5 “Bueno” Tips on How to Learn Medical Spanish

I work in a clinic located in a primarily Spanish-speaking-only community in Southern California. When I started working in this clinic approximately three years ago, I knew perhaps at the most a total of five Spanish words (no joke):

“Hola!” = Hello!
“Como esta?” = How are you?
“Gracias” = Thank you
“Adios” = Goodbye

And truly, that’s about it. No kidding. I did not take Spanish in high school, I took French. Mais, oui. I grew up on the East coast; no one speaks Spanish there, do they?! And my entire family spoke French and I wanted to use them to help me with my homework in school. Plus, I had a great French teacher in high school who I still keep in touch with today. How should I have known that I would move within hours of the U.S./Mexico border and would one day be unable to function without Spanish later in life?!

When I first started working there, almost every single patient encounter required an interpreter. Thankfully, every member of our super talented staff is also gifted with the Spanish language. I was so envious. Granted, it was their native tongue. But I was still envious at how easy they made it seem.

My typical day was as such: I would knock on the exam room door, enter and introduce myself. I very quickly learned the phrase “Habla ingles?” (Do you speak English?), and was almost always given a head-shake “no” in response. Then, with a “Con permiso” (which I later learned is “excuse me”), I would leave the exam room and search all over the clinic for a staff member looking not-busy-enough to help me interpret. That was truly a pain in the “nalgas” (behind), and caused me to waste a lot of “tiempo” (time).

This made me very motivated – I wanted to learn Spanish just so I can avoid having to search for an interpreter. And it was a challenge that really got my juices flowing. I was done with college, done with medical school, done with residency, and now I needed a “nuevo” (new) challenge to keep me going. I love a challenge. So I set my sights on learning Spanish. I was determined.

Thankfully, and perhaps somewhat miraculously, I now very rarely need an interpreter. Seriously, I think the last time I used one was “meses” (months) ago. I cannot even remember when.

So “como” (how) did I do it? Here’s my advice:

1. Find a good medical Spanish book: There are not that many. Buy the best one. And read the entire thing, word-for-word. Underline as you go. Then, re-read the underlined items from the first round. If you want to know which book I used, you can email me: jillalltradesmd@gmail.com.

2. Make note cards: I bought some large index cards, and made one for each “tipo” (type) of visit. For instance, since I see a lot of women, I made one for the “Papanicolau” (the Pap Smear). I would then literally whip it out of my pocket each time I had a pap.

“Que metodo usa para evitar el embarazo?” = What contraceptive method do you use?
“Por favor, acuestese y muevese hacia mi – mucho mas.” = Please lie back and move towards the bottom of the exam table – much more.
"Muy bien. Es todo. Por favor, levantase.” = Very good. That’s all. Please sit up.

As another example, I made one for “gripas” (head colds), and I’d whip that one out each time I had a patient who complained of a sniffle.

“Tiene tos? Nariz tapada? Dolor de garganta?” = Do you have a cough? Stuffy nose? Sore throat?”

You get the idea.

Soon, I realized, I don’t even need the note card because I whipped it out so many times that it was all bent around the edges (you may want to laminate yours).

3. Ask “mucho” (a lot) of questions: I was shameless. Seriously, shameless. I did not care if I sounded like an idiot. I pronounced everything wrong in the beginning. But I made sure to ask my patients to repeat everything “otra vez, por favor” (one more time please), and asked them to repeat it “mas dispacio” (more slowly). And the poor things, they did “todos” (everything) I asked. If they used a word or phrase I did not understand, I made sure to ask them what it meant.  My patients became my teachers.  I also learned to ask the following three important phrases:

“Como se dice ____, en Espanol?“ = How do you say ___, in Spanish?
“Que quiere decir ____?” = What does it mean ____?
“Disculpe, no entiendo” = I’m sorry, I don’t understand.

4. Learn the culture: There are many cultural beliefs and values when it comes to my Mexican patients, and many may pertain to their health. I tried to learn as much as I can about why they believe what they believe so that I can better educate my patients. For instance, I learned that many Latinos believe that insulin causes blindness. Not uncontrolled sugars, but insulin. I learned this while I was trying to understand why my patients were so reluctant to start the insulin I prescribed. Now, every time I want to start insulin, before they even say anything, I tell them from the get-go that there is a “mito” (a myth) out there about insulin causing blindness, but that it’s the opposite; it’s the uncontrolled sugars that may cause this to happen (they all nod their heads when I say this). I’m on to them, and they know it!  Submerge yourselves in their culture. Go to Mexico. Visit Barcelona. Listen to the Gypsy Kings. Wear a sombrero. Eat tamales (no, eating at Taco Bell does not count). Ask questions. Learn the culture. It will help you to understand and appreciate the language even more.

5. Work on the accent: If they can’t understand what you are saying, even if you are saying the right words, it’s not going to work. So I bought myself some Spanish CD’s for every day conversational phrases. I bought the ones that designed different real-life scenarios all in “song.” It was totally cheesy, but it worked! I played it in my car every day. And I repeated and repeated, while singing along out loud (thankfully I drove alone to work and back every day).

And there you go – 5 "bueno" (good) tips to learn medical Spanish. Ok, so I have been mostly living in the present tense when I speak to my patients. But they understand me. And most importantly, I don’t need to waste so much time looking for an interpreter. And, I have built a closer connection to my patients because I have made such an effort to learn their language. They never made fun of me, not even once (at least to my face). In fact, they have been so supportive. They know I understand them, and they understand me. It’s a priceless connection.

My next step: I bought a verb tense book, and now I’m learning the past and future tenses.

“Hasta luego, Amigos!” (Until later, friends).

And “bon chance!” (good luck) – oh, wait, no...that’s French.

Second Chance at Life Rejected

One of the very saddest, yet at the same time horrifying, patient stories I have heard:

Me: “So how may I help you this morning?” I asked, meeting my new patient.

Patient: “My kidney doctor told me to see you.”

Me: “Why did he ask you to see me?”

Patient: “Because he thinks I’m depressed.”

Me: “Why would he think that?”

Patient: “Because I didn’t take my anti-rejection medication for a couple of months, and I lost the kidney my twin sister donated to me 3 years ago as a result.”

My heart sank so low that I’m sure there was a loud thump as it hit the floor. After a period of what seemed like forever, I was able to move on from the shock of what I thought I had initially heard wrong.

Me: “Are you depressed?”

Patient: “I don’t feel depressed. But he kept insisting, so now I’m here.”

Surely this cannot be. It seemed so surreal. How can he let this happen? His sister gave up her kidney, risked her life, and underwent surgery so that he can live a better life. In fact, his sister’s health will never be the same – she’ll always have to be careful with her one remaining kidney. So that he can live. And that kidney was working so well for him. And now he just gave it up, so nonchalantly. As if he just merely gave away a pair of old, used shoes.

Me: “I can see why he would want you to be evaluated.”

He then went on to tell me that finances were tight, and he chose to pay other bills rather than the co-pays for his medications. I can understand that the economy has truly hit most of my patients hard, but the kidney that his sister donated wasn’t just a nice pair of shoes gift-wrapped in a box for his birthday. This was an organ. Those are not easy to come by. The wait time to receive one is years to a lifetime.

I was disappointed that he did not discuss his financial situation with his doctors to let them know he was having difficulty affording his medications. Was it because he couldn’t afford his co-pays, or was it because he just didn’t make an effort to find a way?

He was so lucky that his sister was a match. He was so lucky that she agreed to donate it. He was so lucky that the surgery went well. He was so lucky that the medications kept his kidney alive and thriving in his body.

If you are having difficulty making your co-pays, please communicate this with your family and with your doctor. You can find a way as a team when you know it can save your life. There are patient assisted programs that help patients with their medications when they can’t afford it.

This is a perfect example of why as a physician I believe that your health has to be priority in life. Sure I’m a little biased in that it’s my job to take care of my patients’ health. But if you don’t have your health, you don’t have life – quite literally, in this case.

Now he’s trying to get back on the waiting list for an organ, while he is back on dialysis three times a week. There are no other family matches.

Should he get another chance at an organ? Or should he be forced to continue with dialysis for the rest of his life instead?What do you think?

Dancing With the Doctors: Learn 5 Steps to Tango Effortlessly at Your Doctor’s Office

A friend recently asked me in great frustration after her visit to her doctor why doctors “always run late.” Why do doctors make their patients “dance around” the office, getting moved around to different spots in the clinic, but still having to wait and wait at each location. Instead of explaining what really goes on at the doctor’s office, I ended up emailing her a couple of links to some of my favorite blogs that have quite eloquently addressed this issue already:
1. Lockup Doc
2. Common Sense Family Doctor

Dr. Rob Lamberts also designed a very concise  list of both patient and doctor “rules,” important for every patient and physician to read:
1. Patient Rules
2. Doctor Rules

I believe it worked, having her read these illuminating posts on why doctors’ offices do what they do. Then it dawned on me, if only I can convince all patients to not only read these eloquent posts, but to go one step further – to learn what they can actively do during their office visit, as well. If patients simply learned “how to dance” while they are in my clinic, perhaps I wouldn’t be running as late, I’d be able to provide thorough and more focused care, and I’d be able to perhaps get all my extra work done on time, and maybe even have time to eat lunch. But every patient would have to be on the same page, learning the same dance moves. The clinic would run so efficiently if every patient learned these basic “dance steps,” and we’d all be doing the tango effortlessly. Here are the 5 basic dance steps each patient should learn in order to dance like the stars at the doctor’s office:

Step 1. Arrive on Time to Dance Class: In fact, try to arrive 10 minutes earlier than your appointment slot. This will give you enough time to park, check in at the front desk, and compensate for the unpredictable. Like a domino effect, one late patient causes everyone else for that day to run late, including the doctor. And that may just cause the judges to deduct points during a poor dance performance – and we want that trophy now, don’t we?

Step 2. Don’t Try to Learn More Than One Dance at a Time: This is perhaps the most important lesson of all to learn. It will become much too confusing to learn the Samba, the Salsa, and the Merengue at the same time, wouldn’t it? The doctor will have 15 minutes to spend with you at the most (some doctors even less). Therefore, your expectations need to be realistic. The doctor will not be able to address every single issue you may have on your list. Select 1, or at the very most 2 problems per visit. Why? Because each problem requires the proper line of questioning (called the history), the physical exam, and a possible work-up of tests. If you come in with a longer list, your visit will not allow the greatest focus and proper attention that each problem deserves, and something’s got to give. I would assume you would want your doctor to be very thorough, no? You don’t want the doctor to gloss over something important in this very detailed and meticulous process by becoming distracted, and your health is too important for that. Don’t risk it. If you need to be seen once a week every week until all your problems have been addressed, then so be it. Then, you will have learned each dance thoroughly well, ready to earn a perfect score in the end.

Step 3. Make Sure You Sign Up for the Correct Dance Class: Tell the nurse who takes your vital signs and places you in the exam room exactly what you are there for. If you have 1 or 2 problems, make sure you tell the nurse BOTH problems. If you need refills on your medications, make sure to tell the nurse that, too. Why is this? Several reasons. First, the room will need to be set up a certain way depending on your symptoms. For instance, if you are there for a pap smear, the nurse will need to give you a gown to have you change into it and set up the proper supplies. If you are there for chest pain, they may need an electrocardiogram (EKG) before they see you. If you do this after you are already with the doctor, the doctor will need to leave the room (which may cause you to wait while the next patient is seen), ask the nurse return to set up the room, and then return again. This is very inefficient, and it causes a big delay in the patient schedule. Second, the doctor really needs to know why you are there so that they can plan your 15 minute slot appropriately from the get-go. If you are there for headaches and a diabetes follow-up, and you also need your medications refilled, the doctor needs to know all of this before they see you so that they can come up with a timeline of how your short visit time will flow. Whatever you do, do not bring up a new problem after the visit has already begun. So when you sign up to dance, make sure your instructor knows which class you signed up for beforehand – you don’t want to show up for a tap class when you signed up for the tango!

Step 4. Don’t Forget Your Dancing Shoes: As important as those dancing shoes are to learn how to dance, so are your medication bottles when you visit your doctor. A simple “list” is not sufficient. Why? First of all, the amount of information you get from looking at the bottle is invaluable. When I look at the bottle, I can tell when the patient filled it, how many refills they have, when it expires, and how many pills are left in the bottle. Just because a medication is on the patient’s electronic pharmacy records doesn’t mean that they are actually taking it. Also, I occasionally catch mistakes that the pharmacy has made on patient prescriptions in this way. Whatever you do, don’t tell your doctor that you don’t know the name of your medication, only that it’s a “little white pill.” Almost every pill is a “little white pill”!

Step 5. Don’t Forget to Practice Your Moves at Home: If you have diabetes, bring your blood sugar log with you. If you have high blood pressure, bring your blood pressure log with you. This information is very important. Although your doctor may check your blood sugar level or blood pressure while you are in the office, this is just one number for one day. What your numbers look like over time are so much more important, and are significant chunks of information for the doctor. No one wins the competition without practicing the moves at home!

Now that you have learned the 5 basic dancing steps to make the most of your visit with your doctor, go ahead and show off your dance moves! Go on, shake it!

Defensive Medicine

True story from this morning:


Nurse: “Oh, Dr. Jill – I’ve been looking for you everywhere!” my seemingly frustrated nurse exclaims, panting, after finally catching me running in between two exam rooms.

Me: “What happened, Nurse? Is everything ok?”

Nurse: “The pharmacy has been calling me all morning about a patient prescription.”

Me: “What did they want that is so urgent? Did I make an error on a prescription? Do they need an urgent refill on a patient’s super important medication?”

Nurse: “No. You wrote for #30 insulin syringes, and they have a box that contains #31. They want to know if that’s ok?”

I started to laugh really hard. 'Surely you’ve got to be kidding,' I was thinking to myself. Isn’t this a silly reason to call the doctor’s office? Then it dawned on me -- the pharmacists practice “defensive medicine,” too.  And some just take it an extra step further. They don’t want to be liable for anything. Even for something so miniscule. I do empathize with them, but to some extent, for goodness sakes. These are the types of daily events that interrupt good patient flow, and take time away from my efficient staff that could be handling something much more useful instead of answering the phone and searching for the physician all over the building. It’s all in a day’s work as a physician, though. It is part of the job, and I know that.  In fact, it brings some humor to my day on occasion, like today. 

But really, one syringe?

Just another one of those things that make me say "hmmmmm"…

Advancing Birth Control Options: Evolving Quickly Since the 80's

I see a lot of women in my office. Perhaps because female patients tend to seek out female physicians -- especially when it comes to pap smears and birth control. It never ceases to amaze me how advanced birth control has become throughout the years, and how many options women truly have nowadays to prevent pregnancies. After the creation of the birth control pill 50 years ago, it has truly evolved into so much more -- most especially and most rapidly since the 1980's, with the creation of more advanced methods such as the intrauterine device, the rod implant, and newer sterilization techniques. Whether you are a woman or a man, you should know your options. Here are the options I discuss and offer my patients in the office:

Abstinence: This is the only option that is 100% effective. The only one. Never allow anyone to pressure you into having sex.

(White Wedding, by Bill Idol)

Condoms: 85-98% effective. One of the oldest methods, it can be traced back to ancient civilizations, but first patented in 1930.  Still one of the most popular methods today. And it’s the only one that provides protection against the transmission of sexually transmitted infections, except for abstinence of course. It’s best to combine one of the below options with the condom as a back-up.

(The Safety Dance, by Men Without Hats)

The Good Ol' Pill: 92-99% effective. It celebrated its 50th birthday this past May!  There are so many -- just because you couldn’t tolerate side effects of one, doesn’t mean you are out of luck. Some people need to try a few before they find one that they like. Side effects of nausea and mild headaches are transient, and resolve after the first pack if you can hang in there. But if you just can’t remember to take one pill around the same time every day, this is not for you.

(Freedom, by George Michael)

The Patch (Ortho Evra): 92-99% effective. Introduced in 2002, it is a small thin patch placed on the body that releases hormones into the skin, and then into the bloodstream. You don’t need to remember to take a pill every day, but you need to remember to change it once a week for 3 weeks in a row, and then skip the fourth week (when you will typically have your period). Studies show that those using the patch may have a higher risk of blood clots in the legs (a potentially life threatening problem) compared to other methods, but the risk is still very low, and is higher in women over age 35 who smoke.

(Stuck On You, by Lionel Richie)

The Ring (Nuvaring): 92-99% effective. Released in 2001, it is a plastic circular vaginal ring that you insert into the vagina yourself (similar to inserting a tampon) and leave in for three weeks. Then you take it out for one week, and replace it with a new ring again for three weeks, etc. The hormones are released from the plastic ring into the vaginal tissue. If you’ve never used a tampon or you are not comfortable inserting an object into the vaginal area, then this may not be the best option for ya.

(Ring My Bell, by Anita Ward)

The Injection (Depo-Provera): 97-99% effective. Approved in 1966, it is one of the oldest and most effective forms of birth control, a progesterone-only hormone is injected in the clinic once every three months. The two most common side effects I hear from my patients is weight gain and irregular periods. However, most women have lighter periods or stop having periods altogether after 6 months. It is not recommended for more than 2 years at a time because it has been associated with a decrease in bone density if used longer than that; however, the bone loss is usually reversible once you stop using the shot, and is more severe the longer it is used. It’s a great option for young women or teens who find it difficult to remember to take their birth control in a timely manner and who want a more discrete birth control option.

(Hit Me With Your Best Shot, by Pat Benatar)

The Implant (Implanon): 99% effective. FDA approved in 2006, it is one of the newer more advanced methods: a 4cm x 2mm single-rod implant that releases a progesterone-only hormone, and is placed 8-10 cm above the elbow into the skin of the upper/inner aspect of the arm. It lasts 3 years and is highly effective, comparable to the effectiveness of the Depo injection. During the first year, however, 50% of women report more bleeding (either more frequent or heavier periods) and 50% report less bleeding. After the first year, most women report less bleeding overall. And it's very discrete, almost "invisible," but you can feel it if you gently rub your hand over it.

(Invisible Touch, by Genesis)

Intrauterine Device (IUD): 99% effective. It is a T-shaped device that's been around since the 1980's and is inserted into the uterus in the office. There are two types – one that lasts up to 5 years (Mirena) and releases a progesterone-only hormone, and one that lasts up to 10 years (yes, years) without any hormones (Paraguard). The Mirena may cause irregular bleeding the first 6 months, but then after most women report less bleeding or cessation of periods altogether. It is more ideal for those with heavier periods in order to lighten it. The Paraguard may cause heavier periods, and therefore may not be ideal for someone with already heavy periods. However, less risk of side effects in general since it does not contain hormone products. Make sure your provider leaves the strings long so that you can feel it, and so that it does not “rise up” into the uterus – because if that were to happen, you’d need to have surgery under general anesthesia to remove that IUD (not fun).

(Holding Back the Years, by Simply Red)

Tubal Ligation: 99.5% effective. The traditional method of sterilization for the female is under general anesthesia laparascopically by a gynecologist. But women have been tying their tubes as early as 1880's.  You do need to be absolutely certain that you no longer desire children, because the chances of reversal are slim to none. There now is a newer method of sterilization for women, called “Essure,”  since 2002.  It is an office procedure under local anesthesia, with less complications and discomfort.

(Point of No Return, by Expose)
 
Vasectomy: 99.9% effective. Being performed since the 1950's, it is definitely the fastest, most effective, and less complicated method on this list. It is a quick 15 minute procedure under local anesthesia, with a quick recovery time. There is now even a newer “no-needle no-scalpel” technique with minimal discomfort, developed in China and brought to the U.S. in 1988.  No need to be afraid any longer, men! Yes, you can go for that!

(I Can't Go For That (No Can Do), by Hall & Oates)

Times are changing.  Even though the music of the 80's is still arguably one of the best of any decades', it's a good thing that birth control is evolving so rapidly, bringing so many options for both men and women.  Now there’s an option for almost everyone. Not one method is right for every person. Each individual is different, and the choice is really dependent on multiple factors such as your personal medical history, your age, your menstrual periods, medications you are taking, whether you are breastfeeding, the length of time you desire to prevent pregnancy, etc. So make sure you learn about your choices, and then discuss them with your doctor. And most of all, be safe!