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On Being a Doctor |

Lost in Translation

Mark Saxena, MD
[+] Article, Author, and Disclosure Information

From the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08903.

Requests for Single Reprints: Mark Saxena, MD, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB 486, PO Box 19, New Brunswick, NJ 08903; e-mail, MarkSaxena@yahoo.com.

Ann Intern Med. 2009;150(6):419-420. doi:10.7326/0003-4819-150-6-200903170-00013
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Marta walked into my office, a seasoned veteran. She had been getting monthly international normalized ratio checks, annual eye exams, and quarterly hemoglobin A1c tests for years. On my first day as an intern, she looked at me skeptically and said, “Doctor Sa-sss-ayna?” I was the new doctor with a funny name but also the one who was about to surprise her. For the Spanish-speaking patients in our residency office, we use local college students formally trained as Spanish interpreters to translate. I asked Marta, “Do you prefer to speak in English or Spanish?” She said “Spanish,” and as I began speaking to her in Spanish, a visible smile grew across her face. I completed that visit by giving her medication refills and carefully reminding her of their side effects. Several prescriptions and follow-up sessions later, she casually commented, “I never would have expected you spoke Spanish … what is your background again?” I smiled and explained that I learned to speak Spanish while training in Puerto Rico. I told her that Spanish was not my first language, but I became fluent speaking on the island. Speaking a second language had never seemed unusual to me; however, it soon began offering some unexpected benefits.





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In Search of Lost Time
Posted on March 30, 2009
Charles T. Thornsvard
Veterans Affairs
Conflict of Interest: None Declared

Dear Editor: Reference: On Being a Doctor: Saxena, M. "Lost in Translation" Ann Int Med 150: 419, 2009. Dear Sir:

Reading "Lost in Translation", an article about how Dr. Saxema's Spanish speaking ability was instrumental in his patient's medical care can only invite envy and embarrassment. Many years ago I practiced in San Antonio, Texas but my Spanish was never more than pidgin. My attitude was not what is observed on T Shirts recently: "As an American you shouldn't have to press 1 to speak English." I was just lazy. However, I also know that speaking a foreign language, it nuance and idioms, is challenging. That is why translation is such a difficult task. The late William Crosby, eminent hematologist and translator of Baudelaire's Flowers of Evil, (1) told me that Thomas Mann said it was virtually impossible to translate lyrical poetry into another language. I do believe Bill succeeded. But, a colleague, whose native languages were French and Italian, reflecting each parent's origins, said of Bill's translation: Traduttore: Traditore. (Italian:Translator : Traitor). I'm sure Saxema would be the first to agree that his ability to speak the language learned while in Puerto Rico as a student still left room for improvement.

While stationed in Germany in the late 70s, my family and I lived in a small German village, Fockenberg-Limbach. Few spoke English. I threw myself into the language and got very proficient. The single Gasthaus in our village had a swinging sign sponsored by Parkbrau Bier. Virtually every German town had a Gasthaus with a beer-sponsored sign. Local breweries are as common in Germany as local dairies used to be in America. In fact we got bottles of beer delivered to our doorstep on a weekly basis "“ how many is classified. This set the stage for my denouement. The In -Laws came over from the US to visit"“ and we made the grand tour, finally back home after two weeks on the road. We had eaten in many Gasthauser; quaffed many a local brew. Throughout our trip they marveled at my facility with the language and cultural awareness. I relished it. It was in Kindsbach, not far from Landstuhl Army hospital where I was stationed, that I had my ultimate "triumph." The swinging sign pointed the way "“ Asbach-Uralt. The four of us were seated. The Ober (waiter) came over. "Zum trinken," he asked. "Wir moechten fier flasche Asbach-Uralt," I said. The waiter spun on his heels and disappeared. Meanwhile we engaged in desultory conversation. The waiter reappeared in a few minutes with a bottle and four shot glasses filled with the popular German brandy, Asbach-Uralt. In English he said he was certain I did not want four bottles of brandy. Indeed! Like a landing carrier pilot missing the 3 wire, this was a bolter. How do you say humble pie in German?

The brilliant film by Sofia Coppola "Lost in Translation," (2) starring Bill Murray and Scarlett Johansson, no doubt suggested the title for Saxena's article. In that film Bill Murray was "lost" in a sea of Japanese language and culture. Can you imagine how difficult to be "lost" and sick at the same time? In today's productivity driven primary care, we have so little time to discern nuances of language or gesture for those who speak English, let alone trying to understand and be understood by patients who speak a different language. Knowledge of Latin was at one time required for admittance to medical school. Given the demographic changes in America, with Hispanic/Latinos making up 15.5% should Spanish language skills be a prerequisite for medical study "“ or part of the curriculum?


(1) The Flowers of Evil & Paris Spleen, Charles Baudelaire, translated by William H. Crosby, Boa Editions Ltd., Rochester, NY, 1991.

(2) Lost in Translation, Focus Films, 2003.

Conflict of Interest:

None declared

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