“People who ’emigrate’ from the land of the healthy to the land of the sick have much in common with people who emigrate from one county to another. It is a new culture, with its own language, customs, and mores. Doctors are, in many respects, interpreters of the culture of medicine.”
So writes Dr. Danielle Ofri, author of Medicine in Translation and a practicing physician at Bellevue Hospital in New York City. A year spent in Costa Rica made her acutely aware of the problems faced by patients who don’t speak the language of their doctors, who must interpret the language of medicine in another language all together. In an essay on her site, Found in Translation?, she recounts her search for a common language with a Congolese patient.
Years of French study had left her speechless in front of her Francophone patient, Mr. Mezondes (a maddening experience shared by any student of language away from the classroom):
“I gestured for him to sit down, and tried to signal a polite, “just a moment,” as I started down the list of options. First was calling the office of our volunteer interpreters.
“Sorry,” the person answered, “our French interpreter is no longer with us.” I hoped he had merely quit his job and not reached an untimely end.
I asked around in the waiting room, but nobody spoke French. I surveyed the clinic staff—only Spanish and Chinese to be found. Back at my office, I resorted to the final option and called AT&T. When a French-accented voice graced my ear, I exhaled a sigh of relief.”
How disappointed I was to read those lines! That the good doctor would prefer an amateur or an ad-hoc cultural broker-type over the professional service we so proudly provide — to use a trained linguist only as a last resort…
Surely it must be safer, and the communication more accurate, to use a full-time professional, but as they passed the receiver back and forth, she felt as if she was talking to the telephone interpreter rather than her patient:
“It was more like we were each having a conversation with the polite but business-like interpreter. And that’s what our conversation was: polite and business-like. I asked the questions, he supplied the answers. I kept my utterances brief, not wishing to overload the operator and I sensed Mr. Mezondes doing the same. I was also cognizant of the cost of the services, so I tried to be as efficient as possible.”
Perhaps a dual headset could have helped? That’s what people tell us. But our best practice did not facilitate this physician’s practice of medicine. The personal touch was absent, even if diagnosis and recommended treatment were efficient and successful, and communication clear. After all, that’s what’s important, right?
I got this feeling in my gut. Not over this story, but kidney stones, I think (I’ll get the scans tomorrow). It took the urologist and me about 90 seconds to sort this out over the phone today, whereas it would have taken about four minutes with a telephone interpreter relaying for us in two languages. So no heart-to-heart talk, but no problem in terms of care either. Overall, a good medical outcome, right? (Except for the stones, which really, really hurt.)
But I know what Dr. Ofri means. When I see Dan Adler, my own internist, he works with equal dispatch, but there is always some time to hole up in his office for a bit and trade hunting stories, which is how he knows me and part of how he cares for me.
So the transaction between physician and patient is a matter of heart too, and our interpreters, no matter how diligent and accurate, are too distant to carry that message, cupid-like over bed sides. Best practice sometimes comes at a higher price than a per-minute rate.