Saturday, December 30, 2017

Listen First, Read Later: Back at the Beginning

It’s hard to speak fluently if you spend all your time reading in silence.
                                                                                                            -Denis Ivanov

When you’re first learning a language, it is better to hear it first before you see it in written form. You want to be able to associate the objects in your environment with the sounds that represent them. Otherwise, when you see something around you or hear something,  you will first have to think of the word in your mind, then you must translate it, then lastly you think of the object being referenced.

Did that make sense?! Let me explain...

To give you an example, I’ll start with my own experience. My primary language is English. When I started learning Spanish at age eleven in school, I learned the Spanish words that coincided with English words, usually presented in long vocabulary lists like this:

the table=la mesa

the couch=el sofá

the chair=la silla

and so on and so forth.

I read the words in a vocabulary book. And, yes, we (the other students and I) read them aloud, too, but seeing the lists was the first introduction to these words. It’s not as if the teacher pointed to a chair and said simply, “silla”. We didn’t look at a chair and see in our mind’s eye “silla” and hear in our inner ear “silla”.  Instead this is what we saw:

silla ---> chair

I’m thinking back to some of the first English words I remember learning as a young child. No, it wasn’t “mom”, or “dad”, or a color of the rainbow, or a barnyard animal. It was “George Washington”!

I mentioned early on in this blog (see the entry Beginnings)  that I grew up in a two-family home with my parents and my grandparents (maternal). When I was a preschool-age baby, my parents and grandmother were working full-time, but my grandfather was retired. He was home and took care of me until my mother got home from work. My grandparents were very big on colonial America. They had some form of yester-year memorabilia in every square inch of their house: a Paul Revere statue, a Thomas Jefferson decanter, a replica of the Liberty Bell, and, of course, a rather large wall plaque of George Washington. My grandfather carried me on his shoulders, pointed to the objects and said their names. “George Washington. George Washington.” But remember, every time he said those words, I wasn’t seeing the actual words “George Washington”. I saw this:



 
The fact of the matter is, when we are exposed to language before we start school, we never see the words we learn. We learn the sounds that describe the things in our environment. We hear a sound and we know instinctively and immediately what it is. We can see the object, and practically taste and feel the object. That’s language. That’s communication.

But later on in school, we see what these sounds look like on paper and we learn to read and write. And we continue to read and we continue to pick up new vocabulary this way.

The problem is, this is not true language communication. This is why it is so hard for students learning a second or third language in school to communicate with native speakers of that language – even after years of school-based study.

Donovan Nagel, creator of The Mezzofanti Guild, a website dedicated to linguistics and language learning, explains this concept more in-depth in his blog article, “How important is reading for learning to speak a language? Not very. Here’s why...”. He states that, “Language is 100% spoken. What we read...on paper is a representation of those sounds.” As a result of this, he goes on to say that simply reading words will not make you a fluent speaker (and I’m adding here, will not make you a good listener, either).

Mr. Nagel continues in the article, encouraging language-learners to practice a skill known as “chunking”.  This means, listening to audio conversations in the target language repeatedly (without reading!) and trying to use what you hear before you even understand the grammar or every vocabulary word. He insists people would have much more success on the road to fluency using this method instead of reading and memorizing the written word.

What Mr. Nagel has to say in this article rings very true to me, and I’ll explain why. As I said, I started my Spanish studies at about age 10 or 11. I learned vocabulary by reading long lists of words written in Spanish, along with their English counterpart. My studies continued that way- all with written text in Spanish- throughout junior high, high school and college.  I had memorized quite a bit of vocabulary and felt that I really knew the language well. But the moment people started speaking Spanish, I could barely understand them. Instead of understanding the foreign sounds coming out of their mouths, I saw a few words here and there that I could pick out. Words that I had to first translate in my head into English before I could understand. Said a different way, the sounds had no meaning to me, even though I knew what the words meant. This is because my language education focused too much on what was written down, and not enough on oral expression.

Frustrated, I often thought to myself, “When will I reach a point when I won’t have to think so hard when I’m having a conversation in Spanish? When will I understand naturally? When will I respond only with my thoughts and feelings and not have to think about the words and the sentence structure?” Well, after reading Mr. Nagel’s article and reflecting on my own experiences,  I finally have the answer to those queries: never.

...at least not until I let go of what is written down and instead simply listen to what is being said.

This is truly a eureka moment for me! In essence, I’ve been studying Spanish (written, written, written) for 31 years and though I communicate better now in my 31st year than in my 1st year, I still feel at a loss in some spoken conversations. I always felt more comfortable reading and writing the language, which is why I feel much more competent as a Spanish translator rather than a Spanish interpreter. And I spent years thinking it was because my brain was wired to understand written language better. I blamed a genetic flaw. A genetic tendency.  (There were for a time –now disproven- education theories that stated that some people learn better by reading/writing vs. speaking/listening. No study has ever proven this to be true. Now we know the reason.).

Granted, during our first few years of life, ie. birth through 3 yrs of age or so, our brain is pruning away unnecessary connections, removing redundancies and leaving behind neuron connections that serve in our survival. When we grow up around one language, our brain maintains neurological connections to understanding the sounds involved in communicating in that language, and eliminates foreign sound connections. This is the reason why learning a language after this neurological “plastic” period – as older children or adults – is difficult to become accustomed to hearing new and different sounds and conversation flow of a foreign language. But this can be overcome, simply by doing more listening and more familiarizing oneself with these new and different sounds. It is not the primary reason why communicating in a non-native language is difficult. The real reason is: we must associate objects with sound first before we associate them with their written representations.

It is now the end of 2017, a time when we make our new year’s resolutions. In 2018, I am going to resolve to do much more listening and speaking to increase my communication skills in Spanish and the other languages I want to learn. It is my hope to add French to that list, as well as Croatian, the language of my husband and his family.  Linguistically, I am going to turn back the hands of time and be a child again, doing the only thing a child can do in an effort to interact with her environment: hear, listen, mimic and speak.


What are your language goals for 2018?  


References

Ivanov, D. (2015, July 9). 9 beliefs 99 percent unsuccessful language learners have. [Web log post]. Retrieved December 30, 2017, from http://www.learningtoknowrussian.com/2015/06/9-beliefs-learning-russian-marathon.html

Nagel, D. (2015, July 2). How important is reading for learning to speak a language? Not very. Here’s why... [Web log post]. Retrieved December 30, 2017, from https://www.mezzoguild.com/reading/#

Tuesday, December 12, 2017

Patient Correspondence Letter 2

This is an example of a letter I wrote on behalf of a fellow general ophthalmologist, my practice colleague, for his patient. The patient, a young woman, was found to have papilledema during a routine eye exam.  For any non-MD readers of my blog, papilledema describes a condition of bilateral swollen optic nerves as a result of increased intracranial pressure. This is a dangerous condition that if left untreated has very negative implications on not only the patient’s sight but on the patient’s life. As a result of this finding, she was promptly referred to a neurologist for the appropriate testing and management. Unfortunately, the patient never kept the neurology appointment and the administrative staff  made the referring ophthalmologist aware of this.

In these cases, it is very important to reach out to the patient and explain, once again, the importance of following up with the treatment and management of such conditions. The patient here needed to understand that her eyes—and her health—were at grave risk.

When sending such correspondence letters, the communication should be done in a language the patient understands. As this patient was Spanish-speaking with limited English proficiency, this letter was written in Spanish plain language (aka non-technical Spanish language).  For purposes of this blog entry, I have provided a translation of the letter in English as well.

*names have been changed for privacy purposes

Estimada Sra. Méndez*:

Recibí recientemente un informe de la Dra. Smith*, la neuróloga.  La carta me informó que usted se suponía tener una cita de revisión con ella después del examen conmigo, pero le faltó la cita.  Usted recuerda nuestra conversación durante su examen aquí, cuando le dije que usted tiene nervios ópticos bien inflamados y hinchados.  Esto significa que usted tiene alta presión dentro del cráneo y necesita más pruebas por la neuróloga (incluye una punción lumbar) y medicamentos para tratar y curar esta condición.

También, la Dra. Smith me dijo que usted no ha recogido de la farmacia las pastillas que ella le recetó. Ella me dijo que ella ha tratado llamarla muchas veces, pero no podía contactar a usted.
Esta presión que tiene en el cerebro es muy peligrosa para su salud y la salud de sus nervios ópticos.  Si no recibe el tratamiento para bajar la presión del cráneo, puede quedar ciega por esta condición.  Por favor, le ruego que llame usted la oficina de la neuróloga inmediatamente cuando recibe esta carta, para hacer el examen de la espina y la punción lumbar y también, le solicito que recoja los medicamentos de la farmacia.

Después de que empieza usted el medicamento y tiene el examen de la espina, necesita regresar aquí por otro campo visual para hacer un examen de seguimiento de los nervios ópticos. Si tiene preguntas, llame esta oficina en cualquier momento. Si nos necesita para hacer la cita para usted con la neuróloga, nos complace hacer esto para usted.

Gracias por su paciencia y atención en este sentido. Recuerda, la salud de los ojos y del cuerpo están en juego.

Sinceramente,
Dr. Johnson  

                                                                        *


Dear Mrs. Méndez:

Recently I received a report from Dr. Smith, the neurologist.  The letter informed me that you were supposed to have a follow-up appointment with her after your exam with me, but you missed that appointment.  You remember our conversation during your exam here, when I told you that you have very inflamed and swollen optic nerves.  This means that you have elevated pressure inside your head and you need more tests by the neurologist (including a lumbar puncture) and medication to treat and correct this condition.

Also, Dr. Smith told me that you have not yet picked up the tablets from the pharmacy that she prescribed for you. She told me that she has tried many times to call you, but has been unable to contact you.

This pressure that you have inside your head is very dangerous for your health and the health of your optic nerves.  If you do not receive treatment to lower this pressure, you can become blind from this condition.  Please, I ask you to call the neurologist’s office immediately when you receive this letter, to have the spinal exam and lumbar puncture, and I ask that you also pick up the medications from your pharmacy.

After you begin the medication and you have your spinal exam, you need to return here for another visual field test to follow up on the optic nerves.  If you have questions, call this office at any time. If you need us to make the appointment with the neurologist for you, it would give us pleasure to do so.


Thank you for your patience and attention in this matter.  Remember, the health of your eyes and your body are at stake.

Sincerely,
Dr. Johnson

The Eye Exam 2017