Each Thursday, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.
Barry Saver, MD, associate professor of family medicine & community health, residency faculty member at Family Health Center of Worcester and active department researcher, reminds us what a little respect for a patient's ethnicity, culture and language can do for the physician-patient relationship.
It was another busy day in clinic, with nothing going exactly as scheduled. I had been held up waiting for a Vietnamese interpreter for another patient and was running behind even more than usual. I had already poked my head into the exam room a couple of times to apologize for being late and to say I would be there soon.
When I finally came into the room and sat down, he ended his cell phone call and we began to talk. I had informed him a few months earlier that his tests showed he had impaired fasting glucose—not quite diabetes, but getting there. Before that, I had informed this healthy man in his 40s of his slightly elevated cholesterol and low HDL. He started telling me about the changes he had made in his diet. He paused. Then, he asked me, “Why are we speaking in English? Before, we always spoke in Spanish.”
I tried to remember our previous encounters. “I’m sorry. To be honest, I didn’t remember that we had spoken in Spanish before. I was in a rush and, when I said something in English and you responded in English, I just continued. Actually, your English is much better than my Spanish. I think we’re better off speaking in English than with me struggling with my bad Spanish.”
Not having foreseen the path my life would take, I had studied French in school. When I started having Spanish-speaking patients in medical school, I took a once-a-week medical Spanish elective that lasted a couple of months. I tried to look over a Spanish grammar book every now and then, along with lists of “medical Spanish” words—dolor, estómago, corazon, and the like. I invented Spançais—if I didn’t know a word in Spanish, I tried to guess what it might be based on the French I knew. On my OB rotation as an intern, I learned a specialized vocabulary— bolsa de agua, calambres, ¡Empuje! I reached the point where I could get through a delivery in Spanish, but would probably starve to death in a restaurant. (“Would you like your placenta roasted or fried, Señor?” Over the years, I gradually learned more; sometimes I was the only “Spanish-speaking” provider where I worked, with no interpreters available. I reached the point of sounding like a very precocious three-year-old—good technical vocabulary, terrible grammar. At times, I would apologize to my Spanish-speaking patients for my bad Spanish and receive thanks in return for speaking any Spanish at all.
Thus, there was no reason any sane patient who spoke reasonable English would want to converse with me in Spanish. However, after pausing for perhaps 30 seconds, this apparently rational patient said, “When it comes to my health, I think I would prefer to speak in Spanish.” We finished the encounter in Spanish. And I have remembered to address him in Spanish on his subsequent visits.
I still think my patient is nuts to prefer my Spanish over his English. However, it is clearly more important for him to use his native tongue when thinking about and discussing something as important as his health. I have tried to pick up a new tense or two by looking at an old Spanish textbook. Recently, a patient whom I had not seen for a couple of years commented, “Oh, your Spanish has gotten much better!” When I ask a Ghanaian patient with diabetes how much fufu they eat, it evokes a big smile, even if the answer is, “Too much.”
I have worked with interpreters for many languages and have enormous respect for the value of a good interpreter. But I have also learned the value of learning even a little of a patient’s language (and, hopefully, culture).