Basically none of the patients at my home hospital speak English, and the whole place is just wearing me down

[EngineerPreMD]

My home hospital is a safety net hospital in a very poor area with a large number of refugees. The patient population is extremely poor, and even the simplest CHF patient has a laundry list of extra tasks related to their socioeconomic limitations. Everyone, from the residents to the nurses, is worn down and unfriendly. I've been rotating through various services in this hospital for 12 weeks now and I'm just absolutely beat. I think 80% of the patients in this hospital do not speak English, and doing a comprehensive interview and physical exam at 6 am using a phone interpreter is just exhausting. Then presenting to an equally exhausted and angry team on rounds is just a soul-crushing experience day-in-and-day-out.

I know medicine is hard and not supposed to be fun, but it's nice to at least sometimes bond with a patient without a laggy iPad interpreter. My first rotation was at a hospital where ~75% of the patients were English speaking. I impressed attendings and residents a ton with my patient rapport, and was able to actually help some patients by chatting with them and establishing a great therapeutic alliance. It was my biggest strength by far. I honored the rotation with flying colors. In this hospital, the rapid turnover and inability to freely converse completely dehumanizes the patients and flattens the experience. Residents barely speak to students, and everyone gives average evals without a second thought or any meaningful feedback (literally "continue reading").

I chose this school because I knew the patient population would be challenging. I know I'm learning being here. However, I'm already burnt out. I'm all about treating the underserved, but just once I want to be able to walk into the room and chat up a patient who can relate to me in even the slightest way. Just once I want to be able to work on skills in medicine without language being the primary barrier of communication and socioeconomics being the primary driver of the management plan. For every single patient I check the chart and it's just like, "Arrived from the Phillipines/Papau New Guinea/Bosnia 3 years ago. Filipino/Tok Pisin Creole/Bosnian preferred. Patient is unsure of their medical care in country of origin." And then you have 15 minutes to get a history, which is inevitably garbage because everything takes 2-3x as long with the interpreter. You have no time to make a connection. It's just, "hey immigrant, give me your entire complex medical history and absolutely no irrelevant information." Then when you've been in the room for 20 minutes and the resident is waiting for you, you just have to leave, inevitably don't get everything, and get chewed out for missing some piece of information you knew you should get, but didn't have time for. Or you do the interview in front of the attending, and they get annoyed because the interpreter makes the interview go long, so they take over and then dock you on evals.

Learning medicine here feels like learning to juggle on a unicycle. It's like learning to play a scale on piano and then jumping straight to Chopin. I just want some solid ground.

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[Esmolol]

I’m sorry you’re going through it. However as to making a bond with a non-English speaking patient, I had a patient on my IM rotation who only spoke Cantonese. I did not know a word. I tried to learn at least basic phrases and it was a blast. What I’m saying is - make the best of it! The language barrier itself can be a bonding experience.

 

[EngineerPreMD]

I’m sorry you’re going through it. However as to making a bond with a non-English speaking patient, I had a patient on my IM rotation who only spoke Cantonese. I did not know a word. I tried to learn at least basic phrases and it was a blast. What I’m saying is - make the best of it! The language barrier itself can be a bonding experience.

You're right, but one non-English speaking patient and practically everyone in the hospital are just totally different situations. I was fine with the first hospital, where I'd probably have one non-English speaker per day. You have more time to make the most of it. You budget out more time for that patient. When it's everyone... it just never ends. Everyone here is just at their absolute breaking point, from the sick patients with no social support to the worn down residents who are probably just as sick of the iPad.

Then doing all that extra work (12 hour days in the hospital even on peds) you come home to average evals, because you have absolutely no chance to really stand out. You're just trying to survive.

 

[operaman]

I work in a hospital with a similar population. An English speaking patient is by far the exception to the rule. Many of my patients speak languages for which we have no interpreter option, so it creates significant challenges. Thankfully I’m learning which hospital staff speak some of the weird obscure languages and use them as unofficial interpreters when all the official channels fail.

I think you’d be surprised just how much rapport you can build even without the language in common. Sickness and suffering are universal human conditions and you don’t really need an interpreter to understand what someone is going through and show empathy. Some of my favorite most beloved patients who bring me homemade goodies and usually an entourage of grateful family members don’t speak a lick of english, but we find ways to understand each other.

It definitely makes for a tough training environment though. The workload is high but so is the need. I’ve personally always enjoyed the train wrecks a little just because nobody else is brave enough to take them on. If you can practice in this kind of environment you’ll be able to practice anywhere!