Louise Kenny: Lost for words

It wasn’t until the last couple of weeks that I began to have terrible, panic-stricken nightmares about my dreadful communication skills.  I wake in a trembling state, sweating because I can’t remember how to ask my patient ‘Does the pain radiate anywhere else? Does it come and go?  Is it sharp, stabbing pain?’
In my night terrors, it’s always the same patient, and me standing open mouthed bubbing like a goldfish. Now don’t worry, this memory problem isn’t pathological, I’m not dementing or growing a tumour, I’m moving to Guatemala for work.  Despite my 6 months of Spanish lessons slotted in around understaffed rotas, without a doubt I’m going to have some total communication failures.  The Calgary-Cambridge model probably isn’t going to cut it in the event I forget the words for ‘I need some help, she’s haemorrhaging’.The thought of quite how bad it could be fills me with horror.

Now I’ve been a doctor for 2 years, and I like to think that I am a good communicator, although we do all have our moments.  I’ve certainly had positive feedback from colleagues, and indeed patients, regarding my ability to talk, listen, understand, and interpret the frequent subtleties of a patient’s history.  Skills that I had taken for granted until my recent awake-sleep moments scrabbling through the Spanish dictionary next to my bed.

During my short career, I’ve sadly been witness to several truly dreadful interactions between doctor and patient.  While attitude and mannerism can be blamed for plenty, the language barrier inherently creates a broken, stilted conversation while one or other party thinks, translates, and constructs sentences.  English spoken as a second language can, at times, sound abrupt, as I’m sure any language does.

I met an extremely helpful, lovely Argentinean GP who now works up in the Northeast.  We sat in a pub and chatted medical Spanish, identifying those circumstances most terrifying.  I said breaking bad news, so we gave it a go:

‘Lo siento, pero esta muerte’ was my first attempt, literally translated as ‘I’m sorry but he’s dead’.  Now I recognise in English that this could be said better and I do know more appropriate Spanish tenses to build the sentence, but my grasp of Spanish grammar is too basic to think on my feet.  My friendly Argentinean suggested ‘he has died, or he died, might be better?’

Well of course it would!  Precisely demonstrating how I’m dangerously close to being that abrupt, direct, slightly shirty doctor that makes us all wince on ward rounds.  He doesn’t mean to omit all the niceties that cushion the blow, he just doesn’t know the grammar!

So here I am, black of the night with sweaty palms and palpitations about imagined interactions that may soon be a reality.  Last night it was the operating theatre – it was a horror flick involving looking up the word for ‘forceps’ while scrubbed.  Simply remembering and writing it gives me pit-of-the-belly anxiety.

With poor communication identified as the primary cause in 70% of malpractice suits, it’s obviously the all important skill to get right for more than just the sake of patient satisfaction.

I’ve been well-informed by someone who has worked in the Hospitalito Atilan before that I really need not panic about the Spanish, that, I quote, ‘it will be the least of my worries’.


Louise Kenny has completed F2 year in the Northern deanery. She starts work shortly at Hospitalito Atilan in Guatemala