Inside the orientation packet he received as a first-year resident at NewYork-Presbyterian Hospital, Dr. Christopher Kellner found a flier advertising a course in performing basic life support alongside a handout describing free Spanish-language instruction.
The aspiring neurosurgeon, who starts his residency this week at the hospital’s Columbia University Medical Center campus, speculated that the language skills would prove the more useful training. “Working in Washington Heights and going to Columbia, you need to speak Spanish,” he said.
By encouraging residents to learn Spanish, the most commonly spoken language in New York City after English, hospitals are signaling the increasing importance of the skill in overall medical training. In some cases, hospitals are even encouraging residents to receive “medical” Spanish instruction that focuses on the terminology they will need to examine, diagnose, and treat patients.
“If you can’t elicit what the patient is feeling, you’re going to lose a lot,” the director of a medical Spanish program at the Albert Einstein College of Medicine of Yeshiva University, Maria Marzan, said. “I don’t need for my students to learn what to say in a Spanish restaurant. I need them to learn to ask questions of this patient in a culturally sensitive way.”
At NewYork-Presbyterian, the reason for offering Spanish lessons to residents was simple: “They’re here and they don’t know Spanish,” the director of the internal medicine residency program at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, Dr. Mark Pecker, said. About one-third of the hospital’s patients speak Spanish as a first language, he added.
In New York City, the large immigrant population makes the need to speak Spanish to patients particularly acute. By law, the state’s Department of Health requires hospitals to provide a certain level of language assistance to patients who do not speak English. Most hospitals have translators on-site, or special telephone hookups that provide translation services.
Yet some residents said they still prefer to speak and understand Spanish themselves, as translators can be hard to find, particularly during the night shift. One resident at St. Luke’s-Roosevelt Hospital, Dr. Komal Jhaveri, said she took a Spanish course for that reason. “I need to know words that describe chest pain,” she said.
Other aspiring doctors said speaking a patient’s language helps them form a better relationship with them. “The main reason we’re in medical school is to learn how to treat patients. I think an important part of being a good doctor is being able to communicate with your patients,” a fourth-year student at the Mount Sinai School of Medicine, Ryan Ungaro, said. Starting this fall, Mount Sinai will offer medical Spanish classes to students, after several years of urging by Mr. Ungaro and other students.
In general, medical Spanish courses are designed to complement courses that teach clinical skills. “The primary goal is to get a student to the point where they can take a medical history,” a Spanish-language instructor who teaches at several New York hospitals, Michael Shane, said. During a recent lesson at NewYork-Presbyterian’s Weill Cornell Medical Center campus, Mr. Shane said many medical terms are similar in Spanish and in English. “I mention sarcoma and carcinoma,” he said. “They’re exactly the same. You just put on your Spanish accent and you’ve got it.”
Still, according to Ms. Marzan, of Einstein, stressing cultural sensitivity is also key. For example, some immigrants take herbal supplements to treat their ailments. Patients might also describe symptoms in a way that doctors are not accustomed to. For example, describing pain as being felt everywhere might mean the patient feels a lot of pain, and pain that is described as moving from the stomach to the chest to the face may be a reference to nausea.
Slang should also be taken into account. During the language lesson at NewYork-Presbyterian, students were taking turns naming parts of the human form when one doctor mistakenly used a casual word for buttocks. Laughing, Mr. Shane corrected him. “‘Culo’ is basically ‘ass,'” he said. “You would never say that to a patient.”
By E.B. SOLOMONT, Staff Reporter of the Sun | June 16, 2008