Family Webicine

By Rod Moser, PA, PhD

Our area is really blessed with people from all over the world. In our practice, on a typical week, I may encounter dozens of different languages. I find the cultural differences fascinating and love meeting people from parts of the planet that I have only dreamed of visiting. Many people immigrate to the U.S. with a wonderful command of the English language and an understanding of our medical system, but many do not. Here is where problems can arise.

Large medical institutions, like medical centers, employ interpreters at great expense, but smaller offices often need to rely on family members or special telephone services to communicate with a sick patient or their families. Language issues aren’t always anticipated, so most interpreter requests will need to be done during a typical fifteen-minute encounter. Our office did install a special phone that we can use for remote interpreter services, but no one has ever used it.

I don’t consider language differences a barrier, but they can be challenging. The most common non-English language in our practice is Spanish. Most people from Mexico, Central America, or South America speak just enough English to get by, and I speak just enough medical Spanish to fill in the gaps. Using friendly sign language and patience, we can usually complete the visit without help. Many non-English speaking people will bring a family member to help. In many cases, this family member may be a child. It is very awkward to discuss personal adult issues using a child as an interpreter.

Using an adult family member to interpret is usually sufficient, especially in smaller practices that cannot afford a cadre of qualified interpreters for every language. I have always been highly appreciative of a family that brings their own interpreter. This practice is not ideal, but it’s better than nothing. Still, serious errors in communication can still occur. Professional interpreters are competent, well trained, and very ethical, but unfortunately, they are not always readily available.

We do have two or three certified Spanish interpreters in the office. Some of our providers speak Spanish, so whenever possible, we book the appointments with them. One of my colleagues speaks about four languages, including Mandarin and Spanish, so she gets plenty of referrals. A mistake was made in the printing of one of our past referral books and incorrectly identified another colleague, an older gentleman from Mississippi, as speaking fluent Mandarin and Cantonese. He was puzzled for several weeks when Chinese patients started to show up on a regular basis.

We have staff members who are native speakers of Ukrainian, Russian, Chinese (Mandarin and Cantonese), Oromigna (Ethiopia), Tagalog (The Philippines), Hindi, and French. Some were former Mormon missionaries who speak various languages. Personally, I speak English, and since my wife and I have traveled to Japan and hosted three different Japanese exchange students, we understand the culture and speak a few words. Most Japanese have spoken English since nursery school. On one visit to Japan, we stayed at one of our exchange students’ homes. The father, in preparation for our visit, took some English classes and was anxious to practice his new skills on my wife. Sitting next to her on a couch, he leaned over and said, “May I buy you a drink? What is your sign?” Those hilarious pick-up lines were just enough to break any awkward moment.

One cannot forget American Sign Language. Unless a deaf patient brings a sign interpreter, I usually use the exam paper to write out my questions, being careful to overly articulate for the lip readers. I learned a few signs years ago, but doing them incorrectly can get you in trouble. I once asked a deaf patient about dizziness and used a circle motion around my ear as emphasis. She looked at me in horror and said, “You think I am crazy?”

Our local School for the Deaf will provide sign interpreters at no charge, but the deaf patient must make those arrangements in advance. I vividly remember an encounter with a young deaf man who had a few dozen “personal questions,” mostly related to sexual practices. The interpreter, a mild-mannered man with a little bow tie, was sweating profusely as we discussed some very edgy subjects. At one point, the patient and I could not stop laughing. The highly professional sign interpreter never even smiled, although we both knew he was in living hell.

There are multi-language interpreter programs for handheld devices now, but I have not found one that is appropriate for a medical encounter. Medicine has enough trouble with our own language, often called Medicalese. Sometimes, I think patients would benefit having an interpreter just to explain what your doctor is telling you, seconds before he exits the exam room.