REPEAT

Doctors tend to be in a hurry.  They come into each patient room with a mental list of subjects to cover, and very limited time.  When rushed and anxious, they can succumb to the temptation of pouring forth a verbal gush without regard to patient comprehension.  Doctors in this situation have a hard time adjusting when they are talking through an interpreter, because they are busy with their mental checklist and not fully present. When doctors talk too quickly and for too long, especially on multiple topics, it makes it very difficult for interpreters to convey the information accurately and completely.

As interpreters, we have various techniques.  We can raise a hand.  We can start interpreting, even if the doctor has not paused for us.  We can switch to simultaneous mode.  I have another technique I like to put into play that I believe helps the doctor to gain awareness of how much they are running on and how disjointed their speech has become.  I only use it as a last resort when I see we are approaching a communication breakdown.  I repeat back in English the last set of speech so the doctor can hear what they just said.  Their eyes get big as they experience how it feels to be on the receiving end.

It is important to note that I am not just displaying my prowess.  I am engaging the doctor.  I am asking the doctor to actively listen, compare what they now hear me say to what they remember they just said, notice if anything is missing or incorrect, and be ready to feed that back to me before I convey it to the patient.  I believe this is akin to what the doctor is asking the patient to do: listen, understand, remember, and mentally prepare any questions or comments to what is being stated.  We are asking a lot of the listener when we speak in a healthcare setting.  What we say matters.  How we say it matters.  How it it received matters most of all.

Yesterday, for example, I had a doctor dealing with multiple risk factors in a new patient.  The appointment had gone over the scheduled time, so the doctor unthinkingly sped up and started rinsing out her mental palate by spitting out words without any apparent awareness of patient or interpreter.  Her face was showing the relief of “getting it out” but it was a rapid-fire presentation.  So I raised a hand, and said,

“Doctor, to make sure the interpreter isn’t missing anything:  We’ll do a glucose intolerance test at your next exam, in which you’ll drink a really sugary liquid, then after an hour, they’ll do a blood draw, and if you handled it great, but if you didn’t, then there are two different ways we can follow up, either a longer test with another sugary drink or you’ll take a little machine home and poke your finger and check your blood sugars and then you might have gestational diabetes which means diabetes during the pregnancy but you might not – we don’t think you do it’s just something we offer everybody – we’ll have to see and we’ll do a blood test to see if you are anemic meaning low blood iron and also to see if the right side of your heart is getting stretched from having to work too hard since you had that mitral valve condition even though we don’t know if you still have it because we don’t have your records but we also need to repeat the transvaginal ultrasound, right, because we want to see if the cervix is changing.  It looks like it changed from the ER visit but different machines, different techs, hard to say.  Is that all, doctor?  Is that everything you just said?  Shall I now say all of that in the patient’s language, doctor?”

The doctor looked at me in complete surprise and said, “Oh my gosh!  I am so sorry!”

I went ahead and rendered all of that in the patient’s language while the doctor stared at me blinking as if she had just woken up.

After that, the doctor spoke a couple sentences at a time, and I interpreted accordingly, and the patient was able to grasp the information.  The patient went home feeling safer about her pregnancy and clear on warning signs and followup.

This is not a bad doctor, in fact she is a good one.  But as the saying goes, bad systems overcome good people all the time.  And when we have a set-up that doesn’t allow enough time for patients, especially new patients, we are setting ourselves up for communication failures, confusion, and possible harm.