Medicine Mensch goes (Poly)Glatt
Number seven in a series.

Visiting Patients, With Dictionary In Hand
By Zackary Sholem Berger
July 1, 2005

Before I became a medical student, I thought I spoke Spanish pretty well. I spent six months after college researching minority languages in Spain and, after moving to New York, I've had many a friendly conversation with miscellaneous Spanish speakers I've accosted: random passersby from Puerto Rico, law students from Colombia, grocery packers from the Dominican Republic.

Having a conversation on the street or a chat in a café about politics or literature is one thing. If you don't understand a word, you can smile or nod and pick up from context what's going on. But say you've been called down to the E.R. to take a history and do a physical, and you find a drunk, toothless man in handcuffs gesturing frantically at something underneath his bed. If you could understand drunken, toothless Spanish a little bit better, it might not take you 15 minutes of sympathetic listening to understand that the man wants his cell phone (which the cops sitting nearby are not about to let him have).

The difficulty isn't simply a matter of decoding the speaker's register (someone from a different socioeconomic class can be hard to understand, even in one's native tongue), nor is it the fact that various dialects of the language are represented at any urban hospital. It's often the words themselves that make things hard. Like every other medical student, I have a command of several different kinds of medical terminology: the mind-numbing jargon of the scientific literature, the half-macho talk of rounds and last but certainly not least important, the normal words people use to talk in English about whatever's the matter with them.

It's this last kind of vocabulary that I lack in Spanish. I can talk a blue streak about genetic predispositions and infectious agents, about endoscopies and anesthesia — these are international terms, much the same in Spanish, English and many other languages. But lay language is different. I've already experienced a certain kind of linguistic blockage more than once. I've started a conversation with a Spanish-speaking patient, we've built up something of a rapport, she's complimented my Spanish, I've figured out why she's come to the hospital. Then, all of a sudden, I need to ask a specific question to narrow down the field of possible diagnoses. I use what I think is the right word, and one of two expressions appears on the patient's face: either outright incomprehension, or a polite glazed-over look that means, "I'm going to keep my mouth shut until I can figure out what the heck this nice doctor is saying." It's then that I have to search my dusty old neurons for a Spanish word I learned once, many years ago, or for a synonym that's used in the home country of this particular patient. During one memorable conversation, a patient and I sat through a long, awkward pause before she figured out that I was asking about her period.

Those familiar with the overscheduled life of the medical professional might wonder what's the point of trying to achieve "medical fluency" in Spanish or another foreign language. For most doctors it might be enough to master a minimal vocabulary, and the extra minutes spent figuring out the Colombian word for "tampon" or "leg splint" can more profitably be devoted to a more extensive history or exam of the other dozen patients that have to be seen today. It's also true that a translator is (usually) available. That's if one wants to take the legal route. Many doctors use the Spanish-speaking janitor, or the patient's sister who's waiting in the lobby; neither alternative would be applauded by medical ethicists.

It all depends on how the doctor sees her practice. If her task is to see clients who are visiting for necessary medical services, they probably can be more efficiently served (not to say "processed") with minimal communication. Many common complaints can be divined from the patient's presentation and demographic with only the bare outlines of a conversation. If this approach isn't warm and personal, it's certainly necessary when there are hundreds of patients to see in a week.

But since I'm still a medical student, I can still afford to let my personal tendencies influence the way I see medicine. I'm a person who doesn't mind sacrificing a little efficiency (or even a lot) to get a good conversation going with the person sitting in front of me. Will that make me a better doctor? Beats me, but I know I'll have more fun this way.

"You can't learn every language," a medical student friend of mine pointed out when she heard about my linguistic ambitions, i.e., trying to learn some Chinese. Many people at Bellevue know some stock Chinese phrases, but if I can avoid it I'd rather not storm into the hospital room of an 80-year old man and blurt out the Chinese version of "Did you piss today?" Most medical students wouldn't be caught dead asking an older person that question in English; clearly there must be another way to do it in Chinese. And I'm still trying to find the Yiddish speaker who doesn't assume that accented English will impress me more than mameloshn.

If you happen to speak English, I will make every effort to accommodate you once I'm a physician. Please realize, though, that since I'll be a doctor, my handwriting will be illegible — in any language.

Still a medical student, Zackary Sholem Berger has a bunch of dictionaries at home, but he never can seem to remember the word he needs. When he's a physician himself, he can have a medical student look everything up for him. Send him questions in the language of your choice at doctor@forward.com.