Spanish in the medical setting...Accommodating or enabling?

As I walked into the exam room, the beautiful staccato rhythm of the Spanish language reached my ears.  I knew that this visit was going to be like the majority of my visits this morning, conducted in the family’s native tongue.  I would usually tease them as I entered, asking them, “¿Inglés o Español?  “¡Español!”, they would invariably cry.  The next question would follow (in Spanish, of course)-How long have you lived in the United States?  Something in the realm of 10 to 20 years would be the customary reply.  Just out of curiosity, I would inquire as to why they hadn’t learned English yet.  Too hard or not enough time was the usual sheepish reply.  I then would tell them that that couldn’t be an excuse; that I lived in Chile for only two years, well over 30 years ago, and I was speaking a fluent Spanish.  Then I would tell them that English couldn’t be that hard to master; I learned it when I was just a kid…

This vignette was played out many times in my career as a pediatrician.  As a resident in San Diego and in my practice years in New Mexico and Arizona, I had ample opportunity to hone the Spanish I had learned as a missionary in Chile from 1979-81.  There would be times in clinic when I would spend virtually the entire day communicating in Spanish.  This wasn’t and would never be a problem for me.  I was glad for the opportunity to be a resource for these families that needed the rapport necessary to communicate their medical needs to someone.  I never felt that the medical office was the place to worry about the immigration debate and I went along my way collecting cherished memories from some of my favorite patients and families.

I was reminded of these episodes in my career the other day when I was discussing the Puerto Rico Republican primary with a close friend.  Rick Santorum stepped in the euphemistic “it” politically there when he averred that Puerto Ricans should learn English in order to be admitted into the Union.  My friend was of a similar mindset, believing that the ability to communicate in English is an important aspect of living in the United States.  I can't disagree. Now, I'm not convinced that the United States as we know it will cease to exist if folks don’t learn English.  Besides, the latest census shows that fully 97% of us speak English already.  I will admit that not being able to speak English will make it difficult for this bunch to assimilate into society and it does indeed make navigation of the health care system more precarious if one doesn’t speak the lingo.  I also think that this demographic should be responsible for providing a translator for their personal needs.  It shouldn't be an imposition upon each doctor or clinic provider to be required to pay for this expense.  If they wish to do so for better customer service, so be it.  On the other hand, do we need to mandate that everyone speak English or punish those that don't? 

Creo que no.

Dr. K  

 

Comments

[Dan Mason]

Teh bigger question is who should pay for translation services?
In the US that burden falls on the physician solely (doctors/hospitals have to provide translators to patients free of charge to the patient), which then increase the cost of health care on everything/everyone else to make up for it.
If you or I were to go to china/turkey/Russia/mexico and wind up in a hospital do you think they would be nice enough to provide translators? The answer is no, we would be expected to pay or provide those services ourselves. I don't disagree that people who end up in the ER while traveling etc.. should not be afforded these services but when oyu have resided in a country for 10-20 years and refused to learn the native language, well that is a choice and it dose have consequences.

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I think it's best if our physicians speak and understand other languages to make the treatment process easier.

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This wasn’t and would never be a problem for me. I was glad for the opportunity to be a resource for these families that needed the rapport necessary to communicate their medical needs to someone.