Take the effort to reach across cultural and language barriers

I was working in an urgent care clinic when I walked into the exam room to see my next patient. He was a six-year old who primarily spoke Spanish, with some broken English. Jose’s mom was with him, she only spoke Spanish.

I sat down and picked up the phone receiver to contact our translator service. With the Spanish interpreter on the line I was able to proceed. I then asked Jose’s mom, “What is the problem?”

Jose’s mom told me in Spanish, my son has a fever, he’s been vomiting and has a sore throat.

I continued to take Jose’s history using the phone translator. Finally I said, “Okay, well it sounds as though Jose has the swine flu which is going around like crazy right now.”

As the phone translator told Jose’s mom this information, Jose burst out crying and he yelled, “Mama, she said I’m going to die. I don’t want to die!”

Not knowing what Jose had just said in Spanish, I asked the phone translator whether she had heard it. Thankfully, she had, and informed me of what he had said. Just then, his mom started to cry.

“Okay, Jose what’s going on?”

Jose spoke in English, “The TV says there’re people dying from the swine flu. I don’t want to die!”

So I quickly explained to the translator what I was going to do for Jose so he wouldn’t die from the swine flu. The translator explained all of this to both his mom and Jose.

As the translator explained this to both Jose and his mom, I watched Jose’s mom’s facial expression relax and her calm down.

As I addressed Jose and his mom’s misunderstanding of what the local and national media had been saying about the swine flu deaths, I was reminded once again of how different people receive news. Due to Jose and his mom not totally understanding what the media was saying about the outbreak of swine flu, they misunderstood it to the point of Jose internalizing a fear of death about it, if he came down with it.

Thankfully, I had used a Spanish translator to speak to them. Not every primary care office has the use of such services though. It made me think of what would Jose and his mother thought of me had I not spent the extra time it took to explain everything to them? I can probably bet that Jose’s mom would have thought that I was just another example of a rude clinician who didn’t want to talk to her because she spoke Spanish.

Helping patients many times takes more time than we are allotted on our clinic schedule. Addressing the real needs of a patient takes time, using a translator takes extra time, addressing misinformation takes time, as does doing appropriate and needed patient education.

May we all remember that to be an excellent clinician, it takes time, effort, as well as reaching across cultural and ethical barriers.

Sharon Bahrych is a physician assistant who blogs at A PA View on Medicine.

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