PHYSICIAN-IN-TRAINING/MEDICAL STUDENT CATEGORY
2015 RICHARD SPEAR, MD, MEMORIAL ESSAY CONTEST
on his body and the lack of compliance with the daily prophylaxis
for his CGD, whether due to lack of education, poverty, or flat out
neglect. Mom had been prepared for this outcome, but we couldn’t
know for certain if she really knew the consequences of the decision.
If the child knew, then he gave no indication to that effect. The intern
lifted up the receiver and asked for Spanish. Mom was given the
other phone. Both mom and child looked up expectantly. Updates
and instructions relating to purely medical care were offered first.
Then came the unsavory news and it was so seamlessly incorporated
into the spiel that it almost seemed like a matter of routine care.
The proverbial bandaid had been ripped off, compliments of a third
party interpreter. I held my breath waiting for the reaction that I
felt would likely be an outburst of histrionics. But, mom and child
both dimly nodded- yes. No tears or tantrums. Whether this was
because they already knew what was coming or were uncomfortable reacting so emotionally in the presence of a group of masked
strangers or they hadn’t had time to fully process the news, we didn’t
know. The intern confirmed that mom understood what had been
said and she again nodded, yes. Both receivers were set down. The
attending, seated on the bed, lightly patted the child’s back and told
him to continue to be good, that he had a bright future ahead of
him. Then, we took our leave.
This experience represented a microcosm of the remote language
interpretation experience. I think the situation was dealt with appropriately and compassionately, considering the imprecise science
of the interpreter phone and the sensitive nature of what had to be
said. Nonverbal attempts at rapport and compassion were the rule,
rather than the exception. Despite care in making eye contact and
involving mom in the discussion however, it was obvious that the
phone represented an ultimately inadequate compromise between
relatability and communication. The impersonal nature of the technology, the extent to which it depends entirely on objective words
to the exclusion of very human mechanisms of understanding and
empathy, and the reliance on a stranger’s interpretation for comprehension make it a tenuous technology at best, albeit a necessary
one. Since it is not feasible to have human interpreters on hand for
every encounter with an exclusively non-English speaking patient
or family, these drawbacks have been rendered forcefully palatable.
But we don’t have to swallow them whole. The key is to remember
that the phone does not excuse us from trying to build rapport the
same way we do with all patients. It does not and cannot perfectly
relay the information we would like to get across (such is language
interpretation). It has the capacity to stifle discussion and questions, thereby making it necessary for us to find ways to rekindle
that exchange of ideas. It can make patients and their families feel
vulnerable and uncomfortable. Gestures like a smile are universally
understood and can and should be used liberally. We do not want
to let it become, as Albert Einstein once said, “appallingly obvious
that technology has exceeded our humanity.”
The child and his mother likely will not remember the exact words
used to describe his current condition or even the way in which
they were told about his ‘disposition’ to foster care, but there is solace in thinking they might recall the gentle smiles, the reassuring
glances, and the tender pats on the back that they received from
their physicians.
Note: Sarah Khayat will be a fourth year medical student at the
University of Louisville this fall.
The Richard Spear, MD, Memorial Essay Contest is a yearly writing competition hosted by the Greater Louisville Medical Society. Dr. Richard Spear, a respected Louisville general surgeon, passed away in 2007 and left
GLMS a bequest to fund an annual essay contest. To view the Richard Spear, MD, Memorial Essay Contest
archives, visit www.glms.org/Default.aspx?PageID=530.
JULY 2015
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