Working in both hospitals and courts, I sometimes wish I had a judge to order the doctors about at the hospital. How convenient that would be! I could use an arbiter who could direct the doctors to slow their rate of speech, repeat their last utterance, rephrase a convoluted statement, or pause appropriately for consecutive interpreting for a question and answer session (instead of talking over me and confounding matters!) A judge could issue a general ruling that doctors stop interrupting me while I am doing my job. Or issue an absolute prohibition on doctors trying to do my job when I am so strictly prohibited from encroaching on the practice of medicine. Fair is fair! And a justice would understand the justice. Alas, I am on my own with no one to turn to when doctors behave badly. So I have to do my best under adverse circumstances, and decide in each case when and if to stop the session and attempt on my own to direct the medical staff so we can have more adequate communication and understanding.
Today in court was one of many routine occasions where I enlisted a judge to order a speaker to improve their manner of speech. This time, it was a new prosecutor who spoke very softly while pouring out a veritable gush of staccato words in her rush to present one of her very first cases. It was clear that she was not aware of her speech pattern although everyone else in the courtroom surely was. But thanks to being in court and not the hospital, I didn’t have to stand by wondering how to tactfully guide her into better communication. In court, I had the luxury – and the recognized right – to simply interrupt her by calling out, “Your Honor, the interpreter cannot hear the prosecutor and requests that she repeat her last utterance, speak up, and slow her rate of speech!” The judge so ordered, and we started over. Wouldn’t that be nice in a medical appointment? To have an actual judge in our corner!
In my experience, when doctors go into verbal overdrive, it is not so much nerves as hurry that causes them to squeeze words into small spaces and then either hammer them home or cut them to pieces. One solution is to switch to simultaneous and simply render the doctors’ words while they are still speaking. But for those patients who speak and understand some English, they are apt to reach cognitive overload and cannot parse out the interweaving threads of the two languages spoken at the same time. It can be confusing for doctors as well, some of whom have told me that they “cannot think while you are talking!” The standard for most medical centers is to use consecutive across the board, but for that to happen, the doctors need to pause regularly and cede the floor to the interpreter. In lay terms, the doctors need to “let the interpret interpret”. Sounds elementary, but I would literally need a judge and a court order to make some doctors do it. They are in their own world, and sadly it is one that tends to exclude their patients by obstructing clear communication.
The situation is exacerbated when some care providers understand some – but not all – of the target language, and start interrupting and talking over the interpreter before I can get the words out. Like an eager squirming child raising their hand in school and calling out while the teacher is still talking: “I know the answer!” Some doctors don’t seem to understand that from the patient perspective, when they interrupt me while I am conveying what the patient just said, the patient consequently feels interrupted. Why? Because the patient cannot possibly know how much is understood by the doctor without full interpretation, so the patient naturally feels cut off every time that I am cut off. The patient feel disrespected. Once that happens, the patient grows quiet, disengages, and doesn’t ask any more questions. How could they dare to when the doctor keeps cutting off their words, just as they are about to arrive – just as they are literally in the process of being conveyed into the doctor’s language?
I had a doctor the other day who spoke a language close to the target language and kept guessing ahead, not listening to the interpretation, and cutting me off. The patient had come in hoping to ask questions about the dire things he had read on the internet about the proposed treatment for prostate cancer. To start, he said with great fear in his voice: “I read that my penis could be dead and my kidneys could fail.” Before I could even convey that much, the doctor had raised a hand to interrupt me (but was of course interrupting the patient) while loudly exclaiming, “No, no no! That won’t happen! No!”
The patient was immediately shut down, and could not fully discuss what he cared most about, because the doctor had already moved on. So he just sat and listened resignedly with a deer in the headlights look. At the end, the doctor wondered if he had any questions. What the patient was too uncomfortable to say was: “Uh, no, doc. I just offered two questions but you shut us up by yelling no and waving your hands at us, so no. Never mind me. I can just keep waking up at night in a cold sweat, worrying about the things you didn’t have time to hear me say. Worried sick that I will either lose my life or lose what to me makes life worth living. No questions. I’ll just go back to the internet and try to figure it out myself, thanks.”
Now, I get the doctor. He had other patients waiting. He was feeling rushed. He was frustrated by his own lack of language skills, and he understood the patient to some nebulous extent. But what I also know is that his frustration was only partly due to his scheduling. It was also due to his subconscious resistance to (and shame about) needing an interpreter. And subconscious class prejudice in judging the patient for immigrating from a poor country without any education, and not learning English. Thus he vigorously interrupts me to signal that he already knows the gist of what the patient is trying to say. He knows! He is competent! Let’s skip it and move on! Close enough! He doesn’t take a moment to realize that his patient is having a very different experience. And with all due respect, the patient would love it if the doctor would just shut up for once and listen to the patient, through me. The patient wants carefully considered answers, not an offhand dismissal. His fears remain foremost.
The patient is uttering his deepest concerns and needs clear answers. He is talking about a very central organ, his precious family jewel, and the loss of his male identity. He is talking about becoming disabled, needing dialysis, and other scary, life-changing possibilities. He is being brave and vulnerable. He deeply fears the answer to his high-stakes questions. And the doctor’s manner of response to his questions and concerns is of utmost importance to him. Too bad the doctor, for all his learning, has not yet learned that the very first thing that patients using an interpreter wish to hear is their own question, their own statement, their own words, conveyed safely into the ears of the care provider, in words that the care provider can understand, by yours truly, the humble yet kick-ass interpreter. Getting their fears and doubts across is such an offload of care and worry – such a relief! Seeing it happen, watching the delivery, is hugely important.
Dear interrupting and hurrying medical care providers. God bless your fragile little hearts. Please be aware of the complete lack of respect you show when in your hurry, or in your eagerness to display your knowledge, you cut off your patient’s interpreter. You don’t have to arm-wrestle us for control of the communication. Try to think of it as a shared dance rather than attempting a submission hold in a mixed martial arts contest. The interpreters are not talking simply to display our knowledge and make you feel inadequate. We are conveying what our patient wants to say. Never forget that they have no way of reading your mind as to what you may (or may not) have understood (or misunderstood) before you interrupt and talk over us as we convey their words and thoughts. So let us do our job. Let us get their words across to you, whole, unharmed, and uninterrupted. Your answers will mean so much more to them if you do.