treating them like second class citizens
2:30 am. She has been sitting in the triage area of Labor and Delivery for 2 hours now. She doesn't know it yet, but she is going to have a C-Section. It was deemed an urgent C-Section (but not EMErgent, an important distinction). She also doesn't know she is going to be waiting another hour and a half until she finally finds out, literally as she is on her way to the operating room.
Why doesn't she know? And why must her urgent operation wait until 4 am?
Simple: she speaks Spanish.
But most aggravating of all is the fact that I speak Spanish as well. And not just "I took Spanish in High School, so I speak Spanish". No, I am fluent. I speak well enough to occasionally fool native Spanish speakers into thinking that Spanish is my native language. I lived in Central America for 2 years, studied Spanish grammar and literature in college, and continue to keep it up. Sure, there are words I don't know now and then, but I have never come across a term I couldn't explain perfectly well, even if I didn't have the exact word.
But apparently that level of fluency isn't enough for Duke. Never mind the fact that my Spanish is better than some of the "professional interpreters" I have listened to here. Never mind the fact that I have worked as an interpreter and Spanish tutor for college courses in the past. And never mind the fact that my Spanish coupled with my medical knowledge makes me that much more effective when dealing with Spanish speaking patients.
See, if I go in and interpret for a patient Duke can't bill for that service.
I can't help but see this as an example of the bottom line taking precedence over patient care. Of course, this isn't the reason they tell me I can't interpret. They tell me it is because I haven't gone through their ridiculous and idiotic certification process. But that is only necessary to interpret hospital and clinic wide. To interpret for my patients (as a medical student meaning whatever patients are on the service I am currently assigned to) I was told I just needed to have a conversation with the lady in charge of International Patient Relations so she can assess my Spanish.
But if it really was just because they wanted to make sure I spoke good Spanish, why make the process so difficult? Money talks, don't it.
I was told this by another student who received such authorization. According to him he simply called her, spoke with her over the phone for a few minutes in Spanish and BAM, he had is interpreter number. So I thought I would make things even easier. I went to her office to find her. Of course she wasn't there, so I left my name and pager number. I never heard back.
I called her, at which time she admits to having it but was apparently too busy to page me. So she says she will email me some times I can stop by and speak with her. I guess I can't do this over the phone? Hmm, I wonder why. I have a guess.
My fellow classmate's last name is distinctly Hispanic in origin. And as anyone who knows my real name can attest, well, names just don't get much more Anglo. And so, because of my name (and lack of any accent when I speak English) I am discriminated against. Not only does she not return my page (after seeing my Anglo name), she refuses to talk to me over the phone, as she has with others (even after I called her on that and gave her the names of those I knew she had spoken with).
She never emailed me either.
Now, let's think this through. If I can interpret my patients don't need to wait. As the medical student (aka monkey) I am pretty much always there, at the beck and call of my attending and residents. So in the above example, as I sat in triage all night, this woman could have had her baby at least 2 hours earlier. That is 2 fewer hours of high level nursing care, 2 less hours of monitoring, and 2 fewer hours of meds to keep her comfortable while we twiddle our thumbs waiting for the interpreter to show up.
Then you have interpreters who, though they speak great Spanish, have no clue what they are saying most of the time. Oh, and they don't tell the patient everything the doctor says at times, or they alter it. They claim it is because they are conscious of cultural norms and such. I say bull. It is because they are lazy and have too many patients to see. While I could sit in there with a patient, carefully explain everything, and offer them plenty of time to ask questions, the interpreters are continuously looking at their watches, the list of patients they still need to go see and their pager to see where to go next. Maybe it is just me, but that doesn't seem to make for the most comfortable and open environment.
So I say screw 'em. When I was on Pediatrics I just did it. I didn't care. Sometimes the nurse had called an interpreter already, so I quietly stood in the corner, listening, then corrected the errors they had made after they left the room. But most of the time my residents, attending and I just did the job. And you know what?
The patients received better, more timely care, and I was a heck of a lot more warm and personable than any interpreter. I actually knew my patients, their names, their medical history, what they did/didn't like, and saw them as people, not a job to be done. So when one of my patients told International Patient Services that she never wanted to see their interpreter again, and that she just wanted to talk to me I knew we were doing the right thing.
Some will argue the Spanish speaking population needs to integrate. And you know what? I agree. But it ain't going to happen overnight. And so, in the meantime, I will continue to talk to my patients, sans idiotic interpreter, and I will also continue to fight to become official. The discrimination card is going to be played in the next phone call. Let's see if that makes a difference.