Fluent in Human

spanish_signIs a little knowledge actually dangerous?

I get asked this question a lot when I tell people that I teach Medical Spanish to learners who have never taken a Spanish class before. The literature is filled with anecdotes about how one regional or dialectical idiosyncrasy makes a huge, in most retellings, tragic difference in patient care.  How can students possibly learn enough in a semester-long course so that they aren’t liabilities?

And when the New York Times publishes op-ed confessions like this one, which one astute commenter called ‘a charming description of malpractice,’ people tend to get a bit uncomfortable. A tad concerned. Or perhaps fearful that all of their own best intentions could result in catastrophically bad outcomes.

This is a natural concern. And a pervasive perspective. And, I would argue, a view through a narrow lens motivated by a litigious culture, rather than what really matters: human connectedness.

I received this email from a student this week, halfway through the semester:

I have been really excited about taking medical Spanish because I feel more equipped to speak with and help care for Hispanic patients, especially because they are one of several (many?) underserved populations in the US. However, a clinician that I respect (and who is herself fluent in Spanish and cares primarily for Spanish-speaking patients) told my class of medical students during a panel discussion that unless we are completely fluent in Spanish, we really shouldn’t be trying to care for Spanish-speaking patients without an interpreter because we’re bound to mess something up.

If we lived in a world in which interpreters and/or Spanish-speaking clinicians were in abundance here, I think I would be better able to appreciate her logic, but as somebody who really wants to help in less-than-ideal situations (both in the US and potentially elsewhere), I found her words really discouraging. It made me wonder if there was really much of a point to taking Spanish at all since I doubt I’ll ever really reach fluency.

What are your thoughts on what our role can be in caring for Hispanic patients as health care professionals who only speak the most basic of medical Spanish? I’m mostly concerned about the possibility that speaking only a little Spanish in a healthcare setting will literally be “just enough to make me dangerous.”

She brings up an excellent point, and yes, it is quite a conundrum.

My stance has always been that if you have interpretation services available, then you absolutely must utilize them. But that is not always the case, no matter how plentiful the resources might be. Additionally, there is much care that happens in the health care setting that does not require medical training or language fluency, which has just as much of an impact on positive patient experiences as a fluent/bilingual provider could.

Especially now, when federal remuneration depends, in part, on patient satisfaction survey scores, making sure that patients feel connected and cared for in ways that go beyond the medicine can have a real impact on the financial stability of health care institutions.

Knowing how to appropriately address a patient with the correct surname makes a difference. Knowing how to ask about pain in a culturally appropriate manner enables the patient to advocate for himself. Knowing how to interpret basic symptoms can help identify emergent situations and inform care options. Knowing how to ask if a patient is hot or cold or hungry or tired gives them a way to feel heard.

It’s not about being fully fluent. Unless you plan to spend time abroad, working in a medical setting, it’s true. The goal of fluency is probably unrealistic.

But there are countless moments where being able to connect with another human being at their most vulnerable is going to make a profound difference for them, and for you.



Sarah is passionate about helping people effectively communicate and has been teaching the Medical Spanish Program for 14 years at the School of Nursing. The interprofessional program includes terminology, language structure, and cultural awareness for learners at all levels. Contact [email protected] for more information.

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