Yesterday, I was ushered into a room with an elderly woman and a young male resident. He immediately dismissed me as interpreter, telling me that he speaks her language. I told him that I shall stay and interpret for the actual surgeon when she arrives. He repeated that he doesn’t need me. But I stood by anyway. Then he launched into a barrage of complex language, rapid-fire and sprinkled with his own local slang. After all, he is a native speaker. So why is this a problem?
Number one. The patient could clearly not understand him. Number two. The resident did not pick up on the very obvious fact that the patient could not understand him. Number three. The patient felt “put in her place” by the young male doctor’s use of the informal “you” which is NOT how one addresses an elder, and further taken aback by his hurried and confusing speech. Thus, the patient was not made comfortable to ask questions, or even say when she could not understand. The patient was further judged about not working outside the home, and being overweight. On paper, we all speak the same language. Box checked. We even “brought in” an interpreter, who is sitting in the room. So no lawsuit. But really, can we be confident that we have informed consent for the upcoming surgery? I cannot. Because I was not allowed to do my job.
Here is the flavor of the resident’s word choice, in speaking to someone who left school in elementary. In asking what makes her pain worse, he asked, “What starts it on a chain of events?” The patient answers that she doesn’t know (because she doesn’t know what he means). Her answer starts the doctor judging her. Meanwhile, she is having a different experience. She is wondering what chain of whatever he is asking about, and she is feeling anxious. She is wringing her hands and clutching her bag. She is shifting in her seat. Why is the doctor impatient with her already? The doctor is shaking his head while taking notes, and talking quickly.
In saying they were going to have to talk more about her case with his attending doctor, this resident uses the word that in her speech community means to exchange words or to argue. Even more worrisome! He goes on to ask if she can “reduce” the hernia, and she thinks that means to make it smaller, so she says no. He asks if she has noticed any “brusque growth,” and again she says no because she doesn’t know what he means. He uses agile to mean quick. For an allergic reaction, he asks what the allergy “generates” and again not understanding, she again doesn’t know. He asks if she has hyperlipidemia and she says no. He gets impatient and tells her the chart says she has high cholesterol and she takes meds for it. He even asks if she has had any “fever or dogs” lately, because his local word for “chills” happens to be a common word for dog , pooch, or mutt in most places. Virtually every answer she gives is no or I don’t know. All the way to the end: Do you have questions? No. What do you expect from this appointment? I don’t know.
The resident truly had no grasp, not an inkling, that he was doing a poor job. That he was scaring the patient. That he was disrespecting the patient. That he is a horrible communicator. That he was getting “no” and “I don’t know” to all his questions NOT because she is stupid or stubborn or a bad patient or doesn’t care about her own health, but because she didn’t know what the hell he was talking about half the time. He exhibited zero sensitivity or awareness as to how the communication was going, and the appointment is for a surgical consent.
Part of cultural sensitivity is overall awareness and respect for the people we serve and acknowledgment of their humanity. Those of us who work as professional communicators are clear about this. Most staff consider us experts and professionals and thus welcome and integrate any linguistic guidance we can give them to keep open lines of communication. They understand that above and beyond our basic linguistic skills, we can pick up on subtle cues such as facial expression, body language, hesitations, unexpected answers showing confusion, fear, or misunderstanding, and they rely on us to monitor the quality of the communication throughout. This resident just plowed on getting no and I don’t know over and over, without once stopping or adjusting. He had words to deliver and he was checking boxes on the screen. He was doing his job as he views his job, but seemingly unaware of the patient as a real person having her own subjective experience.
Speaking of the patient’s subjective experience, here is an elderly lady who has worked hard to raise eight children and take care of them, and now helps out with her eleven grandchildren. As a matriarch who has dedicated her life to her family, she has earned their respect. She is looked up to as a very important head of her growing clan. This doctor walks in and his first move is to tell the interpreter – that the patient requested – to leave. Then he talks down to her in using the informal address. He is hurried and rushed and he talks over her in every sentence, using words she cannot understand, not explaining anything well, confounding her and limiting her ability to exchange needed medical history and information. Even in asking about her work situation, instead of asking whether she works “outside the home” which would be a standard culturally appropriate question, it goes like this:
“You work?” “No.” “You unemployed?” “No.” “You retired?” “No.” “Then what can’t you do?” “Uh, I don’t know.” He may have been trying to inquire as to the ways in which the hernia impedes her daily activities, but he never directly asked that and he never found out. She looked very confused and mumbled something about mopping, then looked to him for further help, which she did not get. He had already concluded that she was incapable of answering to his satisfaction. On his way out to get the attending, already standing in the doorway, he looked her up and down and asked, “Have you been to bariatrics? Do you even know what that is?” She said no. He walked out. Bariatrics, by the way, is the specialty clinic for weight loss.
While the patient and I were alone waiting for the actual surgeon, she heaved a big sigh and looked up at me for sympathy. I asked her if she had fully understood the young doctor, and she no. That she understood some, but not all, of what he was saying. He spoke so oddly! I apologized on behalf of the hospital for the miscommunication. I went over the list of the few terms I had had time to jot down in the rapid-fire resident interview. For example, I told her that when he asked if she had dogs he wanted to know if she had chills. She was surprised and enlightened by the terms we went over. She asked me questions, and I assured her that once the actual surgeon arrived, she could ask all her questions and get them answered in a way she could understand. I encouraged her that as a hospital, we do like our patients to ask questions and we do want them to understand. I am sorry to say that I assured her that I would be there and help her once the surgeon came, so we could get everything cleared up, because as it turns out, I was not allowed to do my job.
As soon as the doctors returned together, the resident again told me in English to leave, explaining that “I will be translating so you can go ahead and leave.” I did point out to the attending surgeon that their patient had not understood quite a few things and that she had not been able to answer appropriately as she had not understood. That she was having a hard time with his vocabulary and delivery style. I offered some examples. “She cannot understand you very well,” I said in conclusion. The attending surgeon smiled and thanked me, then told me to go ahead and go because she knows “interpreters are busy” and she will be just fine with her resident as her “translator”. I felt compelled to leave.
When I spoke to my boss about it, she asked me to write them up. Knowing it may be investigated along with other unsafe and unethical practices, I felt a little less “moral distress” which is defined as the emotional pain of knowing what should happen and being unable to make it happen. Basically watching something you know is wrong and being helpless to make it right. This patient’s body language and gestures spoke volumes, but nobody was listening. Except me. And when I pointed it out, I was dismissed. My heart is heavy thinking of this patient and her experience. A grandchild had taken the day off work and they had driven several hours for this long-awaited consultation at “the best” hospital with the “best” staff. I wish that she could have felt seen and heard, and been treated with the dignity and respect that she deserves.