When You Don’t Speak the Patient’s Language

 "Considering Culture BOX 12.1  The Challenge: When You Don’t Speak the Patient’s Language Mrs. Reyes gave birth by cesarean section to her first child, a baby boy she named Carlos, yesterday, and she is recovering well. She speaks Spanish only. On the previous shift, she had received a mild narcotic twice for incisional pain. Her nurse on that shift had learned Spanish through high school and then two semesters in college, so she felt that she was able to communicate very basic information with Mrs. Reyes, who will be your patient today. When you go in to take care of Mrs. Reyes, you find her lying on her side, weeping brokenheartedly. You know only a few words of Spanish, so you ask her if she has pain, and point to your lower abdomen. She replies, “No, no, aquí”and puts her hand on her chest. You are wondering if she is having some problem with breastfeeding or if she is having chest pain, so you take her pulse and blood pressure, which are both a little elevated but within normal limits. You know she is upset, and her pain appears to be emotional. You realize that she has said something about “mi niño”[my baby boy] and “cirugía”[surgery]; you decide it is time to call in a medical interpreter, because you know that her baby is healthy and is in the newborn nursery. The interpreter arrives and you explain briefly what you understand Mrs. Reyes to have said. Mrs. Reyes is still crying when you go back in her room with the interpreter, and you tell Mrs. Reyes through the interpreter that the interpreter speaks Spanish and will be assisting you in figuring out what is wrong. Mrs. Reyes begins a very animated narrative to the interpreter who tries to get her to slow down and let her tell you what she (Mrs. Reyes) has said. Mrs. Reyes tells you through the interpreter that the nurse on the previous shift had awakened her to sign a paper giving permission for a doctor to “do surgery—to cut”on her baby, and now she is afraid something is wrong with the baby and no one has told her. You realize the nurse had gotten Mrs. Reyes to sign a consent form for circumcision, a common procedure in newborn male infants, and that the nurse had not explained it properly, nor had she used an interpreter to help. You explain through the interpreter, carefully, about circumcision and Mrs. Reyes calms down quickly, because she understands what circumcision is. You realize that a serious, preventable communication problem has occurred. As you think about this situation, address these questions: 1. What were the errors that occurred in this situation? 2. How could they have been avoided? 3. What are the ethical considerations in this situation? 4. What are your next steps in helping manage this situation? 5. What should you do regarding your co-worker?"