Hello! ¡Hola!
By: Ripudaman Singh
PGY-2, Internal Medicine, Saint Peter’s University Hospital, New Jersey
Thursday is a happy day. Happy because it entails a half-day at work and a customary lunch with my co-residents. Post-lunch scenes include a panel of patients waiting to be seen and a mind which is recovering from that food overload. Last week, I kept my coffee on the counter as I picked up the pages for my next scheduled patient. Zeynep, the name sounded really nice to my self-acclaimed poet. As I enter the patient room, I see a tense, middle-aged woman with facial freckles hardly able to sit. I say Hello!, to which I get a nod but no vowels. This interaction was different from the other patients I commonly see who would express explicitly their allegiance to Spanish, mandarin or the Russian language. I glanced over the patient pages I picked and it mentioned “Turkish speaking”. Like the regular drill, I dial the interpreter service to find myself a translator. But unlike the other times, the wait time runs >20 minutes and I am helpless. Helpless to help the lady who is uncomfortable and dire in pain. Helpless to help myself and a stream of patients waiting to be seen post-her. The encounter finally finishes with me handing her a bunch of documents/labs/medicine lists which are all written in English. I asked her to come again in subsequent months for the drill to be completed all over again.
I learnt three languages growing up. And all three at times had translations which were very different and unique. The expression and tone would change, and so would the literal meaning. Now by any means, those three were not Spanish, mandarin or Russian as I grew up in the northern plains of the Indian subcontinent. Healthcare at times involves big words with even bigger meanings. While doctoring at times, I wonder if what I said was comprehensible first to the translator and if that translator was comprehensible to the patient. I try my best but language-related challenges in healthcare exceed expected numbers. It is easy for us to tell a patient that they have Diabetes but we never really know if they know what diabetes is. We ask them to get a metabolic panel but since when is metabolic an everyday word? Medical jargon is huge and contributes to a challenge amongst patients and providers with major cultural, language and medical proficiency differences. We wish our patients knew our day-to-day talk about vents, vancomycin and vertigo but alas, that is not how the general public talks. A study published in 2021 surveyed people attending a state fair where 91% of the respondents preferred doctors who communicated without medical jargon (1).
My clinic patient care technician is an efficient and caring person. She is bilingual and has helped me at times beyond mention. She acts as a part-time interpreter for me when the translator service hangs in technology or vocabulary (I owe her a lunch, but will address it later). Medical translators do a formidable job helping with the task. Let it be in-person, over video or via voice call. A PubMed article highlighted no difference in patient rating of remote vs in-person translation (2). Improving access to these technologies with reduced wait times and efficient conversation with persons or computers which equips even cultural AI can be a great step forward. A definite method will be the inculcation of more bilingual medical professionals. With the ever-ongoing shortage of staffing, there has to be further encouragement for underrepresented in medicine to join the community. Only 5.4% of the currently registered nursing force are Latinos while the U.S. Census projects an increase of Latinos in the United States to 28% of the total population by 2060(3).
Long way ahead to tackle these but I came across a few innovative initiatives. The Icahn School of Medicine at Mount Sinai introduced a course providing training in interpreting techniques and language skills to bilingual medical students. This program garnered high approval ratings by patients and student clinicians helping to tackle the challenges better while providing medical students with a unique skill set (4). MediBabble ® is another one. This app was developed by two UCSF-trained doctors and involves language translation with the questions starting from chief complaints of the patient to a physical examination coordination and even follow-ups (5). With the world becoming increasingly accessible, we might all need to innovate or practice most or all of the above as we continue to learn and unlearn in the practice of current medicine.
References:
1. Allen K, Charpentier V, Hendrickson MA, Kessler MM, Gotlieb R, Marmet J, et al. Jargon be gone – patient preference in doctor communication. Journal of Patient Experience [Internet]. 2023 Jan 1;10:237437352311589. Available from: https://doi.org/10.1177/23743735231158942
2. Locatis C, Williamson DE, Gould-Kabler C, Zone-Smith L, Detzler I, Roberson JR, et al. Comparing In-Person, Video, and Telephonic medical interpretation. Journal of General Internal Medicine [Internet]. 2010 Jan 27;25(4):345–50. Available from: https://doi.org/10.1007/s11606-009-1236-x
3. Cheshire MH, Cuellar NG, Figueroa-Delgado JM, Rojas P. A nursing workforce initiative: Increasing the Latino/Hispanic BSN workforce. Hispanic Health Care International [Internet]. 2020 Feb 17;18(2):117–20. Available from: https://doi.org/10.1177/1540415320904929
4. Medical students as certified interpreters. AMA Journal of Ethics [Internet]. 2019 Mar 1;21(3):E232-238. Available from: https://doi.org/10.1001/amajethics.2019.232
5. University of California San Francisco. UCSF medical students create free medical translation app, conquering language barriers to patient care | UC San Francisco. UCSF Medical Students Create Free Medical Translation App, Conquering Language Barriers to Patient Care | UC San Francisco [Internet]. 2011 Jun 22; Available from: https://www.ucsf.edu/news/2011/06/103822/ucsf-medical-students-create-free-medical-translation-app-conquering-language
Image 1 – getty images
