I learned English out of necessity — not only for myself but also for my family. I grew up in Mexico and moved to a small Northern California town at the age of eight. When we moved to the United States, I was placed in an English-speaking classroom with no one who spoke Spanish. Necessity forced me to learn English quickly and, as a result, I became my family’s unofficial interpreter, including at their medical appointments. It was the necessity that forced me to learn how to fill out official paperwork in English, how to navigate social services after my sister was diagnosed with autism and how to speak with physicians and nurses.
My background as a child interpreter has been one of my main motivations for becoming a physician. I have experienced the fear, vulnerability and doubt that comes with trusting a physician who does not speak one’s language or doesn’t understand one’s culture. As a medical student and former child interpreter, I have realized that my background puts me in a unique position to connect with my patients. In the past two years as a medical student, I’ve used my own experiences to guide my interactions with patients who feel similar emotions of vulnerability and fear that I did years ago as they navigate a foreign health care system.
In the United States, there are about 16 million people who speak Spanish fluently; of those 16 million, about nine million report that they speak English “not at all or not well.” Language barriers are associated with lower patient comprehension and trust in physicians which can result in worse patient outcomes; the language barrier between patient and physician does not only affect clinical outcomes, but also the amount of trust and vulnerability they allow themselves to show. Although interpreters play an essential role in bridging the communication gap, many of the concerns with language barriers can persist despite interpreter use.
A 2020 survey given to Spanish-speaking caregivers found that they heavily rely on interpreters, but in many cases felt limited in their ability to communicate with health care professionals. For example, caregivers felt that the long waiting time before interpreters became available impeded communication, as did the pressure of having to think of questions before the interpreter left the appointment. Furthermore, for the millions of Spanish-speaking patients and caregivers, the use of interpreters can feel impersonal and can prevent them from speaking about topics they might feel are sensitive or embarrassing.
As a former child interpreter and current medical student who has had the privilege to connect with patients early in my medical career, I have learned two major lessons that I will forever keep on my mind during patient interactions. As health care professionals, we must provide the patient with an environment in which they feel like they matter; and secondly, even if we cannot speak the patient’s language we must take the necessary steps and considerations when using interpreters to make the patient feel in control of their health care and able to advocate for themselves.
The first and most important lesson is to listen to your patient and give them the time to open up to you. I acknowledge that as a bilingual medical student I can devote more time to each Spanish-speaking patient than most physicians would, but simply speaking with a patient conversationally — not as if you are completing a checklist of questions — has made patients more comfortable being vulnerable with me. I remember as a child receiving rushed and sterile responses when speaking with a physician. We felt like the physician was only rushing us, and the sense of feeling rushed was amplified by not being able to communicate directly with the physicians in the same language. As a medical student now, I wonder how my family’s distrust of the medical system would have been different had our physicians dedicated time to building rapport with us.
I myself have learned firsthand the importance of paying attention to the patient and making them feel heard. One especially memorable example of this occurred during longitudinal family medicine clinic rotation in my first year of medical school when I was speaking with an elderly female in Spanish. While asking her typical medical history questions, I also prioritized building rapport by speaking with her about her interests, home country and grandchildren. While speaking about her family she suddenly broke down crying and said that she thought her children were going to leave her. Along with my preceptor, we assessed the situation and were able to refer her to mental health services. She did not show signs of depression until I made her feel comfortable enough to disclose personal concerns.
Undoubtedly this patient of mine was able to feel more comfortable building rapport with me since we spoke the same language, but the second lesson I want to impart is that it is possible to do this work even if you don’t share the same languages as your patients. Growing up interpreting for my parents I never met a Spanish-speaking physician. I had the misconception that we were not listened to by our physician primarily because of the language barrier. However, in my two short years working at the clinic, I have learned that it is possible to make a patient feel understood and cared for even if we don’t speak the same languages by learning how to provide care with cultural humility.
Although my clinic preceptor does not speak Spanish, I have been told multiple times by his patients to learn as much as possible from him. I learned from him the importance of utilizing resources such as videos and pamphlets in a patient’s native language to provide them information that they can take home and learn from. I’ve also learned the importance of using drawings, making eye contact and repetitively asking if the patient has questions in order to make sure everything is understood. I’ve realized that by adopting these practices, my preceptor is modeling how to approach his Spanish-speaking patients with a cultural humility that allows his patients to feel heard and cared for. Fortunately, I will be able to communicate with my Spanish-speaking patients, but I now understand that even when I have patients with whom I cannot communicate in their native language, I can still make them feel comfortable and understood.
As a medical student, every time I visit a clinic I try to keep in mind these two lessons with each encounter I have. Taking the time to speak with patients and making them feel comfortable can create a safe space to share something that could be affecting their health. Patients who do not speak English might feel scared, confused and dehumanized, and it is up to the physician to work with an interpreter to make sure the patient feels like more than a number or a name in a list. As physicians, we have patients come to us in their most vulnerable moments. It is a privilege and an honor to treat patients and help them get through such difficult times.