Friends who live in Spain and are not fluent in Spanish, tell of their various problems when seeing a doctor. Many physicians in Spain won’t see patients who don’t speak Spanish and, as a doctor, I can understand this very well. At least sixty percent of diagnosis comes from what the patient says and how he/she says it. The history of the problem and the patient’s expression, attitude and body language are vital components of the interview and prompt appropriate questions from the doctor. Even body language varies from culture to culture so that getting accurate information to and fro can be a problem.
The use of an interpreter has multiple problems. One can’t be sure that the information has been translated correctly. The vocabulary may be accurate but the use of another word or phrase may, more accurately, indicate the real message. The nuances of language are every bit as important as the strict content and the experienced physician is always alert to what the patient isn’t saying but should.
Many people are reluctant to discuss intimate and, sometimes embarrassing information in front of a stranger, especially one who is not bound by strict confidentiality.
Then, there is the issue of informed consent. Most people believe that this applies only to matters like surgery but it is a part of all medical intervention, including the prescription of medications. The vital word here is “informed”. It’s the responsibility of the physician to explain to the patient the nature of the medication, what it is intended for, how long it should be taken and how it should be taken e.g with food, at night etc., as well as, importantly, any and all possible significant adverse effects that might occur. Yes, I know, I know, many physicians don’t do this but that does not alter the fact that it is his or her responsibility as well as the right of the patient to be informed. Ask questions, always, but again, impossible if you don’t speak the language.
There is a wonderful book by Dr Jerome Groopman called “How Doctors Think” and, in the last chapter, he gives questions that all patients should ask and he points out the following, “ The first detour away from a correct diagnosis is often caused by miscommunication.” How much more likely is it when doctor and patient speak different languages?
The first question he suggests is “What else might it be?”
“¿Qué otra cosa podría ser?” in Spanish.
Then:
“Is there anything that doesn’t fit?”
“¿Hay algo que no encaja?”
“Is it possible that I have more than one problem?”
"¿Es posible que tenga más de un problema?"
These are important questions, but, of course, one needs to be able to understand the answers.
Some years ago, I developed a medical history form for my patients along with a set of instructions on how to complete it and why certain things are required. It’s designed to be put on to a small flash disc that can be carried or worn in case of accident. Following is an example of a typical form in English then in Spanish;
MEDI-TELL™
MEDICAL HISTORY
My first name is :
My date of birth is:
If I am unable to respond, in order to obtain my full information, including insurance and other essential items, please call one of the following numbers. The person will ask you to identify yourself, your location and to give a number at which they can call you back immediately.
Tel No: 1-9**-862-7***
Tel No:`` 1-9**-862-2***
Tel No: 1-9**-862-6***
ATTENTION
I have had since childhood an extremely low repiratory rate:
6 to 8 per minute. This is normal for me.
Basal temperature is also lower than “normal”.
I am sensitive to: Demerol, Opiates, Corticosteroids.
It/they cause(s) me to: Elevate blood pressure, cause hallucinations (Demerol), headaches, lethargy, ataxia.
I am a carrier of the following condition(s): N/A
I have a pacemaker. No
I have metal implants in the following areas:
Screws attaching dental implants. Mainly titanium, Vanadium + (0.2% iron). Safe for MRI.
I cannot tolerate contrast dyes. Headache, nausea.
MEDICATIONS
Prescribed by a doctor: Metoprolol, Xanax
Bought in pharmacy: Gaviscon, aspirin.
Bought in health food store: N/A
Illnesses and conditions I have at present:
Mild osteoarthritis: knees
Significant osteoarthritis: hands
Mild bursitis : hips
Fibromyalgia
Significant illnesses I have had and recovered from: N/A
Surgeries I have had with dates: N/A
Hospital(s)
Females Only
Number of pregnancies: 2
Number of children: 2
Problems with menstruation/ovulation: None
Age at menarche: 12 yrs
Age at onset of menopause: 52
Childhood Diseases
Chickenpox
Measles
Pertussis
Bronchitis
Vaccinations and Inoculation
Smallpox
Polio
Tetanus
________________________________________________________
Family History
(Place an X next to the answer chosen)
Father alive: Yes No X
If No: Cause of death:
MI At age: 50
Mother alive: Yes No X
If No: Cause of death: Congestive heart failure with metastatic breast CA
At age: 83
Do you or anyone in your family have an inherited disease? Yes No X
If yes, please describe.
Disclaimer: The author of this form accepts no responsibility for its accuracy or for any damages that may result from misunderstanding/misapplication of its content or errors in its completion.
© I.Campbell-Taylor 2014
MEDI-TELL ™
HISTORIA MÉDICA
Mi nombre es:
Mi fecha de nacimiento es:
Si no estoy en condiciones de responder, con el fin de obtener mi información completa, incluyendo seguros y otros artículos de primera necesidad, por favor llame a uno de los siguientes números. La persona que le pedirá que se identifique, su ubicación y para dar un número en el que puede devolver la llamada inmediatamente.
Tel No: 1-9 ** - 862-7 ***
Tel No: `` 9.1 ** - 862-2 ***
Tel No: 1-9 ** - 862-6 ***
ATENCIÓN
He tenido desde la infancia una tasa repiratory extremadamente baja:
6 a 8 por minuto. Esto es normal para mí.
La temperatura basal es también menor que "normal".
Soy sensible a: Demerol, opiáceos, corticosteroides.
It / que causa (s) que yo: elevar la presión arterial, causar alucinaciones (Demerol), dolores de cabeza, letargo, ataxia.
_________________________________________________
Yo soy un portador de la siguiente condición (s): N / A
Tengo un marcapasos. No
Tengo implantes de metal en las siguientes áreas:
Tornillos de fijación de implantes dentales. Principalmente titanio, vanadio + (0,2% de hierro). Seguro para la RM.
No puedo tolerar colorantes de contraste. Dolor de cabeza, náuseas.
_____________________________________________________
MEDICAMENTOS
Prescritos por un médico: El metoprolol, Xanax
Comprado en farmacia: Gaviscon, la aspirina.
Comprado en la tienda de alimentos saludables: N / A
_________________________________________________
Las enfermedades y condiciones que tienen en la actualidad:
Osteoartritis leve: las rodillas
Artrosis significativa: manos
Bursitis leve: las caderas
Fibromialgia
Enfermedades importantes que he tenido y recuperados de: N / A
Las cirugías que han tenido con las fechas: N / A
Hospital (s)
___________________________________________
Sólo mujeres
Número de embarazos: 2
Número de hijos: 2
Problemas con la menstruación / ovulación: Ninguno
Edad de la menarquia: 12 años
La edad de inicio de la menopausia: 52
_______________________________________________
Enfermedades infantiles
Varicela
Sarampión
La tos ferina
Bronquitis
_________________________________________________
Vacunas y Inoculación
Viruela
Polio
Tétanos
________________________________________________________
Historia Familiar
(Marque con una X al lado de la respuesta elegida)
Padre vivo: Sí No X
Si no: Causa de la muerte:
MI a la edad: 50
Madre vivo: Sí No X
Si no: Causa de la muerte: insuficiencia cardiaca congestiva con metastásico CA de mama
A la edad: 83
¿Usted o alguien en su familia tiene una enfermedad hereditaria? Sí No X
En caso afirmativo, por favor describa.
Descargo de responsabilidad: El autor de esta forma no se hace responsable de su precisión ni de los daños que puedan resultar de la incomprensión / mala aplicación de su contenido o errores en su terminación.
© I.Campbell-Taylor 2014
As you can see, a great deal of time is saved and the information is full and accurate. Almost all hospitals and doctors’ offices have computers and the form can be produced as .pdf which is universally readable. If one is not able to respond, for example after an accident, wearing the disk that has a Caduseus, the universal medical symbol, indicates that it probably contains information relevant to the person’s health.
There are probably few physicians practicing in Spain who are bilingual in English and Spanish, but, since many areas are favourite retirement spots, there may be retired, English speaking doctors who can assist in understanding and/or explaining what the Spanish doctor has said, or proposes to prescribe. I believe that this might well avoid wrong medications, wrong dosages, missed diagnostic indicators and other problematic issues for the non-Spanish speaking patient. Medicine is potentially dangerous enough without the constant risk of miscommunication. Even when both doctor and patient speak the same language, presently, in the US, over 90,000 people per year die of medication errors. I see a need for some type of informed liaison in a country where a significant segment of the population is not understood and does not fully understand the medical providers.
When it comes to assessment of memory and other possible cognitive problems both patient and doctor must speak the same language. The misdiagnosis rate for all dementias is already so high that we don’t want to make it worse by not understanding directions and/or questions. I think that will be the topic of my next blog.
Your comments are more than welcome.