Blog | Friday, August 2, 2013

The languages patients speak

I am privileged to work as a preceptor in our residents' clinic, where junior doctors learn how to provide care tailored to individual patients, many of whom have multiple significant medical problems. One thing that all of our residents should learn is the care of a patient who speaks a language other than English. For such a patient, if you don't speak their language, you are supposed to provide an interpreter.

That's a way to provide minimal care, but not necessarily to provide good care. Interpreters might be only intermittently available, or for some languages, not at all. Interpreters might not be well trained for the medical encounter; and practitioners might labor under the illusion that an interpreter guarantees good communication.

But a broader realization needs to be conveyed as well. Every patient speaks a different sort of language. The patient from a different group or culture might express themselves using health beliefs, or health vocabulary, that differs from the doctor's. A patient who is not fluent in the language of the health care system, or of privileged America, might be tongue-tied before the doctor.

The resident, or indeed the attending, might make the same mistake with these speakers of "other languages" as they do with speakers of other languages as ordinarily understood: thinking that it's okay to get by, make do with the minimum because that's better than nothing. In these cases, though, the doctor needs to be their own interpreter. It is hard to speak in English but make the "translation" to the terms appropriate for a different sort of person. But, from a communication perspective, medicine is not a communicative profession without it.

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins School of Medicine. His research interests include doctor-patient communication, bioethics, systematic reviews, and the role of the primary care provider in cancer care. He is also the author of "Talking to Your Doctor." This post originally appeared at his blog.