Clinical

Things I've Learned About Communication in a Country with 11 Official Languages

Tom Groom
Published on Apr 11, 2022. Updated on Apr 19, 2022.

Communication with patients is not always easy. It can get even more complicated when you do not speak the same language. Tom, a 3rd-year medical student, is sharing with us three tips on how to communicate better.

We are always told that a comprehensive history can lead you to a differential diagnosis even before touching the patient. Now, I don't know about you, but I have definitely found this to be true, and when you miss things in history, it can send your whole examination in the wrong direction. Have you ever been in a situation where you take a history from a patient, and then when it comes time to present to your seniors, the patient suddenly brings up all kinds of symptoms that they are experiencing or medicines that they are taking that you had no idea about, even though you asked them about those exact things a few minutes ago? You stand there not knowing what to say to your doctor and wondering why your patient seems to be making it difficult for you.

Communicating effectively is difficult, and communicating well is an art. But now, throw in the added difficulty of a language barrier, and things really start to get tricky. I study medicine in South Africa, where we have 11 official languages, and I happen to only speak one fluently. Here are a few tips and realizations I've learned after trying to communicate with patients from all backgrounds in my three years of being a medical student.

Tip 1: Try your best to learn other languages

Nothing can replace actually speaking your patient's home language. Throughout my junior and high school career, I was taught one additional language. Still, back then, I was only focused on doing well in the theory tests (to get into a good med school), and I didn't see the relevance of becoming a fluent speaker. But now I realize that medicine is as much about people as it is about science and so being able to communicate with more groups of people is an invaluable skill. 

If you feel as if you missed the boat, like me, think again. There is no better time than now to start learning another language. It won't be easy, and there will always be work you feel is more urgent, but consider setting some time aside to invest in a skill that will benefit you for the rest of your career rather than just the next test.

Tip 2: There is a language that we all know

It sounds ridiculously cliché, but love is a universal language. I am a strong believer that we should be growing in how we care for and treat patients at the same time as we become more knowledgeable and skilled. The most common thing laypeople tell me when they hear that I am a medical student is that I must never forget to be kind to patients. There are a lot of doctors who get the diagnosis and treatment right. While it may provide answers, should that be enough for them? What really sets you apart from the crowd is your bedside manner; how well you make patients feel cared for and heard. Empathy doesn't require words and is understood by everyone. 

When I was on my obstetrics rotation, I learned how futile words can be at comforting women in labor. They were in excruciating pain, and there were a lot of young girls who were afraid and alone. Now, as a man, I will never be able to understand how they felt, and I couldn't pretend that anything I said would make their experience any less difficult. But I decided to sit with a young girl and squeeze her hand for hours until we delivered her baby. Showing someone that they aren't alone when they are in pain or if they are receiving bad news is worth a lot more than words.

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Tip 3: Communicating is hard enough in your own language

Just like the example, I used earlier, it is sometimes difficult to get the information you need from patients even when you speak a mutual language. There is definitely a lot of skill required in talking to a patient in a way that makes them feel comfortable and willing to share the truth with you. This is especially true when asking more sensitive questions or ones that could make your patients feel judged. 

A doctor once shared a great tip on how to ask about things like smoking, drinking, or pill compliance. If they smoke, ask, "How many packs do you smoke a day?" And then start guessing high, "Two packs?". And usually, they will say," No, no, doctor! Only one pack." But if you had started by guessing lower, say five cigarettes a day, they might feel guilty and be less likely to admit to smoking a whole pack a day.

Tip 4: Sometimes listening is better than speaking

It's easy to forget that communication involves both speaking and listening. Apparently, most doctors interrupt patients within the first fifteen seconds of telling their story. There are a lot of techniques you can use to show that you are listening, like summarizing responses and using non-verbal cues. Still, nothing can replace focusing and showing genuine interest in what they say. I know that time constraints make it difficult not to interrupt or guide patients when they start going on a tangent, but let's at least do it gently and kindly. The feeling of not being listened to or valued is not something I ever want for myself or my patients one day.

Thankfully, even if you only know one language, there are bound to be people around you who speak more than one and can translate for you. But my challenge to you is to become that person who is able to translate for someone else. Rather than hoping our patients speak our language, let's start learning theirs and becoming more intentional about the way we communicate, even without words.

About Tom

Tom is a 3rd-year medical student studying at Stellenbosch University in Cape Town, South Africa. He is most interested in pediatric medicine and spends his free time exploring Cape Town with a camera.

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