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It’s been a rough week, and I’m well past overdue for a solid update to this blog. Still, sometimes it is the little things that stand out in a day, so as a study break I would like to take you for a little behind-the-scenes look at how interpreter call lines work.

In the hospital setting, especially at a big, public hospital, there are often language barriers between doctor and patient. The best way to deal with something like this is to get a family member or friend to translate. The second best scenario is to enlist the help of someone on staff who speaks the language. Still, there will be times when an on-site interpreter cannot be found, and for those occasions many hospitals have hotlines hospital staff can call to gain access to an interpreter.

For our patient presentation this week, we had a doctor interview a gentleman who recounted for us his experience with an illness we had been studying in the past few weeks. He also spoke almost no English

If communicating to your patient through a third party via phone sounds awkward and cumbersome, that’s because it is. And if you happen to think presenting such an awkward and cumbersome activity to an auditorium of 150 medical students sounds like it might present some logistical problems, you would again be right.

The presentation was sent up with the doctor and the patient in the front of the auditorium. A microphone was positioned over a cell phone lying on the table in front of them. The cell phone was on speaker, and the microphone actually managed to pick up most of the call surprisingly well, given the technical difficulties we’ve had with sound during many of our lectures.

On a screen above their heads was a list of basic guidelines for using an interpreter hotline.

  1. Introduce yourself and your patient to the interpreter
  2. Write down the interpreter’s ID in the patient’s chart
  3. Speak directly to the patient and make eye contact
  4. Speak in short, direct sentences

The physician dialed and we listened to the phone ring. Then, like with any hotline, a recording answered.

“Thank you for calling the interpretation hotline. Please enter your ID number and PIN.”

(ID and PIN, I thought. I guess you wouldn’t want just anyone taking advantage. I could picture a lonely patient looking for the sound of a familiar language sneaking a call in the middle of the night.)

I believe a real person picked up then, but it was hard to tell the difference from the recording. “Please state the language you need translated,” she said.

The doctor leaned forward and spoke slowly into the phone and the mic at the same time. He requested the patient’s primary language and then added a backup in case they couldn’t find a translator for the first.

“Please hold while a translator is located,” said the woman on the other end. There was a click followed by the all-too-familiar strains of hold music drifting up through the mic. The class laughed.

The hold music played for a minute. There was another click and recording announced, “All translators are currently busy. Please hold for the next available translator.” Another little laugh passed through the crowd.

A few moments later the operator returned and told us an interpreter for the primary language was available. We were transferred over.

Through all of this, our patient sat…well…patiently, looking down at the phone. I wondered how much of this process he understood; certainly he must have been through it dozens of times. He seemed pretty calm, but I couldn’t help thinking how uncomfortable I would be, sitting in front of so many white-coated students, unable to understand most of what was being said around me.

The interpreter came onto the phone. She introduced herself and gave her ID. The doctor introduced himself and the patient. I waited for him to explain to her that she was on speaker in front of a classroom full of medical students, but he never told her the situation directly. Instead he dove right into the interview, asking the patient if he was nervous to be in front of us all and tell him that we were just kids and didn’t know anything. I wondered what the interpreter was picturing on her end of things. She gave no hint at being surprised or annoyed at being called upon for demonstration purposes.

I don’t know if it was the awkwardness of the set-up, or the convention of such translations, but the doctor was robotic throughout the interview. He spoke slowly and loudly in simple sentences, probably to make the translation as easy as possible, but there was no inflection or emotion in his voice. I found myself looking away when he would ask his question, embarrassed by his stiffness and unsure if the extent of his simplicity was entirely warranted.

The patient spoke in short affirmatives at first–we quickly learned the word for “yes”–as the doctor narrated his background. Eventually he began to answer real questions and fill in the pieces of his tale, the soft flow of his words melodic in contrast to the short, direct sentences of the physician.

Despite my interest, it was hard to sit through. The translation took a long time; even beyond having to wait through the interpretation and reply, there were times when seemingly short answers seemed to necessitate far more words in translation. There were times when I could hear the interpreter struggling to find the right words or phrase in both languages. Sometimes her translations hinted at a nuanced answer that simply couldn’t be conveyed adequately in the given situation.

On the other hand, we were able to find a translator who spoke a very specific language fairly quickly , and went from a complete language barrier to effective communication in a short period of time. Clumsy though it may feel, that is something of a miracle.

Amid all the whining about exams and stress and studying, I want to share with you one of my favorite things about medical school. I am sure I’ll come up with a few more in time (I am expecting awesome things from the simulation center, for example), but right now the highlight of every week is our class patient interview.

If you’re not familiar, a tried and true habit of medical schools since ye-olde-days is to get find patients with the disease you are studying and bring them in front of the class to talk about their condition. I suspect that in said ye-olde-days they also demonstrated their ailment or had to deal with some undignified poking and prodding by the presenting physician. In our class, thus far, they have simply sat in the front of the room with a clip-on microphone and answered questions by their physician or, in a few cases, a specialist in the field who may not have met them yet.

I have a few selfish reasons why I love patient interviews. First of all, it isn’t material we’re tested on. Yes, the disease of interest is related to what we are studying, but there is no expectation that we will take notes, and the interview is not recorded, for confidentiality reasons. We’re not even allowed to have our computers open during the interview, which is a big deal in a curriculum where everything is online. The only expectation is that we show up on time, we dress professionally and we wear our white coats. Some people do take hand-written notes, but I am happy enough for the chance just to listen for a change.

Besides the low-stress environment, a patient interview offers so much to learn. First of all is the variation. Lectures strive to teach you typical cases, but seldom do I expect a patient to walk into my practice with every single hallmark sign of a disease. It’s kind of fun to watch the physician try to lead the patient down a particular path (and when did you start to experience X symptom?) only to have the patient go off in an entirely different direction.

We also get the chance to see how a disease affects day-to-day life. Most of the lecture pathologies come with a cause, a list of symptoms, and perhaps a few lines about what the patient might say if they wandered into your office looking for a diagnosis. Patient interviews follow a narrative. They fill in the blanks between doctor’s visits and express frustrations I might not expect.

Also? I love any excuse to wear my white coat. I know it’s terribly dorky of me, and I’m usually uncomfortable in my nice clothes before I even get to school (last time we were all caught in a rainstorm that somewhat (haha) dampened the professional spirit), but dressing up for patient interviews makes me feel like I’m really in medical school. Like I’m actually going to be a doctor someday. That thought still catches me by surprise sometimes.

I do, however, wonder what it looks like from the patient’s perspective. I understand the need to dress professionally–how awkward would it be to talk about your health problems in front of 150 kids slouching around in T-shirts and sneakers–but I wonder if the white coats don’t make it a bit more intimidating than it needs to be. A friend of mine who has been the subject of such interviews said that everyone looked like clones. I suppose you have to be a brave soul to agree to the patient interview in the first place. I also wonder if it isn’t a bit pretentious for us first years, who know nothing much of merit, to be sitting around wearing these symbols of knowledge, as though we had something to offer this individual other than gratitude. Regardless, I am glad they are required, because if left to my own devices, I would never quite feel my white coat was an appropriate wardrobe addition.

White coats notwithstanding, I hope the interviewed patients have a positive experience as the subjects of our scrutiny. When the floor is turned over to the students for questions, at least one individual usually voices thanks for the opportunity. I hope the patients know how genuinely it is meant. We future physicians like to pretend that we’re something special, but in the end we are nothing without the trust of the sick. I have not yet earned that trust, and it feels very special that, despite that, there are those out there willing to put themselves out there for our education.