The social and cultural diversity of our society is nowhere more evident than in health care practice. Because illness beliefs and behavior are so influenced by culture, and because establishing a trust relationship with patients is so important for effective treatment, today’s student clinicians must acquire the knowledge, skills, and attitudes needed to understand and respond effectively to their patients’ cultural differences. In recent years such cultural competence has become a byword in health care education.
However, the most obvious and fundamental barrier to communication is lack of a common language. In the metropolitan area where I practice, dozens of languages are spoken by people from several continents, but the Latino community is by far the largest, constituting nearly 15% of our patient population. While many of these patients are bilingual, many others are not, especially the elderly and those who have arrived recently in the United States. How can we provide optimal medical care for these patients? The best approach, of course, would be to train a sufficient number of thoroughly bilingual clinicians. Failing that, we are obligated to ensure that our clinics and hospitals provide the services of professional Spanish translators.
Nonetheless, situations commonly arise when non-Spanish speaking health care professionals must assess and treat patients who speak no English or whose English is rudimentary. Such patients may sometimes be accompanied by family members willing to translate, but communication via relatives can present privacy problems and may not always be reliable. Moreover, professional translators may be a scarce resource, often unavailable in triage situations and urgent care. Clinicians are then faced with a dilemma. How might they perform a targeted patient assessment, given the lack of a common language?
This is where a book like Kaufman and Alegre’s Yes/No Medical Spanish provides an invaluable service. By presenting basic Spanish words, phrases, and questions related to symptoms of illness and other aspects of the clinical examination, the text allows the learner to accomplish much more than might appear at first glance. First, of course, the language tools, in conjunction with nonverbal communication, will allow the learner to accomplish the basic task of clinical assessment. In addition, the learner’s willingness to communicate in Spanish, even if carried out in a rudimentary fashion, will help generate a trusting relationship. Patients and their families almost always appreciate attempts to “reach out” to them in their own language. Finally, the discipline of learning and using these basic tools will likely help students develop confidence not only in their ability to manage the difficult situation at hand, but also in a capacity to learn the language in greater depth. Clinical practice provides a great venue for doing so. With sufficient practice, what began as a series of yes/no questions, might eventually lead to the satisfying accomplishment of true clinician–patient conversation in Spanish.
—Jack Coulehan, MD, MPH
Stony Brook University School of Medicine