Lost in translation: Getting your doctor to be fluent in “patient”

With the advances of knowledge and technology, the practice of medicine has become more complex. In addition to increasing complexity, there has also been a growing shift in patient care from paternalistic medicine to shared decision making. Paternalistic medicine is when the physician would make a diagnosis based on a patient’s history and test results, and then tell the patient what the plan of action will be. With shared decision making, the physician explains testing and treatment options, and then the patient makes an informed decision based on his or her preferences and health goals as well as physician recommendations.

Time after time

In the practice of modern medicine, there are many challenges which can often hamper a physician’s ability deliver care in a way that would be both efficient and most appreciated by the patient. These challenges include shorter office visits (the choice of administrators rather than physicians in many situations), the need to address multiple health problems in a single visit, and lack of support staff (someone to check your blood pressure, confirm your medication list, etc.). Given this time crunch, physicians often find themselves rushing, particularly at the end of a visit, to keep their clinic running as on time as possible for the next patient. During this rush, physicians must discuss the implications of a diagnosis, testing options, treatment options, drug side effects, the need for referrals to specialists, and appropriate follow-up appointments. Due to this rush, I often preface some of my visits by saying, “We need to fit 80 minutes of material into a 60 minute visit, so I apologize for speaking and typing quickly during your visit.”  I recall when one of my patients from the Midwest asked, “Dr. Mathew, where did you learn to talk so fast?”  I replied, “In the republic.”  He asked, “You mean the Dominican Republic?” and I said, “No, the Republic of New Jersey. In New Jersey, speaking quickly is common, and it has provided me with an advantage over other doctors. In the Garden State, we would say that it is a ‘Uge’ (the ‘H’ is silent) advantage.”

Compliantly non-compliant

While rushing through material, physicians may use complex medical jargon without taking the time to explain what it means, and may not go into adequate depth for a patient to feel comfortable proceeding with a decision to start a treatment. Lingering questions and doubts after an office visit can at times lead to non-compliance (when a patient doesn’t follow through with recommended care), which can have detrimental effects. I recall one patient who after arriving 15 minutes late for a 30-minute appointment came to her follow-up visit saying, “I did not follow your recommendations, because my neighbor suggested an alternative treatment.” I replied, “This would be like me telling my mechanic how to fix my brakes. It is an option, but it may not be the best one.”  With adequate time during her follow-up appointment, we were able to discuss all the details of my treatment plan for her, and she felt confident enough to follow through with it

A foreign affair

For many patients, English is a second language, and adequate interpretation by speakerphone, or, preferably in person, is essential for providing quality care. I have had the pleasure of working with many fantastic interpreters, and one of my fondest experiences involved an elderly Spanish speaking woman and an interpreter. I asked if she had any further questions, and she said, “El Doctor es muy guapo.”  The female interpreter blushed, and said, “The patient thinks you are very handsome.”  I replied, “Please advise the patient that I will not be examining her visual acuity because her eyesight is perfect.”  The interpreter laughed, told the patient what I said, and the her ear-to-ear smile lit up the room.

How you can help your doctor speak your language

  1. Show up on time, or preferably 15 minutes early for appointments.
  2. If English is your second language, make sure to let the office know in advance so interpreter services are available at the start of your visit. (You do not want to waste the first 20 minutes of an appointment waiting for an interpreter.)
  3. Rank your concerns, and discuss them from most to least important. (You may not get to everything in a single visit.)
  4. Bring any records, including test results, with you to avoid repeat testing, and to avoid treatments that were previously not tolerated or ineffective.
  5. Ask your doctor to explain things in simple terms, and do not be afraid to ask questions to clarify what you do not understand.
  6. Ask for patient handouts regarding medications, tests, and procedures. Trustworthy information from the physician’s office is better than misinformation, which is often found online.
  7. Schedule frequent follow-up appointments if you feel you are not getting enough face time with your doctor.

Comments:

  1. David rainey

    Hello Paul,
    The tips you have shown are very useful. Your tips will help people a lot to concern a doctor. Very informative post.
    Thanks for sharing!!
    BTW CHECKOUT this site Dammann Translation (http://www.dammann.com.au/) for translations they provide really good services.

  2. Dana Blankschtein Tilkin

    I can definitely relate to this!! This is such a terrific article !! I really appreciate your sensitivity and attention to folks where English is not their first language and tending to cross-cultural differences!

    English is my third language but I learned to speak it as a small child so only really encounter issues when I take my mother to the doctor. I accompany her at least twice a week and act as a translator in part because English is her fourth language and she learned it later in life, she has mild cognitive impairment and is also hard of hearing.

    I have had providers condescend to her because she has a very pronounced accent. She very much understands what they are saying. She just requires a little bit more time for processing.

    If I could give my two cents to some providers I would ask them to address the patient directly and not just the individual who is helping translate. I know how demoralizing it has felt for my mother when she has been rendered invisible.

    I would say on both ends keep checking in to ensure understanding.

    This is more applicable to the population I work with but be mindful if folks are hard of hearing/have visual impairments!

  3. Usha Jacob

    Thank you so much. The article is very informative.

  4. Paul G. Mathew, MD, FAAN, FAHS

    There is such a thing as medical record overload. For example bringing notes from every Emergency Department visit for a headache may not be particularly useful. When there are a lot of records, categorizing them and making folders can be useful . Previous lab tests, imaging studies, and office notes divided by specialty are broad categories that can be used. Also, all records may not be reviewed during a single appointment due to time constraints, so highlighting the most pertinent things in your record for the doctor may be useful.

  5. Megan Y.

    great article! Since you are a specialist in headache, how much medical history do you want patients to have “in hand” versus the information pertaining to the main issue?

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