Model stories written by young professionals/students.
Different Language, Not Different Care
After visiting with a Spanish-speaking family, a student discovers that attitudes surrounding a difference in language, both from the provider and patient, can influence the delivery and quality of care.
Heads turned and friendly faces smiled as Sandra entered the hub where all the doctors, residents, nurses, and techs collaborate on patients’ cases. I was sitting with Dr. Parker as Sandra approached her and explained to the resident that they’d be working together the rest of the afternoon. Sandra’s eagerness and my interactions with her earlier in the day made me think it would be a pleasure to work alongside her. To my surprise, Dr. Parker was not thrilled. Sandra is the medical translator at the clinic and Dr. Parker apparently didn’t like when they worked together because, as she said, it meant she had to see Spanish-speaking patients and that wasn’t something she preferred.
The pediatric clinic is located in one of the more Hispanic-dominated areas of the city, so nearly half of the patient population here speaks Spanish. I found it hard to believe that Dr. Parker could do her training effectively and learn from her experiences if she truly disliked the patients she was working with due to the language they speak. A few minutes into the visit, I realized that it wasn’t the patients that she had a problem with, but rather the way she interacted with them, and it wasn’t Sandra she disliked, but the way she acted around Sandra as well. Her enthusiasm surrounding this visit, or lack thereof, is reflected in Boys in White, when discussing how students perceive different types of visits; they tend to “judge a service by the kind of patients it provides them to see” (Becker et al. 246). Because this appointment would not provide Dr. Parker with English-speaking patients, whose interactions she seemed to prefer, her disinterest was to be expected.
When the appointment began, I immediately noticed a lack of direct communication between Dr. Parker and the family which then led to a notable disconnect in the room. The language barrier seemed to be the key issue in this visit. With that, it was clear that Sandra was vital to the progression of the appointment. She was the line of communication between the doctor and the patient since neither knew the other language.
I would expect Dr. Parker, as both a practitioner and learner, to want as much medical responsibility as possible in providing the patient and family with a proper diagnosis. In appointments with non-Spanish-speaking patients, Dr. Parker would gladly take on the entire responsibility, but in this appointment she did not. Upon being assigned this patient, she was immediately forced to waive some of her responsibility as she was not able to be the only professional in the room communicating with the family. Instead of delegating just part of her responsibility, she let go of most of the responsibility attached to her role as the provider.
In my observation during this appointment, I noticed how exactly a translator may threaten the role of a physician. In Boys in White, medical responsibility is defined as “the responsibility of the physician for the welfare and ultimately the life of his patient” (Becker et al. 254). In an appointment with a patient who speaks a different language, the appointment would not proceed effectively without a translator. Essentially, not having a translator alongside a physician defeats the purpose of the physician, which is generally to deliver effective care because the care cannot be given or received. I believe working successfully with a translator would take practice. It can be an awkward interaction at first, but I don’t think the translator or language barrier should interfere with the delivery of care, so it is necessary to include learning to work with translators in the training for physicians.