There is a small theater in my town that shows independent and foreign films. A few weeks ago my husband and I made an evening of it and went to a foreign film. It was quite some time since I saw a film with subtitles. Even if a movie interests me, the idea of subtitles is often enough to dissuade me from going. I worry that I will miss something while I’m busy reading the subtitles. It is difficult to focus on the lines and on the action taking place on the screen. Then, there will be a long dialogue between two characters and yet only a couple of lines will appear so I am left to wonder if the subtitles are accurate. Maybe, to keep from interrupting the flow of the story, some of the words are left out. But which ones? How do I know if something important is missing? Since I’m relying on the subtitles, I am left hoping I get the full story. Translating via subtitles is an interesting process. Recently, I had a patient experience where I learned firsthand how challenging editing content into subtitles can be.


“Tell me about the symptoms you are having.” This is how I usually start an assessment. I ask the patient to describe any symptoms they are experiencing. Even when another member of the health care team has alerted me to an issue, I prefer to have the patient tell me what is going on directly. But with this patient, it was more complicated. This was a new communication challenge for me. My patient, Fred, and his wife, Sally, are both deaf. Fred reads lips but does not vocalize, while Sally reads lips, and although she speaks, it is with a flat intonation that is a bit difficult to understand.

Fred was partway through his radiation therapy. He had pain from bone metastases and was also experiencing ongoing nausea. The strategy for assessing his symptoms was not problematic, but communication about it presented some interestingly complex challenges.

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The greater Los Angeles area, where I work, is home to the most languages spoken in homes, with one study saying as many as 135 languages are spoken in this area alone. The 10 most common languages spoken in the United States are English, Spanish, French, Chinese, German, Tagalog, Vietnamese, Korean, Italian, and Russian. Within the department where I work, eight of those languages are represented among my co-workers, which gives me the opportunity for a co-worker to translate. In addition, we have access to a phone language line. I have had enough experience using a translator to appreciate how patient teaching is affected by the process of translation. With all of these resources, I am always confident I will be able to communicate with my patients or their family.

Fred and Sally sat in the conference room and faced me. Although they could read lips, to do so I had to face each one directly, which was impossible to do. We quickly established that it made sense to write down all of my questions and instructions.


What was the most difficult communication challenge you have had?

Have you ever had to communicate via writing? What were some of the mistakes you found you had made?

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