Lost in Translation: Learning to Be a Medical Communicator
As I wheel the iPad "virtual translator" and its stand into Exam Room 3, I'm met with concerned faces. A mother, eager to tell me what is wrong with her child, gestures towards the machine. "Vamos a empezar con la máquina," I begin, "Um, esperamos para la...translator." After close to 15 years of studying Spanish, I still don't know the word for "translator." I begin to explain that I'm a medical student, as I power up the iPad and log into an app that connects me with thousands of human translators.
"Hola! Yo soy el traductor," the translator states. "Traductor," I think, "That's the word!
"Hola," says the patient's mom.
"Hola," the 4-year-old patient shyly says.
"Hello!" I say, excited to get the medical interview underway.
Using an iPad and struggling through Spanish won't be the only translating I do in the emergency department this afternoon. Perhaps the most important translating will come after the interview, when I go back and tell my attending what's going on and then she talks to the patient. My job will then be to translate medical jargon into plain speech, because they are separate languages, too.
Medicine as Communication
As a third-year medical student spending my days on the wards and in clinics, I'm now at one of many key junctures in my medical training. I have enough knowledge to navigate the clinical world, enough to know which questions to ask, and enough to be trusted to hold a retractor in the operating room; however, I have enough uncertainty, enough confusion, and enough fear to be aligned with the patient. I empathize with them and try to bridge the same gap I am straddling myself.
"Your son appears to have a torus fracture of the distal radius. He has good pulses, and there doesn't appear to have been much torque applied to the extremity when he fell. We don't have to worry about his growth plate or any vascular or neurologic injury," the attending tells the patient's mother, now with an in-person translator standing in the room.
"So did he break his arm or did he just fracture it?" asks the mother. The translator relays her question to us in English. My attending gestures for me to answer the question. It is part of my training, one of hundreds of real-life, real-time pop quizzes thrown at me each week. "Fractures and breaks are really just different words for the same thing. The injury is minor and can be fixed by putting your son's arm in a cast for a month or so."
Thank goodness I had happened to check on the definition of torus fractures right before my shift! Until 3 hours ago, I thought breaks and fractures were totally different things. The translator relates the information to the patient's mother, who smiles and thanks us. When she is done with her questions, we offer to get some stickers and a popsicle for her brave boy.
The attending and I head back towards the "pod" to prepare the patient's discharge papers. "We always attach some education materials for the families with the discharge papers," the attending explains. "We also write a note about what happened and reasons they may need to come back to the emergency department. If you want to try your hand at it and then call the primary care doc, it could be good practice." "Sure!" I reply eagerly, grateful for every chance to help this mom and her son navigate the confusing world of the ED.
I start typing out the discharge instructions and plan to translate them to Spanish. I attach a document entitled "Arm fractures - simple [Spanish]" and another one about with information about the pediatric orthopedics team. Then I call the family's primary care physician: "We had a patient of yours come into the ED this afternoon after a fall from standing yesterday with subsequent localized pain, inflammation, and swelling. A few minor abrasions but no lacerations. The x-rays showed a torus fracture of the distal radius, and ortho recommended cast immobilization for 5 weeks. No vascular or neurologic injury suspected. No paresthesias. No numbness. Just some pain relieved by ibuprofen. We told them to follow up with you. Have a good afternoon!"
Remembering to Translate
During my week in the pediatric emergency department, similar encounters play out, each requiring a translation from doctor-speak to patient-speak.
Lidocaine injections are "numbing shots."
Small bowel obstructions are "intestinal blockages."
Strictures become "areas of narrowing."
Osteomyelitis is "bone infection."
Sometimes I'm at a loss for the nonmedical terms now. Edema, jaundice, and epistaxis have completely replaced "swelling," "yellowing of the skin," and "nosebleeds." The doctors I work with who I most admire are those who take great care to remain in the role of translator. They sit down in patient rooms and explain the finding of the x-ray, endoscopy, and CT scan. Heck, they even explain what a CT scan actually is.
As practitioners move farther along in medicine, we often forget how different our lexicon actually is. In forgetting that, we forget something even more important. Although we live in the hospital and see sick babies, broken bones, vaginal bleeding, and bloody cuts all the time, this is often the first and maybe only time patients and families see what the bowels of a hospital are like.
To them, the alarms we've gotten used to are, well, alarming.
The masks we put on every day make even the most comforting faces seem strange and frightening.
The hospital depersonalizes most things, medicalizes them, and proceduralizes them; by design, it turns the dramatic into the routine.
As medical students experiencing these things for the first time, we can appreciate the patient's perspective in an important and valuable way. I'm sure the mother who delivered a healthy baby girl last month appreciated both my confidence in describing the team's plan to her and my huge, goofy smile when we all met her baby for the first time.
Seeing everything with new eyes brings us close to our patients, even when our ambitious, professional selves ache to be accepted into the society of physicians. Being a medical student with fresh eyes puts us at a unique vantage point: We have the chance to help our patients navigate the hospital as we learn how to do so ourselves.
The real test will be to remember what it felt like to be tongue-tied and vulnerable, to see the hospital with fresh eyes, and to preserve those translating and communicating skills as we ourselves become fluent physicians.