Check out this essay on language and medicine by one of our student ambassadors who recently finished his GEMx elective exchange at University of Pavia, Faculty of Medicine and Surgery. He was helped with his italiano under the guidance from fellow GEMx student ambassador, Cristiana Riboni while in Pavia.
Post by Ahmed M. Saleh, MD Candidate ‘18, Weill Cornell Medicine-Qatar
Realizing that this is not going to be as easy as I thought was one thing I knew the moment I stepped on Italian soil. I arrived at Milano Centrale in Italy, the city’s main transit hub, trying to figure out the best way to get to my destination, Pavia, a smaller city 50 kilometers south of Milan. Usually it takes about 20-30 minutes by train to get to Pavia’s main station, but it took me 2 hours, after getting off at the wrong station and having to come back again to Milan and switch trains a couple of times. Clearly, I didn’t do so well communicating or trying to follow instructions.
A couple of days later, I woke up early and found my way to Maugeri Fondazione’s hospital on the edge of Pavia. I walked around the hospital’s corridors trying to find the nephrology ward until I was directed to the doctors’ room. It felt like a regular first day at the hospital of a medical student’s life. Just the usual feelings of uncertainty and being lost. Doctors and nurses spoke enough English for me to follow what was going on, but I realized the day isn’t that typical once we started rounding and talking to patients.
Before my time in Pavia, I never had issues communicating with patients as I’d either speak their language, or I had access to instant interpretation services over the phone through the hospitals where I rotated, which made obtaining history, performing physical exam maneuvers, and explaining the diagnosis and treatment plan to patients less complicated. However, my rotation in Italy made me realize how challenging it could be to provide quality and safe health care services to patients when you do not speak their language.
My abroad exchange experience in Pavia has helped me gain a different perspective on what works well and what does not when practicing medicine if you don’t speak the same language as your patients. I remember spending a lot of time discussing the importance of communication in healthcare during my Medicine, Patients, and Society course; whether its communication among physicians and healthcare workers or between healthcare workers and patients and their family members.
While I was doing an inpatient rotation, where all patients were already triaged and transferred to our service in a relatively stable condition from the emergency room. I thought about how the process of seeing a patient in the emergency room might be different. Take a patient who walks in pointing at his/her chest and is in discomfort, but does not speak the same language as you, the healthcare provider. Without language coherence, is it left sided or right sided pain? When did it start and what’s the character of their pain? Are there any associated symptoms? These are all vital questions that direct the doctor’s time-sensitive management plan, thus, pose a significant challenge.
It is often said that physical exams and diagnostic workups are of no use in the absence of a focused, accurate history. Medical school has provided us with ample opportunities to work with diverse populations and be culturally competent in theory, however, applying such skills isn’t always as easy as it might sound like. My Pavia experience has provided me with a few tips that could be of use in such situations.
It is always useful it is to learn some key phrases and medical terms in a different language. It might not be feasible to learn a whole new language or be able to carry a conversation, but learning some basic terms to help you communicate with your patients to obtain history and perform a quick physical exam is optimal. Learning some phrases such as “take a deep breath”, “stop breathing”, “lie down”, and “look left or right” were all advantageous, and made performing a physical exam less challenging. Additionally, it is important to speak slowly and calmly, even when someone is interpreting.
It is also important to be familiarized with some basic cultural beliefs and practices. In my case, knowing that it is inappropriate to greet people using “Ciao”, and needing to use “Bonjourno” and “Arrivederci” instead was vital. Additionally, the importance of body language and eye contact is one thing a provider should pay attention to, which are things I seldom paid attention to in the past and focused more on verbal communication as my main way of delivering information. Using hand gestures to supplement or replace words might be another way to get the conversation going. Using visual aids could be another way to deliver your message across. Keeping charts and pictures of the human body and the most commonly performed procedures is always useful, especially when treating children.
These tips are definitely not the solution to eliminate any confusion or uncertainty that might arise, but keeping these in mind helps. My time in Pavia was definitely an eye opener and I started considering communication issues on a deeper level and how it affects the doctor-patient relationship. Medicine is all about making sure that patients are getting the best of care with no barriers, and language barriers should not be taken lightly.