Dr. Danielle Ofri is an associate professor of medicine at New York University who practices medicine and teaches at Bellevue Hospital, New York City. She is also co-founder and Editor-in-Chief of the Bellevue Literary Review: A Journal of humanity and human experience (http://blr.med.nyu.edu/). She writes about her medical encounters with “(…) patients who’ve had a powerful impact on me, and whose stories might help future doctors.”
Bellevue is the largest operating public hospital in New York City and the oldest in the United States, tracing its roots to 1736. Bellevue is a hospital that has always been visited by immigrants, some of them in need of political asylum; a number that particularly increased after the implementation in 1995 of the Bellevue/NYU Program for Survivors of Torture (SOT program). Drawing from such a diverse pool of patients with multiple origins, cultural backgrounds, and religious faiths, Dr. Ofri discusses and analyzes her interactions with patients mostly from the physician’s point of view. In several patient-doctor interactions, Dr. Ofri has to rely on professional interpreters, always via a phone call, although she is not completely happy with the outcomes because as she puts it,
“Simultaneous interpretation is a brilliant invention, but isn’t necessarily the easiest situation to navigate.” (…) We’d always been taught to keep our focus on the patient, not the interpreter (whether the interpreter was a human in the room or a voice on the phone). But this was impossible during simultaneous interpretation.”
It is probably the uneasiness with phone interpreters and because of her stagnant knowledge of Spanish, “My Spanish education over the years had been piecemeal – a summer class in Oaxaca, a two-week language school in Peru, a week during a vacation in Guatemala – and although I could speak a modest amount of Spanish to my patients, I still constantly made errors. I knew that I was missing some details and certainly many of the nuances, (…). I hoped that I was getting the gist of it, but I couldn’t be entirely sure. Yet whenever I offered my patients a choice, they overwhelmingly preferred direct communication – even if somewhat flawed – to the unnatural stiffness of an interposed interpreter, no matter how perfect the translation.”
Dr. Ofri is offered an opportunity to travel abroad to spend a year in Costa Rica, for the particular purpose of improving her Spanish language skills to be able to better communicate with her Spanish speaking patients. And then, in an unexpected life turn, Dr. Ofri found herself on the other side of the patient/doctor relationship, in Costa Rica, limited Spanish proficient, and in need of medical care. There, she and her family found themselves in a situation similar to those ones that her Bellevue patients face while in New York.
The Costa Rican experience provided Dr. Ofri a broader understanding of what it is to be an immigrant – barely speaking the local language and in need of health care attention. And even though her experiences were, due to different circumstances, far from being comparable to those ones her patients underwent in the Bellevue’s SOT program she acquired, without any doubt, a more insightful and complete view of current transcultural medical interactions. First hand experiences as such helped her to be even more aware, and have a deeper level of understanding, of the incommensurable importance not just of the language, but of dialects and of the influence of patients’ cultural background in a medical setting:
“(…) expressed perplexity at the term water pill. In Spanish, I always called it pastilla de agua – ‘the pill that makes you produce water’. To most patients (…), a water pill is a placebo. Was that what my patients were thinking about the prescriptions I was giving to them? (…) we typically use the term sugar pill to describe a placebo. To most Haitians, a sugar pill sounds like it has something in it – actual food. But a water pill sounds like there’s nothing.”
Summarizing, Dr. Ofri relates in this book a continuum of memories and recollections regarding her interactions with patients under several personal circumstances and backgrounds. Dr. Ofri exemplifies diverse situations and discusses all along her difficulties, fears, and outcomes, providing a broad palette of thoughts and ideas that might be put to use by other medical providers, health care interpreters included.
- New Book Available for Review: “What Doctors Feel: How Emotions Affect the Practice of Medicine” by Danielle Ofri (medicalhumanities.wordpress.com)