Do You And Your Patient Speak The Same Language?
By Zoe Kiren Deol, MD, FACS
Most every physician I know has hilarious stories of doctor-patient encounters where the patient, when asked his or her medical history, had trouble conveying the name of a medication or procedure that they had taken or had undergone. I distinctly remember my first such encounter with medical translation. I was a general surgery resident, working in the ER. I was taking inventory of a woman’s past medical history. As I jotted down “high blood pressure” and “arthritis,” my eyebrows shot up when she announced that she also had “sugar” as a disease.
At first, I thought to myself, “Good God man …. this disease has probably infected the entire city of Hershey Pennsylvania by now!” But, instead, I quietly wrote “diabetes” on her inventory. However, the real shocker was when she ended her list of complaints by exclaiming that what had brought her to the emergency room was a case of “Barnacle Asthma”. For a split second, I thought this must be something one can catch from deep sea diving. Then it dawned on me that she was referring to “bronchial asthma” …. much more common, but much less interesting. Can you imagine doing a bronchoscopy on the former condition? Instead of mucous membranes, you would see beautiful shades of coral!
After a few months, I had perfected my history taking skills, and I was able to translate on the fly with virtually no giggling whatsoever. That is ….. until a married couple I’ll call “Chester Cheetah and his wife ChiChi” came in. Chester Cheetah resembled his namesake: a cool cat, leaning up against the wall, in what appeared to be a smoking jacket. His wife ChiChi, however, looked worse for wear. Jaundiced and clearly dealing with a belly full of ascites, she was the reason they had come to the emergency room. Being the good cheetah that he was, Chester answered all the medical history questions I posed to his wife. Chester tried to maintain his cool as he struggled to make his way through the obviously unfamiliar territory of medical terminology. Like any good cat, whenever he stumbled, he would quickly right himself and then brush a paw through his hair to demonstrate that he was still in control.
As we approached the questions about prior surgeries, Chester became anxious and started to prowl back and forth, running his hands through his hair more and more frequently. He admitted that she had a previous surgery, but went on to mumble something like, “You know…. she had one of those things done …” I looked through her GYN history for evidence that she may have had a “female procedure” which Chester was clearly uncomfortable talking about. However, no evidence pointed in that direction. Chester finally gave up and motioned for me to come closer so he could whisper to me what she had done. I will warn you that this is “R” rated, so I am intentionally editing this. Chester lowered his voice so that it was barely audible, and confessed to me that his wife Chi Chi, “…had herself one of them Portable Shavable Cu__ts”.
I must say that it took me longer than I care to admit to stop laughing long enough to write down, “portal caval shunt. But I eventually regained my composure well enough to present the case, verbatim, to my attending who, without blinking an eye responded, “I’ve been looking for one of those for years!” I informed him that they could easily be found at the local spa, where a Ukrainian woman spoke Brazilian.
These language barriers make you wonder what picture of health your patient paints in their mind as they leave your office with a mouthful of unfamiliar words. The natural tendency is to “auto-correct” much like your iPhone does as you are texting. Almost every word gets converted to something more familiar. Is it any wonder that patients don’t really understand the risks and complications of a procedure when they think that their cervical fusion is a way to reclaim their virginity? In order to accommodate my patients, I often found myself translating to their language as I spoke to them in my office, or when I gave seminars in the evenings to prospective bariatric surgery patients. After speaking in lay terms for any length of time, you begin to feel like an immigrant who is loosing their native tongue. I found myself drawing a blank on the correct word for choledocholithiasis, and instead referred to it simply as “stones in the pipe” as I spoke to a colleague. So, how do you effectively communicate with your patient without compromising your verbal integrity? The key lies in adopting the local lingo while still living in your native ethnic neighborhood.
As a solo practitioner, I was somewhat isolated from my native medical language. With the exception of the annual trip back to the “old country” for surgical conferences, I spoke in lay terms on a daily basis. On the flip side, those doctors who refuse to learn the local lingo run the risk of losing patients due to a lack of communication skills. So, there is a happy medium and much like everything else in life, it lies in your ability to achieve a balance. After all, would you go to a surgeon who wanted to remove you ear lobe to treat a case of lung cancer?
Do you speak the same language as your patients? E-mail firstname.lastname@example.org
Dr. Deol is a self-employed, board-certified general surgeon.