All of us know that doctor-speak can sound like a foreign language. And even once we get a handle on all the medical jargon, we may wonder if our doctors are really listening to us, really hearing our health concerns—heck, even seeing into our psyche. (I was amazed a few weeks ago when an otolaryngologist that I took my daughter to for a consult didn't even introduce herself when we walked in the room.) Internist Danielle Ofri has focused intently on the art of communicating with her patients—even moving to Costa Rica for a year to become fluent in Spanish to better converse with the large population of Latino immigrant patients who visit her clinic at Bellevue Hospital in New York City. (She's also a professor of medicine at the New York University Medical School.) Her new book, Medicine in Translation, details the cultural, religious, and racial divides that doctors and patients must bridge in an effort to become healthcare partners. Check out my video with her and edited excerpts from our interview.
Video: Doctor speaking his own language? Physician Danielle Ofri finds solutions in her new book, Medicine in Translation.
How is medicine like a foreign language?
Medicine has its own culture, with customs and mores that patients must learn. When you go from the land of the healthy to the land of the sick, it's like you're emigrating. Your doctor has to be your interpreter; he or she needs to translate your illness and make sure you understand what medicine can do and what it can't. Sometimes you may feel overwhelmed and can't even hear what your doctor is saying after you get the initial diagnosis. Being told you have "diabetes," for example, may flood you with memories of your aunt who had the condition, making it impossible for you to hear what your doctor is saying in terms of your own prognosis. It's the doctor's job to know when you're processing the information and when you're not. Sometimes I ask my patients, "Are you sure you understand? Would you like to repeat back to me what I just explained?" By the same token, patients should feel comfortable enough with their doctors to stop them midsentence and let them know that they're not comprehending what's going on. At that point, doctors should be able to pivot, slowing down and speaking more simply and directly to the patient. If your doctor can't do that, it's time to get a new one.
In your book, you seem to get to know your patients' personal background very well. And they often want to know about you. Where do you draw the line between friendship and a professional relationship?
Doctors often have a reflex to want to have a deeper relationship above and beyond the role of medical caregiver. While I'm happy to hear about my patients' personal lives, my rule of thumb is not to talk about my own personal life too much. It all depends on what's in a patient's best interest. I might talk briefly about my husband and children with some to establish a rapport, but I also know when to hold back. I had one patient who gazed at photos of my family and made longing comments about what she judged to be my happy life. I knew it would be best for her if I didn't pull her into my personal world.
How do you establish a level of trust with your patients—especially those who have been through harrowing experiences like rape, domestic violence, or even torture in their native country?
It takes time, and I give them a chance to get to know me. Often, their back stories don't come up for many weeks or months into their regular clinic visits. Sometimes it's easier for us to talk during a clinical exam. As I'm touching them to listen to their heart or probe for pain, they often feel a sense of intimacy, making it easier to tell me what's on their mind.
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