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The Differential

Learning the Importance of Overcoming Language Barriers

Sung Woo Koh, Medical Student, 11:09PM Oct 8, 2017

MS4, Chicago Medical School

I recently had a Nepalese-speaking male patient who came in for progressive dyspnea on exertion. He had COPD and asthma but also a long history of a cavitary lesion in his left upper lung. According to the notes from his past admissions, it was uncertain whether he had a history of tuberculosis and whether it was treated or not. Some notes said he had TB but others said he had a questionable history of TB. Also this patient had a diagnosis of COPD but no pulmonary function tests (which you need in order to diagnose COPD).

When my Fellow and I interviewed the patient, it became apparent why everybody was so confused. Not only did the language barrier make it challenging to communicate (despite use of telephone interpreter), the patient was a terrible historian. He would go off on tangents, not directly answer the question asked, and talk a extensively about something, making it a nightmare for the interpreter. There were a few moments where the patient would say something in Nepalese for 30 seconds and the interpreter would translate it to just a couple sentences. As medical students, we are taught to ask open-ended questions, but this was one of those times where you had to break the rule and only ask short closed-ended questions just to maintain your sanity. I walked out of that encounter confused and frustrated.

The next morning, I braced myself for another long and confusing conversation, as I would preround on the patient. However, during the conversation, I began to feel compassion for this man. He had no idea why he was having trouble breathing, why everybody keeps asking him about tuberculosis, why everyone is wearing funny masks and won't let him leave the room, what tests he was going to get, and when he would be able to go home.

I remembered when my grandmother was hospitalized after her heart surgery, she was just like this man. She didn't speak a word of English, didn't understand what was going on, why they didn't put salt in any of her food, why they had to drain fluid from her lungs, and so on. My grandma was also a terrible historian; she often ignores the doctor's questions and talk at lengths about something tangentially related and then immediately jumps to questions that she wants to ask that the doctors didn't think were medically significant.

I was initially planning on making the conversation very brief that morning, just asking the minimum required to write my pulmonary consult note ("How are you feeling this morning? Any fever? Any chest pain? How's your breathing?"). Instead, I talked to him about what other complaints he had, exactly what our team's differentials were, what tests we are waiting for and why we need them, why everyone is asking about tuberculosis, why we can't tell him exactly what he has until we get certain tests, and so forth. I was going to be late for morning rounds, but I asked him what other questions he had, and answered every last one of them even though they were not under our responsibilities as the pulmonary consult team.

He asked when he was getting his breakfast (it was 8 am, and he had been told he would get them around 7:30 am). Although I was already late for my rounds and I assumed the food would be coming around soon enough, I decided to find the phone number of his nurse and ask her about his breakfast. She thought about it for a bit and said probably he couldn't order his food from the hospital menu because he can't speak/read English, and said she would make sure he would get his food ordered. If I hadn't made that phone call, this nurse just coming onto her morning shift may not have known to look into his breakfast orders, and this man may have gone hungry without being able to ask anyone why.

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Medical school and residency can be a stressful, demanding time. These medical students share their insights and experiences, good and bad, in order to create a community of support and understanding for medical students everywhere.

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    Chicago Medical School at Rosalind Franklin University

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