Say what? Patients and doc should talk same talk

When I was an internal medicine resident at Cedars-Sinai/UCLA– the "Hospital of the Stars"– I never met celebrities like Mikhail Gorbachev or Mikhail Baryshnikov, but I sure met a lot of other Russians. Cedars-Sinai had a large Russian population in the clinic system, and most of us had to rely on Russian interpreters to communicate with them. I tried to learn some Russian, but the interpreters discouraged me because they said I sounded like Ole Yeller trying to speak Russian.

What happens when communication between doctor and patient is difficult?

I'm sure I never got the full story from the interpreters– kind of like Wall Street. For example, I would ask, "Are you having chest pains?" My favorite-yet-unfavorite interpreter was a nice little elderly volunteer who smelled like lavender and spoke like cinnamon. She would sit demurely with her hands in her lap and rattle off a question in Russian.

The patient would say a few sentences, and the interpreter would interrupt and say a few sentences. The conversation would continue for about a minute and eventually erupt into an argument. I would see my interpreter's hands fly out of her lap and start to karate chop the air as she emphasized each point: "Da!" The patient would be screaming back at her until finally she would turn to me, hands in lap, and say, "No."

No, what? I would ask her, "Wait a minute? How can you say no chest pains when you just talked to the patient for five minutes?"

She would smile and say, "Well, he did say he had chest pains, but they were sharp, not dull, and they didn't last very long." I would ask, "Did the chest pains radiate anywhere, like the arm? Was he short of breath? Did it occur at rest or exercise? How many times has he had it?"

She would say, "Of course I asked that! The answer is no to everything."

I always wanted to believe this interpreter, but I was always skeptical, so I would make her ask the patients the questions right away. Ten minutes of arguing later, she would turn to me and say, "He is crazy. He might lose his house, and his wife is cheating on him."

Some days, I feel like I'm a character in Bill Murray's Lost in Translation. For various reasons, I'm not able to get the full story– even from my English-speaking patients. I can't count the number of times I've finished up with a patient, only to get a message from the spouse or family member that reveals something horrifying.

"Dr. Hong, did my husband mention to you that he's having crushing chest pains?" "Did my sister tell you about the voices at night telling her to kill people?"

I always ask my patients a series of questions known in the medical world as the "Review of Systems." I make sure to ask things like, "Do you have chest pains, heart fluttering, nausea, headaches, incontinence?"

Some people aren't really aware of their symptoms and might not acknowledge that right away. Other patients know they have problems but are in denial. "If I admit I have transient blindness in my left eye, then I will become blind. Therefore, when the doctor is talking to me, I will concentrate on who will win the football game this weekend."

That's why I ask all my patients to come with a list of concerns. If the spouse is really worried, I ask him or her to come for the visit as well. I find this method pretty effective, but there are days when I see my Russian interpreter in the room and wonder what's going inside my patient's mind.

It's all Greek to me.

Got a problem? Dr. Hook wants to hear from you?