PRACTICE MAKES IMPERFECT

Doctors sometimes think it is appropriate to practice their varying language skills on patients during their appointments.  It is not.  Those who insist on doing so, even in the presence of a certified interpreter, don’t seem to understand what is wrong with it.  These are not the most sensitive souls in the medical field.  And mid-appointment in front of the patient, during precious few minutes of doctor time, is the most awkward time to try to correct this.  To those doctors who don’t get why they shouldn’t practice their second language skills on their patients, here are some answers for you:

  1.  It is not your job.  We each have a specific and limited role to play with the patient.  Would you be okay if I start practicing medicine?  Think about it.  An experienced interpreter could easily explain the major risks of any surgery to a patient (bleeding, infection, damage to surrounding tissues including organs, nerves and vascular structures) but we are not allowed to.  Sure, your second language may be good.  But it is not about how “good” we are.  We each have our job.  You are the doctor.  You don’t need to confuse the patient by playing the piano. making the bed, or practicing your language skills.  Just as others are not allowed to give medical advice, no matter how sound.
  2. You sound stupid, unless you are very close to bilingual.  Sorry, but it is true.  Here is a transcription of a recent resident encounter:  “Get on the – the there.  Up there.  Lay backwards.  I knead your belly. Is your poo like, like, uh, slippery, or like boulders?  Is it brown or black or the color, uh, bright, like, like, the floor color, this floor?  Look the floor!”  Yes, the resident had to be written up and this encounter is in their employment file.  And the patient asked to switch doctors to someone who “speaks English”.
  3. Instead of speaking in the full range of your luxurious native tongue, bolstered by your years of medical school and formal training in English, you are unwittingly limiting your medical advice and the information you provide to your patient due to the limitations of your second language vocabulary.  Is this treating them equally?  Or are you giving them stunted advice?
  4. You may not understand everything the patient says to you.  This will limit the information upon which you base your diagnosis or treatment.  You may even understand something very different than what the patient is trying to convey, and actually base your medical opinion on your mistaken guesswork.  This is dangerous.
  5. The patients may not understand you.  And your polite and humble refugee and immigrant patients will not tell you that they cannot understand you.  You are an authority figure, with social capital that makes you more than a millionaire in their eyes.  You cannot expect them to say they don’t understand you.  More likely, patients nod politely, then leave scared and frustrated.
  6. Let’s say you are near fluent, though, or even bilingual.  So you walk into a hospital room with your team, and speak a second language to the patient.  Very impressive!  Only one problem: Your care team, the nurse, and your other colleagues do not know what you are saying, so you are excluding your own care team from the vital information you are conveying.  For in-patients, you are leaving the patients for hours or a whole day in the care of nursing staff who were unable to understand what you just told the patient.  How is that helpful?  What happened to teamwork?
  7. To those doctors who are used to “practicing on patients” and who insist that the interpreter should simply correct you as you spit out your spotty second language, we do not know exactly what you are trying to convey with your limited language skills.  So it is quite dangerous for us to play a guessing game of “fixing” your second language.  Imagine how you would like your ten-minute appointment with a Chinese doctor – in China – to turn into an English lesson, assisted by the interpreter you thought would be there to interpret for you.  How scared would you be?
  8. If we are going to trade roles, why stop halfway?  Let’s just trade roles.  Give me your stethoscope, and no one will be the wiser.  We can even use each other’s names and badges for these special encounters, and I will gladly give good, solid medical advice, and you can interpret it into the vocabulary you know.  The boundaries of our knowledge, our scope of practice, our ethics, and concerns of patient safety, along with hospital liability, are not that big a deal, right?  It’s just like, uh, uh, what’s the word?  And hey, if I make a mistake, just correct me.  It’s cool.  And fun! For everybody except the patient and the hospital.
  9. Seriously, it is not safe, appropriate or ethical for us to trade jobs and take on areas of practice for which the hospital has specific licensing and certification requirements.  And it’s hella rude.  Which reminds me, doctors airing out their down and dirty second language skills routinely use a mixture of slang, impolite words, informal greetings, and sarcastic jokes that come across as ignorant and disrespectful.  So knock it off!
  10. Patients feel safest when they know who each team member is, what our respective roles are, and how we will help them.  They feel safe when they know we are each specially trained for the job we will do.  They feel safe when they experience that we are mutually respectful, and working as a team.  Stepping out of our roles to “display knowledge” (AKA show off) is a dangerous indulgence.  It has no place in health care.

So rein in your ego, take a step back, and follows the most basic tenet of healers: First and foremost, do no harm.

Of course, Doctor, if you would like to practice your second language skills in order to improve them, you are free to hire a teacher or a native speaker – on your own time and at your own expense, and off the hospital’s liability insurance.  Who knows, you might even get to the point where you could become certified as bilingual at your medical center, and ethically provide direct bilingual care.  Until then, enjoy the free lesson given at no burden to the patient by carefully listening to the interpreter as your session transpires.  It is a great non-intrusive way to pick up vocabulary, language and even cultural skills.  You might learn something.