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 that our way of doing things, our language, our culture and our priorities are 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.

11 thoughts on “迷失東京

  1. What a great post!
    Of course, if I weren’t such a nice person I’d mention that all those technical difficulties were a just comeuppance to a technogeek-shrink. But I AM a nice person, so I’ll just tell you how much I appreciated the post.
    When I worked in psychiatry, language was one of my primary work tools, as it is yours. As the years went by I developed a love and respect for language as a vehicle of culture, as well as a medium of communication. Later on, when I began to work in language arts (writing, editing, translating) the respect and love grew and grew.
    Thank you for shining light on a love of mine that so many so often take for granted.


  2. Hello Greg:

    Snail’s pace for the progress of Telemedicine, not only Telepsychiatry. Mostly, in my opinion, due to the overblown issues of security, privacy, and getting sued by not issuing a stupid disclaimer.
    Yes, I said it, so sue me. No disclaimer for this post, because let me tell it like it is.
    In this case, is there reason for SECURITY?
    In this case, is there reason for PRIVACY?
    In this case, should you write a long DISCLAIMER, so you won’t be sued?
    Is the primary reason for a doctor’s existence to help the patient, first, then other things later?
    You did more than most physician’s would have, because of these damn issues.
    Now we doctors have no excuses, with all the tech in place. And I have done nothing to help this issue, other than posting and keeping a blog myself. But it is a start.
    Nothing like rabble rousing in the morning, even before I have had my coffee.

    John Bennett MD
    Miami, Florida

    P.S. I copied your post and put it on the front page of my blog, which brings the issue of plagarism to the fore. But there is the Common, something or other, and Google copies all the time.
    But let me know if you want me to take it down, and I will.


  3. John,

    I am honored that you would repost it. I see that you have given me credit for the posts that you have used, so I have no problem with that.
    Thanks very much for reading and commenting.



  4. Hello Greg

    You are welcome. You blog is an example of the benetis of how todays tech can give the reader an inside
    working of a doctors thoughts and viewpoint, obstervations. I had the pleasure of going
    through all the specialties examining blogs for my website, and wish I had more time to evaluate them, and enjoy them.
    Some are strictly informational, informing the reader of their practice, some are promotional, which is fine, and some are personal, which I would say your blog is. I know it is a risk sometimes to air your views in this damn day of litigation, privacy, security. A doctor today has to “CYA”. (Cover Your Ass) as they used to say in the Emergency Room where I worked for about 15 years, Covering my butt, to be honest, , that is one of the first things I thought of, when treating a patient; I just wanted to survive, keep my job to contiinue my bloated lifestyle, and the patient came second. Usually the goals of a good outcome were the same, but sometimes the goal of the ER doc was different than administration, which, at times, was purely financial.
    But I did what I had to do, and maybe I did a bit of good on the way, and I am not apologizing.

    john bennett md


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