Interpretations

Last week felt dominated by a horrible encounter I had with a resident, and a woman's labor experience seemingly forgotten by many. As with all patient encounters I discuss here, details are changed to maintain patient privacy.Myself and another midwife had no patients on the floor, and offered to help with a woman presenting to triage in preterm labor. The Spanish interpreter service was busy in the Emergency Room, and would take a while to arrive. A multiparous birth history, including cesareans, and recurrent preterm labors, made her deep breathing and grunting all the more concerning. A vaginal exam confirmed that she was on her way to birth, sooner than later.Admitted to the labor floor, the Attendings and residents were debating whether to allow the imminent vaginal delivery continue, or to proceed to cesarean. I helped in the interpretation of this conversation, and the doctors left the room to discuss further in the hall.A family practice resident was sent into the room to determine if the baby was presenting head down. I have not worked with him before, and so I introduced myself and said I was helping until the interpreter service arrived. I communicated that whatever he said in English, I would interpret into Spanish the best I could. He responded that he did not need to speak with her, that he knew how to say "cabeza," and that would be enough. Confused, I reiterated that anything he would say to an English-speaking patient he could say, and I would interpret. He repeated his cabeza comment.Taking a breath, I tried to find a quiet and non-aggressive way to remind, or inform him for the first time, that it is poor medical care to speak any differently, less or otherwise, to patients who do not speak English. Who knows how my comment actually came out of my mouth, though, and I imagine it was likely not the most diplomatic tone. He ignored me, never introduced himself to the patient, and squirted the ultrasound gel on her belly. I ignored him and explained the abdominal ultrasound to the woman in-between her contractions. He finished, lifted the abdominal probe and pointed at her belly, and while looking at me said, "cabeza." Then he left the room.A doctor from the NICU entered the room, and speaks Spanish as a first language. She and I spoke with the woman intermittently as she had questions.A few minutes later he came back into the room. I was standing on one side of her bed, and he on the other. He and pointed at her belly, and across her body said to me, "Muy babies." He did not look at or introduce himself to the other provider in the room. I looked at him and said, "If you have something you'd like to say in English, I can interpret it into Spanish for you." He again pointed at her belly and said, "Muy babies." I repeated my statement.He then continued to speak over her, telling me that he could understand his need to speak further and use an interpreter if he was doing a history and a physical, but he did not need to speak with her to just do an ultrasound. That in his view, he has never had a problem with patients understanding him before. He then left the room, never saying anything to the patient.The NICU doctor and I looked at each other, shook our heads, and turned our attention back to the laboring patient. Another resident entered the room and incorrectly thought that the VBAC form was a consent for a repeat C-Section and tubal ligation, which I corrected on the woman's behalf, since I witnessed her being consented for the VBAC, and she emphasized that she did not want a tubal ligation. This resident spoke to the women slowly and loudly in English, barely waiting for the interpretation and the woman's response before continuing with other complicated conversations.In our busy community hospital, it often takes up to 30 minutes for the Spanish interpreter to get to the floor. It is incredibly concerning that if an abdominal ultrasound is thought to be something that can happen to a woman without any speaking, what else does that resident and his mentors think does not need conversation with women? Why do these new providers place so little importance on speaking with women?