Interviewing patients who only speak Spanish

The patient population of Westside Clinic is 75% Hispanic, a large portion of whom speak only Spanish. This presents the particular challenge of learning how to effectively interview these patients either by using the Denver Health translator service or by trying to interview them myself in Spanish.

I started studying Spanish in middle school, took it all throughout high school, and earned a minor in Spanish in college. I traveled for long periods of time in Spanish-speaking countries, and I grew up in Southern California. Even with all of that Spanish under my belt, I'm still not proficient enough in Spanish to feel like I can effectively interview a patient who only speaks Spanish, without possibly missing something that I wouldn't have missed with an English-speaker.

In fact, studies have shown that there is an increased incidence of medical errors when there is a language barrier. Because of this, a doctor at Denver Health who wishes to provide care in a second language must demonstrate proficiency in that language and be certified as "interpreter status." At least 4 of the attending physicians with whom I have worked these past few weeks have interpreter status for Spanish.

This offers me the opportunity to practice my Spanish in the clinical setting, since my Spanish-speaking supervisors provide quality control. I was very rusty during my first week. Given that I was green as grass my first week, too, I was pretty much a disaster that first week when I was put in with a Spanish-speaking patient.

Since then, though, my Spanish has improved as much as my clinical skills. I'd estimate that I understand about 80-90% of what my patients say and that I'm able to communicate about 70-80% of what I want to say. Those numbers go up if the patient understands even a minimal amount of English. Still, it's not enough for me to feel comfortable that I wouldn't be missing something important that would impact my ability to effectively care for my Spanish-speaking patients.

I have enough of a foothold, though, to justify practicing my Spanish. This past week, I was seeing a Spanish-speaking woman in her 60's who had wildly uncontrolled blood sugars. As I was gathering her history, I got the feeling that she was having a very difficult time emotionally dealing with her diabetes and that she was possibly depressed. I decided to administer the PHQ-9, a questionnaire that screens for depression, and found that she was indeed severely impaired by depression. This was all in Spanish. My attending hadn't picked up the depression during her prior visits, and he ended up deciding to treat her with fluoxetine.

This patient interaction emphasized to me how important it is to be able to communicate with my Spanish-speaking patients in their own language. A good goal for me is to achieve interpreter status in Spanish.