Interpreters Can Be Good Medicine for Doctors : Health: Language barriers can obstruct sound medical care. A practiced interpreter can save time and money--maybe even lives.

NEW ORLEANS —  In this polyglot nation, what is to be done when patients can’t even tell their doctors what’s wrong? Language is the first barrier to good medical treatment.

Dr. Faith Fitzgerald, who has treated people from at least three dozen nations at the UC Davis Medical Center in Sacramento, says, “I’m not sure I was ever prepared for this as a physician.”

She and Dr. Eric J. Hardt of Boston counseled other doctors in cross-cultural medicine at the American College of Physicians meetings in New Orleans and San Diego. Language, they say, is only the first of many differences with which doctors must deal.

Culture, too, comes into play.

A good medical interpreter will know common medical and psychological problems of his native country, common treatments and even history, says Hardt of the Boston University School of Medicine and Boston City Hospital. Interpreters should know the importance of telling a doctor about a patient’s own folk cures.

“Every day, including today, I find significant errors in history-taking that are directly attributable to the language barrier,” Hardt said.

For instance, there was the young Southeast Asian man who came to his hospital’s walk-in clinic because of what the friend with him described as noise in his ears.

The resident on duty took that to mean ringing in the ears--tinnitus. He was going to order expensive tests to look for its cause.

“It didn’t quite make sense to me that a young patient would have this,” Hardt said.

Because the man spoke no English and his friend’s wasn’t much better, the doctor didn’t know any details. Hardt told the resident to get an interpreter.

“It turned out the noise the patient heard was machine-gun fire. That, in fact, he woke up in the middle of the night with that noise in his ears, having nightmares, sweats, in terror.”

Most likely diagnosis: post-traumatic stress syndrome.

The Voting Rights Act requires bilingual information and help for voters. So too should interpreters be provided so people can get the medical care they need, some say.

“Civil rights issues jump off the page more quickly when you’re in a legal situation,” Hardt said. For instance, is it right to have a battered woman’s husband translate for her at his trial? But if a woman with a broken arm seemed to accept her husband as translator, many doctors would accept him without a second thought, Hardt said.

Interpreters can save money not only by avoiding unnecessary tests but by keeping people healthy, increasing the chance that they will follow doctors’ orders and return for follow-up appointments, Hardt said.

And it could help prevent malpractice suits should “the minority immigrant community become more sophisticated in learning how to sue us for our mistakes,” he said.

“All of us are immigrants and the children of immigrants,” Dr. Fitzgerald said. “Given the state of the world, about every three or four years, it seems, we see a new wave of people.”

California law requires interpreters for minorities who make up 5% or more of a clinic’s or hospital’s potential patients. New York requires an interpreter if more than one out of 100 patients speaks only a foreign language. Massachusetts is considering a similar bill, Hardt said.

Doctors at St. Mary’s Hospital in Long Beach have several Cambodian translators available, Dr. Carole M. Warde said.

Sometimes trained interpreters aren’t available. Then, doctors need to explain that the relative or friend must be exact in relaying their words to the patient, and the patient’s words to them.

The problems posed by cultural differences are many. Fitzgerald treated a Russian emigre who refused to return to the specialist she had recommended. Why, she asked. “He smiled,” the patient replied.

“A smiling physician for a Russian is a frivolous, not a serious person, not one taking her disease seriously,” Fitzgerald said. She found another doctor for the woman and “explained to him that he would have to be very, very serious with her and look stern,” she said. “She was delighted with him.”

Then there was a Gypsy matriarch who stayed with a pregnant young relative and insisted on controlling her treatment--down to changing the antibiotic dose and IV flow.

The nurses considered them a “family from hell,” Fitzgerald said. But when she gave them information on the Gypsy culture, their reactions changed.

“The nurses’ notes took on quite a different tone--’Aha! We expected this, and it happened!’ ”

Other patients insist on traditional healing as well as--or even in place of--Western medicine. Samuel Dagogo-Jack, a Nigerian practicing in St. Louis, told of a woman who went to a Nigerian hospital with severe diabetes. It made her hands and feet feel as if they were burning. She believed that spirits were setting fire to them.

Someone had told her that Western medication would not work. “We knew the kind of blood sugar she was running. If she didn’t take insulin, she would certainly go into a coma.”

He agreed to let the tribal doctor treat the woman by sprinkling herbal powders on her face and arms and giving her a charm to put under her pillow.

“Immediately after that, I crept in with insulin. She got well.”

Nor are immigrants the only people whose beliefs and culture can affect medical care.

“The Hopi like to have concrete treatment . . . even if you just draw blood, then you give them pills,” said Dr. Robert Nightingale of Casa Grande, Ariz., who has worked at hospitals that served Navajo and Hopi reservations.

White Anglo-Saxon Protestants have their own medical quirks. For instance, many men don’t tell doctors what’s wrong with them.

“Back in Africa and the Middle East where I practiced, it’s quite the opposite,” Dagogo-Jack said. “The men complained quite frequently, almost hypochondriacally. You have to interrupt them.

“Here, the middle-class American patient will come in and say ‘Hi,’ exchange pleasantries. When you ask, ‘Is there any problem?’ he’ll say, ‘Well, nothing. I feel OK.’ ”