnosis was – I told
him of my medical background. Every now and again my husband chimed in with
more details. And all this time Dr. Buonocuore looked at me intently, like he
was really listening, like he was really taking it in. I stopped talking and watched his lips part,
and I waited with anticipation for what he would say.
“
You are...incinta? Incinta?”
My
husband and I looked at each other. I don’t know what made me more frustrated:
the fact that my husband studied Italian in high school and obviously didn’t
remember a lick of it, or the fact that I just poured my heart out to this
doctor and he hadn’t understood a word!
“I’m
sorry, I don’t know what ‘incinta’ is. ¿Usted habla español? Yo puedo hablar español
con Usted.”
“No.
<thinking pensively> “You are....with...the baby?”
And
then I understood that he was asking me if I was pregnant or had the
possibility of being pregnant, because this would help him in his antibiotic
choice for me.
“Oh,
no. No baby. No plans for baby.”
“OK.”
<nervous laughter, writing something down on two slips of paper> “Take
this to pharmacy. This pill, one a day. Finish. This other pill, only if you
need.”
I
looked at the prescriptions, one I didn’t recognize. The other was for “Levoxacin”
which I could see was the equivalent of “Levofloxacin” available in the U.S.. I
thanked him profusely and he left. My husband went to get the meds. Sure enough
after one or two doses, I began to feel better. I was so grateful for this, and
relieved. So much so, that after I made a full recovery days later, my husband
and I brought a bottle of wine to Dr. Buonocuore’s office. I thanked him again,
not entirely sure if he remembered me. Few words were spoken, but I think I got
the point across.
Needless
to say, after this experience I became especially sensitive to the issue of
language barriers in healthcare. I have said many times before in this blog
that medial lingo in and of itself is frightening and confusing for patients,
never mind if another language is thrown into the mix.
I
recently found an intriguing article online entitled, “Si el Pediatra no Habla
Español”, written by Carolina S. Clauss-Ehlers. In it, the author recounts true
experiences of mothers who need to bring their children in for medical care,
but cannot communicate with the doctor due to a language barrier. In one
scenario, a mother woke up to find her child vomiting and with diarrhea and
rushed him to a New York City emergency room. She was already frantic about her
son’s health, but became doubly worried when she realized that she could not
speak with the doctor. She found a bilingual Puerto Rican woman in the waiting
area that agreed to help interpret for her and the doctor. She was so grateful
to this woman for her help, but still felt a sense of dissatisfaction. As she
put it, “It isn’t the same thing as speaking to the doctor in my own words –
imagine if this woman had translated something incorrectly!”
Other
mothers in the article talked about how they try to get around the language
barrier if no interpreter is available. They ask the doctor to speak slowly and
to repeat the phrases that they do not understand. Sometimes they use body
language – pressing on the ear of the child to localize the source of the pain.
The author also interviewed doctors, asking those who only spoke English how
they handled working with Spanish-speaking patients. Answers included employing
interpreters, Spanish-speaking nurses, technicians and support staff and
looking at the facial expressions of the parents to gauge degree of worry and
severity of symptoms.
One
mother described very plainly the dangers of lack of communication. She talked
about how she would always bring her husband, who is bilingual in English and
Spanish, with her when she had to take their child to the pediatrician. On one
such occasion, her husband could not accompany her due to work-related issues.
She tried speaking English with the doctor, but knew very little. What she
really wanted was a prescription for a certain medication for her son, but the
doctor didn’t understand and therefore didn’t give her the prescription.
Ultimately she had to return to the office the next day with her husband to get
the prescription. She felt badly about it, saying, “Imagine if it was something
serious and I didn’t get the medication right away?”.
Health
care is a field where it is of utmost importance to the patient’s well-being
that the doctor understand exactly when & how the symptoms began and how
they are evolving in order to properly examine, diagnose and treat a patient.
If there is limited communication due to a language barrier, then a limited
exam is performed and the patient suffers. It is the ideal scenario if the
doctor can speak the language of his patients, but this isn’t always possible.
Language learning is a lifetime of learning. We all find ourselves at different
stages of that journey. Until language skill catches up to the medical demands
at hand, doctors need to have appropriate staff, interpreters and translators
present to ensure continuous and thorough communication with their patients,
whose life and health depend upon it.
Reference
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