Just Don’t Overthink It

Once in a while, I try to actually imagine myself as a doctor. It feels surreal, though, like I’m watching myself through several degrees of separation. Like Joey from Friends watching himself act as Dr. Drake Ramoray on TV. And what I see myself doing isn’t particularly impressive, either. It’s not like I’m holding a test tube and exclaiming I’ve found the cure for cancer (which I’ve heard is how that sort of thing happens) and I’m not figuring out a difficult diagnosis just by glancing at a patient’s labs. Instead, I’m simply walking into a patient’s room and greeting them.

“Hi ____! I haven’t seen you in a while. I suppose that’s a good thing, huh? So tell me, how are you? How are the kids?”  Maybe I stride toward the bed and take the patient’s hand in both of mine. Maybe I’m greeting the patient’s spouse with the familiarity of an old friend. It’s always something like that. Always friendly, confident – almost intimate. This scene means so much to me because it means that the ideal me has established rapport with a patient through previous encounters. It’s the idea of being comfortable with myself and the patient, having the knowledge that I can and will do everything possible to help this patient. That’s such a basic concept, right? Yet it seems unattainable to me right now as I face my third year with both excitement and fear.

When I was shadowing as a first year, I remember the doctor making a joke to the patient. The patient laughed uproariously, and I chuckled in the corner. I don’t even remember what the joke was, but later, in the hallway, my mentor pulled me aside with a very serious expression. “You know, I only made that joke because I’ve known the patient for a long time. You shouldn’t joke around like that if you don’t know how the patient will react.” I nodded vigorously. I wouldn’t dream of it.

Later that day, while Dr. A was typing away at the computer, I noticed that one of her patients was wearing a University of Michigan fleece. “My parents went to U of M,” I ventured. “I grew up in Ann Arbor.”

“Oh really?” he smiled. A patient (one of many) expressing kindness toward a medical student. “Awesome. Go Blue!”

“Go Blue!” I agreed. And that was my first step into the world of Regular Conversation with Patients. Still, being comfortable with patients was a dream in the distance.

Fast forward to second year. It was the second half of the academic year, and I suppose we had learned enough “clinical skills” to be sent into patients’ rooms by ourselves. We were assigned to seek out one patient a week to talk to. It was my third or fourth time, so I had finally stopped saying my name like a question.

The patient I was talking to (whom I’ll call Mr. S) was a guy in his mid-50s, and we were getting along well. He had a minor head injury and was just killing time as they waited for his CT scan to come back. I finished obtaining the information for what later turned out to be a mediocre write-up. (I heard once that all medical students have a lot to write about a patient’s social history and very scarce information about anything else. It’s true!) Mr. S had pulled out his phone and was showing me photos of the motorcycles he collected with his brother. Then he showed me pictures of his brother’s kids. He also showed me photos of horses that he downloaded off of the Internet because he really liked horses.

“Hey, it’s been a few hours since I ate. Can you hand me my bag over there?” Mr. S pointed at a blue cooler on the chair. Once I brought it over, he unzipped it, rummaged through all the pill bottles he stored in there, and found a yogurt cup at the bottom. “Could you get me a spoon?”

I was happy to oblige. “But wait a second,” I teased. “Are you supposed to be eating or are you just trying to trick me?”

He laughed, but then his face fell. “I’m not sure.”

So I went to get a spoon and ask a resident for permission. It turns out that he was not allowed to eat until they got the results back. I ended up feeling guilty, like I’d robbed Mr. S of his chance to eat yogurt by making what I thought was a harmless joke. At the same time, it’s probably a good thing that I had asked first. It was a little thing, but I can just imagine that if a resident saw him eating yogurt after I left, they’d ask, “Who let you eat this?!” And I’d be in sunglasses with my collar up, shuffling out the door and never coming back.

What did I learn from all this? With each patient interaction, I catch a glimpse of how complex our relationship with patients can be. Maybe nothing I ever say to a patient can just be a lighthearted joke. Patient care is too serious for that kind of luxury. But I still believe that a physician can only provide thorough care by investing in conversations outside of the script. As medical students, we have the amazing opportunity to spend time on getting to know a patient so that they know we care about them as a team.

Well then, here’s to starting MS3. Hopefully I can keep the big picture in mind as I focus on sounding intelligent, not getting lost, and seeing things I may never get the chance to see again!

Just Don’t Overthink It

Almost Bilingual

As an Asian-American, I’ve become increasingly aware of how the culture I was brought up in has shaped who I am, how Taiwanese culture has melded into my everyday life. My family recently celebrated Lunar New Year together, and I helped my mom prepare all the traditional foods we would eat the night before, including various cakes (fa gao and nian gao), fish, and vegetable dishes (chang nian cai), to ensure we would have a prosperous year. However, when celebrating Thanksgiving in November with my friends, I had to Google “Thanksgiving dishes” to figure out what I could cook for the potluck, because I didn’t have much experience with “traditional” American Thanksgivings. The other day, I was watching Chopped, a cooking competition TV show, and became very indignant when even the judges were bashing on how Thousand Year Egg tastes. Some of the contestants tried to fry the egg, and the contestant that got the most compliments made a mayonnaise out of this delicacy – how outrageous!

I realize that my previous examples are all about food, but that’s not the only area of my life affected. Another major part of who I am is my bilingualism. Growing up in the states, I attended Chinese school and always spoke Chinese at home, so I am comfortable with verbal Chinese. However, my literacy level is probably that of a first grader, and when I speak, it’s still obvious that I’m not a native speaker. This year, I’ve had the unique and amazing opportunity of working on the board of a free clinic that serves patients who predominantly speak Chinese. I always assumed that as a physician, I would tell my patients that I spoke both English and Chinese, and that I could accommodate them if they were more comfortable speaking (Mandarin) Chinese than English. I figured to get there, I would just have to study up on medical Chinese vocabulary. However, my experience as a med student volunteering at this free clinic has helped me realize that since Chinese isn’t my dominant language (even though it was my first language), the situation is much more complex and I would have to make a lot of progress before I could lay such claims.

I’ve learned how frustrating it is to come up against a hard roadblock in terms of communication, to be on the edge of saying something but not finding the right words. I’ll give an example. I was listening to a patient who recently moved here from China talk about going to a community center for tai chi. I perked up. I wanted to say My parents do tai chi as well, because I just wanted to make some light conversation. But what was the verb for “doing” tai chi? Later, I remembered how to say it – da tai ji quan. But at the moment, the mental translation didn’t happen on time, so instead I said nothing and smiled. Besides, it’s not like the comment would have made a difference in the outcome of the visit. But that’s what I’ve found disappointingly difficult on many occasions: making casual conversation, witty banter, or joking around in Chinese to make the patients feel at ease. Without feeling completely at home while speaking the language, I’m unable to have the relaxed, back-and-forth conversations that I could have in English.

Here’s another example. I was speaking to a visiting physician from China with some of my peers during a Medical Chinese session, and she was talking to us in rapid Chinese about the differences between physician compensation in China and in the U.S. I can tell you right now that I understood very little of the conversation. How frustrating – though I may not always be able to respond with completely well-formed thoughts, I can understand everyday conversations in Chinese with little trouble. But here, she was using vocabulary that I had never heard before in my life. I was on the edge of comprehension, but I experienced so many lapses in understanding that I couldn’t piece together exactly what she was saying. It’s a weird feeling, understanding all the sounds of a language and yet not comprehending. It’s very different than, say, if I were to listen to someone speaking Russian, because I have no idea what their vowels sound like, how some of the syllables are even formed, and what kinds of inflections they use in speech. To me, hearing a very technical conversation in Chinese is like when those programs play a sentence in English backwards and suddenly the whole thing doesn’t makes sense anymore. I ended up trying to stay engaged, but I could rarely make meaningful contributions to the conversation.

Being bilingual on a basic level also means that I’ll never be able to create an even playing field with someone who isn’t comfortable with speaking English. Whichever language we choose to speak, one of us will not be able to fully express ourselves. What this means is that at the free clinic I’ll be writing down in English the symptoms the patient is describing in Mandarin Chinese before the interpreter has translated it, or I’ll nod along as the patient is talking. We have an excellent Cantonese interpreter, but since the dialect is different, she once was at a loss for how to translate “numbness” from English to Mandarin. I quietly suggested a phrase, and the patient looked bewildered. Why is this interpreter here if the medical student speaks Chinese? There was a great piece about the issue of doctors believing they can communicate with patients in another language called “The Danger of Knowing ‘Just Enough’ Spanish” that really stuck with me. I know I can’t go without an interpreter, because if there’s even a small gap in the translation, a lot could go wrong.

Still, I don’t think it’s impossible that I can one day speak Chinese in the medical setting well enough to at least make my patients feel more comfortable. I have had two primary care physicians that advertised that they spoke Chinese, and my mom was talking to me about how she liked one much more than the other. “It’s strange, they’re both American-born and their levels of Chinese-speaking are the same,” she commented. I think one factor was that one was much more enthusiastic to talk to us in Chinese, even if she spoke with an American accent, whereas the other was more abrupt and business-like. Beyond learning medical terms, I want to keep practicing speaking Chinese in my everyday life so that I can break out of that shell of reluctance when speaking with patients. It’ll be an active process of learning instead of a passive one, but communication is key in a doctor-patient relationship. If I can make even a small subset of my patients feel more at ease talking to me, then I think the process will be worth it.

Almost Bilingual