Saturday, October 24, 2009

Guest Blog: Medicine in Translation

Since I started this blog a few months ago, I've supplied nearly all of the content myself, occasionally quoting others in posts but also adding reflections of my own. However, I always planned to eventually invite guest bloggers with other "common sense" perspectives on health and health care to add to the variety and breadth of content that you will find on this blog, and this is the first of (hopefully) many guest postings.

A practicing internist and Assistant Professor of Medicine at my alma mater (NYU School of Medicine), Danielle Ofri, MD, PhD is the author of three books about her medical experiences and also serves as editor-in-chief of the Bellevue Literary Review. The following piece is excerpted from a blog that was originally posted on the website of Psychology Today.



If asked what a doctor does, most people would probably come up with the standard description of diagnosing and treating disease, usually while wearing an ill-fitting white coat. Before I entered practice, even during my medical training, that probably would have been my answer too. But my years in the trenches of real medicine have altered that definition greatly. I do spend time doing the things I learned in medical school like diagnosing disease and writing prescriptions, but that turns out to be only a part of the job, often a very small part. ...

But when I think about what might be the overriding job description, the one that not only incorporates the above but also extends to the more existential aspects of medicine, I see the doctor as a translator. For most people, medicine is a foreign country, with its own language, customs, and mores. My patients are immigrants to this country, and many feel very disoriented. My job, as their physician, is to translate this alien world for them, to help them acclimatize and hopefully thrive. ...

Being a translator can often be burdensome. It is not enough, as a doctor, to assemble the clinical details, deduce a diagnosis, compose a treatment plan. You also have to be sure the patient understands it all—and that can be an infinitely harder and longer process. But there are also many joys to being a translator. I once had a new patient who suffered from both osteoporosis and osteoarthritis. Her previous doctor had worked out a meticulous treatment plan, including hand-written charts of how and when to take each pill. Yet the patient was entirely confused about her medications.

After a complicated conversation with many false starts, I finally realized that the patient thought that osteoporosis and osteoarthritis were one and the same thing. The pills for each condition were dumped into a communal pill bottle and taken in a random manner. My “diagnosis” was that this patient did not have a full understanding of the language of medicine and that these terms had never been fully translated for her. We spent a long time going over the difference between osteoporosis and osteoarthritis. It wasn’t easy, but by the end of our visit she had a basic comprehension that these were two different diseases and the medicines were treating entirely different things. This patient had many more serious medical conditions to contend with, but she seemed delighted at this small victory, that she finally understood these diseases, that she finally “owned” this aspect of her health.

There was, of course, no place on the insurance form for this sort of effort. The insurance company would never pay my hospital for the painstaking “translation” work that is so critical to good health. But that’s the reality. Luckily there is the patient’s happiness and hopefully improved health that is the real payback.

-Danielle Ofri