INTERRUPTING

A few problematic doctors just cannot help themselves from displaying extraneous and irrelevant knowledge in patient encounters.  My theory is that they were praised almost from birth exclusively for intellectual accomplishments.  I imagine the future doctor in the high chair being asked things like “what does the cow say?” and being fed extra bits of cheese in reward.  This unwarranted display of knowledge in the workplace is not exclusive to the medical profession, but it is a great source of irritation for professional communicators.  And please understand.  Our concern is not for ourselves, but for our patients.

Last week, a doctor was so eager to keep showing that she could understand some of what the patient said, that the dialogue went like this.  I am rendering it all in English, but of course the patient was speaking another language:

P: I started bleeding on Tuesday afternoon.  It was bright red.  I was scared.  My sister has miscarried. I told my husband, and he called the clinic, but they said to just come in today to this appointment.  Do you think something is happening to the pregnancy?

I: I started blee-

D: I know!  Tuesday, Tuesday!  But no cramping?

So……does the interpreter skip all the rest of the patient’s message, presuming if this genius knows the word Tuesday she also knows everything else the patient said?  Does the interpreter just skip the patient’s statements and question and move to doctor’s question?

Or should the interpreter raise a hand, and calmly begin the patient message over from the start?  Not knowing what all was understood, having been interrupted, and wishing to convey the patient’s urgent question, I chose the latter course.

I: I started bleeding –

D: I know!  Tuesday! (Waving her hand in the air like swatting flies.) Cramping?

Now maybe the doctor understood everything and maybe she didn’t.  But there are a couple things she does not understand, and this information might prove useful to improve the old bedside manner.  Take it from a professional communicator.

Dear doctor, when you interrupt the interpreter, you are for all practical purposes interrupting the patient.  Yes, it’s true.  The patient has REQUESTED an interpreter, which is her legal right, and she is sitting there, often scared, on edge, worried, and waiting to hear her words, or something of about that length, conveyed into the dominant culture’s magical language.  She is right there, doctor, having her own independent subjective experience of the appointment, and the whole appointment is about the patient’s body, the patient’s illness or health, and the patient’s experience.  If you insist on the business model, which most hospitals now do, she is the client.  She is the customer.

Second language learning takes us along a lifelong path from knowing nothing of the target language to being perfectly bilingual, an ultimate destination very few of us ever reach.  Patients who need interpreters are anywhere along this continuum.  Like all language learners, they understand much more than they can speak.  So while they cannot say exactly what they want to say, they will often recognize it being said in the language they are learning, and it is a great satisfaction and comfort to hear that interpretation.

These are their words – their thoughts – their questions, rendered into the dominant language.  Their body, their health, their dignity.  Need I go on?  Or do you need to interrupt me?  Please at least realize that by doing so, you interrupt your vulnerable patient, who is not here to inquire as to your second language skills, but seeks exclusively your medical expertise.  Can you really not see how you are disrespecting her?  How upsetting it is?  Please, for the love of medicine, don’t ask the patient to stroke your ego.  She has more important things on her mind, and it is not her job.

In crude terms, nobody gives a flying squirrel how much second language learning you were able to pick up in your privileged and lovely mysteriously educated life.  Truly, we don’t care.  But we are vitally interested in your medical knowledge, dear doctor.  In fact, that is why we made a medical appointment.

And as an institution, we are very interested in following the law on equal access, and language access, so we have hired a state certified professional communicator to render your very valuable, sometimes life-saving, words – and to convey to you, doctor, in front of your patient, the actual words and cares of your patient.  Just because your patient is not usually educated does not mean her words have no value, and you disrespect her just as much whether you interrupt her directly, or you interrupt her interpreter.  So please, stop interrupting the patient by cutting off her words.  She said them for a reason, and she wants them conveyed.

As to interrupting to display knowledge, dear doctor, here’s a news flash! Interrupting is a train that can run both ways.  Believe me, as a long-time professional medical interpreter, I could finish 90% of your sentences with laughable ease and better accuracy than you can mine.  Because I have heard it all so many times.  How would you like the following encounter in front of a patient?  And I am not talking about your dignity.  I am talking about the patient experience.  How do you suppose the patient would feel about this encounter?  She’s getting the same information, and what is more important, she may be impressed with the professional communicator’s incidental medical knowledge.  Let’s try this on.

D: So the main risks to surgery are –

I: I know!  I know!  Bleeding, infection, and damage to surrounding structures including blood vessels and organs!

D: Those risk are –

I: Minimal, because we take precautions to avoid these, and if they arise, we can treat them either during or after surgery!

D: Now because of your diab-

I: Stop! Let me say it!  Because of your diabetes,  ma’am, you are at higher risk for infection or slow wound healing, so we are going to give you prophylactic antibiotics and closely monitor your blood sugars throughout the process.

D: After surgery, you may-

I: I know!  Need wound care follow-up, but don’t worry because we have a wound care clinic that focuses on patients with conditions that can impede wound closure – and this includes patients like you with diabetes! Oh!  And we may keep you in the hospital one extra day post-partum, depending on how your wound looks.  Ha ha! I got this!

(All the while I would have the smirk of displaying knowledge on my face – mirroring the doctor’s from last week – and wave her words away like so many gnats.)

I have no doubt that this same doctor who routinely interrupts would be surprised, disconcerted, and even horrified were the interpreter to give her a dose of her own medicine.  And we could.  Quite easily.  Because virtually any long-time interpreter could interrupt any routine appointment to finish these sentences.  We are actually trained to predict what doctors are going to say as it helps us render better interpretation – always being prepared for the surprise twists or variations.

And to be perfectly honest, as a professional communicator, with a much closer link to the refugee and immigrant population than the typical doctor, I think I could render most medical information in a much more accessible – and more respectful – way.  But I do not have any burning desire to practice medicine without a license, or finish the doctor’s sentences to show that I could.  Especially in front of our patient.

If I wish to practice medicine, there is a clear route for me to become a Physician’s Assistant.  If any medical staff wish to use their excellent second language skills on the job, most institutions have an in-house certification program by which medical care providers can demonstrate that they are functionally bilingual, and thereafter forego the interpreter for that language.   So there are appropriate routes for us to expand our professional scope.  Interrupting is not an appropriate route.  And it is not professional.

And doctor, the reason the interpreter does not interrupt you – even knowing very well what you are about to say – is due to her great and abiding respect for the patient, for your professional position, for the institution where she provides services, and for our health care model itself, with all its flaws, in which each care team member has a specific and limited role.  Please keep this in mind next time you eagerly interrupt just to show you think you know what the interpreter is going to say on behalf of the patient.  Please believe that your respect for the patient’s message – as rendered by the interpreter – will go a long way toward healing.  And toward gaining the patient’s trust and respect.