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HARVARD GAZETTE ARCHIVES 'Take Two Aspirin and Call Me Mañana' By Alvin Powell
America’s increasing diversity is reflected in the country’s emergency rooms and hospital wards, where different languages spoken by doctors and patients sometimes create a communication barrier that can affect care. Harvard Medical School (HMS) is attempting to bridge that barrier, with a set of three medical phrasebooks: Communicating with the Patient during Urgent Care, Communicating with the Patient on Work Rounds, and Communicating with the Patient during Review of Systems. All three are translated into Cantonese, Haitian Creole, and Spanish. Each phrasebook consists of a list of yes-or-no questions with their phonetic pronunciation. With a shake of the head or a nod of assent a patient can tell a doctor if it hurts and where. One exchange in Cantonese, for example, has the English questions in a column on the left, with the Cantonese pronunciation on the right, followed by the question repeated in Chinese characters. Do you have pain? Is followed by the Cantonese phonetic translation: "Nay yaoo tohng mah?" The conversation continues: Where? "Been doh tohng?" And concludes: Please point exactly. "Tzeng dzee bay ngoh tai." This model is used throughout the three phrasebooks, in all three languages and in a conversational format. Although phrasebooks in other languages abound, ones that address medically-specific questions are scarce, if they exist at all. "These are not phrasebooks for ordering a meal in a foreign country. They are designed to make the medical moment safer, more humane, and more dignified," said Daniel Federman, dean for medical education at the Medical School. "If you can’t take a medical history, you can’t give good care." Spanish was selected to be among the publication’s initial three languages because of the nation’s large Spanish-speaking population. Cantonese and Haitian Creole were included because of significant Boston-area populations. The phrases were selected to allow the doctor to give the patient more than just nuts-and-bolts medical care. Phrases such as "We will take good care of you," and "Can I get you a drink of water?" were also included to set the patient at ease as much as possible.The questions were selected – with the help of a large number of HMS students and faculty at Harvard-affiliated hospitals – to ensure that basic medical information is exchanged. They were phrased with the help of native speakers, interpreters, and community centers whose members speak the targeted language so that the questions would be phrased in a way that is sensitive to the cultural traditions of the patient.One common situation the phrasebook is designed to avoid is when doctors are faced with a non-English-speaking parent accompanied by a bilingual child. The phrasebook, Federman said, will give the doctor an alternative to asking a 10-year-old son, for example, to translate his sick mother’s responses to what may be personal questions."We’re trying to get around that to the point where the doctor and patient can converse without relying on the bilingual child," Federman said.The phrasebook arose out of a 1994 student project examining how Asians fare in the medical system. Federman said he remembers one speaker commented that there were no barriers to health care in Boston, as long as you spoke English.That comment got the project moving. From there Federman turned to Nora Nercessian, the Medical School’s assistant dean of alumni affairs and special projects. Nercessian took charge of the project, contacting faculty, nurses, medical school students, interpreters, and community centers to develop the phrasebooks."The design of the questions also carries a special message that the caregiver must recognize the dignity of the patient and that the patient’s vulnerability in a time of medical need is increased by linguistic isolation," Nercessian said.The Urgent Care phrasebook will be published on laminated sheets, which the emergency room physician can pick up on the way to examine a patient. The other two phrasebooks, which consist of questions doctors can use on rounds and questions needed to take a patient’s medical history, will be published in booklet form."None of the phrasebooks are meant to replace a qualified interpreter," Nercessian said. "They are meant to bridge the gap between patient and doctor and make use of the precious time before an interpreter is available."The project is financed through a grant from the Robert Wood Johnson Foundation, which will cover the printing of 200 copies. Beginning early next year, the phrasebook will go through several months of testing at Harvard-affiliated hospitals. After any needed changes, the book will be distributed more broadly. Details of that distribution, which may include publication on the Internet, are still being worked out. Eventually, Federman said, they hope to publish the phrasebooks in 20 of the most commonly spoken languages in the country. Several students at Harvard Medical School, the School of Dental Medicine, and the School of Public Health helped with the project, including Clara Chang, Anthony Chen, Laura Gottlieb, Chi-Cheng Huang, Marcus Ko, Daryl Oakes, Michael Tran, Ernest Yeh, Channing Yu, Wing Lee, Mavis Wu, and Daphney Frederique. Faculty who helped with the project include Assistant Professor of Medicine James Adams; Michele David, of the Boston University School of Medicine; Professor of Ambulatory Care and Prevention Suzanne Fletcher; Associate Professor of Dermatology Ernesto Gonzalez; and Instructors in Medicine Alison May, Ming Hui Chen, and James Meigs. Translation and information technology assistance were provided by Gregory Figaro, Eva Grubinger, Steven Lee, Cecilia Matos, David Orlandella, Jeane Phane, and Robert Thompson. Staff at the South Cove Community Health Center in Boston and the Haitian Multiservice Center in Dorchester also provided assistance.
Copyright 1999 President and Fellows of Harvard College |
