(ED NOTE:  No excuse for a country like Libya having a ton of money from oil, seven, yes, SEVEN cardiologists in all the country, and no Telemedicine service.  Or a simple hookup with a language channel to a desktop to every hospital in the USA with Skype, with an MTV Language Channel for situations like the below.  This doctor went above and beyond what most doctors would have done, as far as effort, time, etc.  But he should not have had to have done so, with the technology we have today.)

 This post is from an excellent blog by a psychiatrist from South Carolina,  Greg Smith MD Mental Health Musings.)



(above is Mandarin for “Lost in Translation”)

I take language for granted.

You probably do too.

I go to work every day thinking that the least of my worries is going to be how I communicate with the people who come to me for help. I’ll have to help them deal with alcohol problems, depression, hearing voices and thoughts of suicide, but the common language between us, English, will facilitate this process, not hinder it.

But as Robert Burns said in his 1786 poem To a Mouse,

But, Mousie, thou art no thy lane [you aren’t alone] 
In proving foresight may be vain:
The best laid schemes o’ mice an’ men
Gang aft a-gley, [often go awry] 
An’ lea’e us nought but grief an’ pain,
For promised joy.

I was tasked with evaluating a patient the other day, a patient with the usual family problems, mood changes, and possible paranoia and delusional thinking that many of my patients have. The history given me by the hospital emergency department staff was pretty straightforward. I needed to see whether or not this person needed to be hospitalized for safety, medicated for psychosis, treated for depression and anxiety, or simply sent home because of a cultural misunderstanding.

The problem? I speak fluent English and absolutely no Mandarin Chinese. He spoke fluent Chinese and very, very little English.

Now, I have written about the positives and negatives of telepsychiatry before. The picture is crystal clear, the sound quality is usually very good, and the ability to assess and intervene from hundreds of miles away is remarkably and surprisingly easy. Except when the two parties involved do not share a common language.

We tried the usual say a few words and use sign language thing. No go.

We tried to find a family member to help, but they had already left the hospital.

We then turned to a translation line out of California, something that most all facilities nowadays must have ready access to in order to provide care for anyone who might walk through their doors, especially if they receive any Federal monies as payment for services at all.

Problem solved, right?


We could not get the translator hooked up through the speaker phone on the hospital’s end so that both the patient and I could hear her.

We tried having her call in to my desktop speaker phone, which would then be picked up through the mic on my Polycom unit and heard by the patient in the ED. No go.

We finally worked out a three-way call that involved her talking to the patient on a corded phone in the ED, on camera, and me on my iPhone in my office at the same time. The patient was on camera and could see me and vice versa. I turned the sound on the telepsych unit all the way down to prevent the double double transmission transmission of of every every word word.

We were then able to proceed, albeit awkwardly and gingerly, through an intimate conversation about marriage, business, and madness with the help of a very patient and very helpful young woman in California who spoke both Mandarin Chinese and English.

Once we were able to communicate, the cultural issues, nuances, and differing manners and cultural protocols became more obvious between us, doctor and patient. This added another layer of richness and frustration to what should have been a fairly easy, fairly straightforward thirty minute conversation and assessment.

Two and one half hours later, I hit send and my consult was on its way to the emergency room doctor and staff.

I was emotionally exhausted. I got up and walked around, got some air, and contemplated what had just happened.

Sometimes we go through our days not even noticing the miracles around us. We take so much for granted. We are sure of what we are going to do and exactly how we are going to do it. We set out schedules and feel that we are in perfect of control of our lives. We think thatour way of doing things, our language, our culture and our priorities and the best, the most important and the ones that everyone else in the world espouses and holds dear.

We would be dead wrong there.

Practicing telepsychiatry has taught me many things in the last four years.

I have learned that people are people, with similar problems and hopes and dreams and fears, no matter the color of their skin or the way they dress or the language they speak.  I have learned that being patient is absolutely essential to doing my job. I have learned that being flexible saves me, the hospital emergency room staffs, and my patients a lot of heartache.

I have learned that communication is key. Without it, my services are absolutely useless.

Enjoy your day. Talk to someone today. Really try to understand what they are saying to you. Take nothing for granted. You will be richer for it.

The title above is Lost in Translation, written in the traditional Chinese. 


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