Parroting Parody

I practice in England where we have a National Health Service that means that medical care is free at the point of care to eligible residents. It is the best thing in the world.....(when it works, but that is a story for another day).

As if this is not enough, people from most parts of the world can see a family doctor without the need to speak English, as an interpreter will be arranged for you. It is awesome! 

It has certainly improved my knowledge of geography and languages. I had never heard of Tigrinya, or Pushto! (Google, if you're like I was)

Sometimes though, I wonder about the nuances in the interpretation, because as you know, emotions and sentiment cannot always be effectively conveyed by language. (Try translating Nigerian "Na wa" to English language. )

Anyway, these three-way language consultations are my bugbear today. 

Patient 1.

Appropriately booked a double appointment. Good start. 

Arrived in foreign attire, enthusiastic non-verbal gestures and limits her conversation to "Interpreter please." with  a smile.

The whole consultation goes well, with the interpreter on the other end of the phone. The consultation ends and we both thank the interpreter and my patient stands up to leave.

She gets to the door and suddenly remembers....."Oh doctor sorry I forgot to ask you about this rash which has been bothering me for a few weeks. "

I was stunned. We went on to have a second consultation in English, which she spoke very fluently in an almost English accent! 🤯

Patient 2.

Face to face interpreter. Comes in with the patient, shows me her ID badge and everything then settles down to her job. 

The patient gives a rather emotional account of fleeing an abusive husband in her home country, leaving her young child behind, and the effect on her mental health. The patient is very calm and composed but the story comes out in bits as the interpreter pauses several times crying, standing up and sitting down. Tapping her feet and snapping her fingers  

The interpreter then enters into a prolonged dialogue for more than three minutes with my patient and it is obvious that she has forgotten why she is here.

"Hello!" I kind of say, butting into their gist.

" Oh yes doctor, she says she is happy to be referred for counselling." The interpreter says.

"Anything else she would like to mention?" I ask, referring to the obvious discrepancy between their long conversation and the few words she has just told me. 

"No, thank you doctor. " 

🤔

Patient 3.

All introductions made, consultation underway. Interpreter tells me why the patient is here and I start to ask a few more questions. 

Suddenly the interpreter says. 

"Excuse me Doctor, actually she does not understand what I am saying and she is speaking a different language. You need a different interpreter, sorry. " 🙄🫨

And finally, Patient 4.

After a somewhat long pause, listening to the rather annoying hold music of our usual Language line service provider, I am connected to an interpreter.  We're on speaker phone, as is the norm, to allow effective three way communication. 

After a couple of minutes, the interpreter suddenly starts whispering. 

At first I thought I imagined it, or maybe she had stepped into the room with a sleeping baby or something, but interestingly, the patient starts whispering back! 

Even more bizarrely, she conveys the message to me in a normal voice and then goes back to whispering to the patient.

The actual clinical content of the consultation is very ordinary, like a urinary infection or Tonsilitis, nothing exciting.

After a couple of sentences, her voice goes to a harsh tone. The patient starts raising her voice too! 

I ask the interpreter what is going on as the whole thing has become a bit distracting. 

"Just a minute doctor," she says "I just need to clarify something. "

Next thing I know, they start arguing back and forth. The argument escalates and they are now shouting at each other. 

I take the phone off speaker and say "Hello"

"Sorry doctor...." the line cuts off.

The patient gets out of their chair, offers an apology and then leaves my consulting room!🤔🙄😤🥸

The day would come when I would have seen and heard everything to be seen or heard in a consulting room, not quite yet though.

         ******      *******      *******

I've not written in a while and that's enough to tell me that my work life balance is tipping the scales. I have had other memorable encounters to share, and hopefully I will be able to come up for air again soon. Ciao

Cradle to grave: Through the generations

One of the fundamental concepts of being a family doctor is the idea of looking after families "From the cradle, to the grave."

I remember using this oversold phrase to buttress my passion for the career choice when I interviewed for my training post some 15 years ago.

Fast forward all these years later, to my reality of managing multi-generational mind sets. 

Patient 1: The Baby boomer

He's a 72 year old man who has recently had a routine health check. His blood tests have shown that his cholesterol levels are a bit raised and he has been advised that he would benefit from medication to lower his cholesterol to reduce his risk of heart attacks and/or strokes.

All other checks and tests are perfectly fine. In fact, he is in significantly better health than most people of his age. He has booked an early morning appointment to discuss this further. He is very well dressed in a smart shirt, jumper and chinos, and I notice that he is wearing smart, polished shoes. This is something I admire about the Babyboomer  generation. They're up early and smartly dressed, born out of habits from many years in one career in the same job.

"I have lived a good life" He tells me. "I have had a good career and good family, all my children are grown and independent. I have tried to live as healthy as I can but obviously my body is failing" He pauses for me to appreciate the seriousness of the situation.  

"I wouldn't exactly put it like that." I start saying. 

"Yes, I know what you're saying but what I would like is for you to sign me a "Do Not Resuscitate" form since I might have a heart attack or stroke soon. I want to go peacefully. I am not ready to end up on many medicines,  I am ready to face the worst."

Very confused, I spend the rest of the consultation reassuring him that he is not dying and indeed, in better shape than most of his mates. 

He walks away even more upright, with a spring in his step.

Patient 2: Generation X.

She is going through the menopause and everything is falling down. 

She cannot entertain the effects of the menopause in this very busy period in her life. She has a high profile managerial job and feels her team will obviously crumble without her, so she can not drop the ball now. The hot sweats and irritability are not helping. 

Her daughter has just returned from university saying she no longer enjoys the course she is studying and is lying in bed all day trying to figure out what to do with her life. Her father has had another fall in the care home and ended up in hospital. 

Her husband's construction business is not doing well and their mortgage is not fully paid. And her hair is falling out.

I empathise with this sister and sort her some HRT sharpish. It has worked wonders for others. I think she really needs breathing space. 

Patient 3: The Millenial.

Guy is 32 and has just been released from a stint in prison for accessory to murder and for causing grevious bodily harm. He needs a referral to be assessed for ADHD (Attention deficit hyperactivity disorder).

He has done some internet researching and thinks this might explain his history of violence. 

He has found some wholistic care centre offering specialist natural remedies and would like to apply for funding to be referred to this service.

I am on my most agreeable behaviour and promise to look into all of this for him, whilst mentally composing the letter to follow: 

"Unfortunately, the bosses at the top have refused to pay for this exotic service but you are on the 18 month long waiting NHS version for adult ADHD assessment and here's the number for the people holding you back. Contact them every month to check your position in the queue. "

I was not prepared to get in his bad books and I have learnt not to argue with Millenials. They know everything. 

Patient 4: Gen Z.

Next up is a young man looking all fresh and tight in a crispy new shirt and tie with his skinny trousers, heralded by the scent of his perfume. He's got his phone in his hand and tells me about his new important job in Tech, by way of explanation for the very important call that he may need to take mid- consultation. 

He looks so young! I am impressed. I still have to remind myself that people born in 2001 are bona-fide adults. 

"So what it is, is.. my girlfriend sent me this Snapchat message saying she needs some space."

I wait for the punchline. He sits tapping his feet.

"The thing is, I'm not sure what she means by that and it's causing me a lot of anxiety. "

I ask  "Have you spoken to her about it. "

"Well we've chatted about general stuff.  But we've not hung out for a couple of weeks cos she's like busy with work and stuff. My mum said to see if she's okay but she's done this Tiktok video with her mates last weekend so I know she's alright. Must be her new job. She's just got a new job and it's been a bit stressful, I think."

Followed by more details about how they were both stressed with working long hours 9-5 through the week, and how his mum identified symptoms of anxiety in him as she suffers the same. 

He lets it all out and finally comes to a resolution that he will go and see her. All by himself! I was so proud of him, I almost gave him a sticker!

Bring on Generation Alpha! 

 😊