Sara: Thank you so much for having me. Today, we will be talking about basic grammar, vocabulary, and taking a medical history. I am a physical therapist but I work very closely with occupational therapists. We have so much in common in terms of what we need to know for taking medical histories and functional assessments. I teach and travel so much in my practice that I see that there are so many cultural considerations that we have to keep in mind when working with Spanish-speaking patients.
Outline
We need to know the Spanish alphabet, numbers, and pronunciation. It is important to be able to greet your patient and have useful OT vocabulary and common phrases during an OT evaluation. We will look at basic verb conjugations. We will go over some anatomy and anatomical positions. Finally, we will go over how to take a patient history, how to assess for pain in Spanish, and a functional assessment including ADLs and adaptive equipment.
Background
According to the 2013 US Census, 38.4 million residents of the US primarily spoke Spanish at home, and about 8.4% of the US population have limited English proficiency. Non-English speakers are less likely to return for follow-up appointments as well. With this population, there are higher rates of drug complications in hospitalizations. A quick anecdote is an inpatient I had one time. He took too many of his pain pills and got extremely sick. On the bottle it said to take them once a day. In Spanish, the word O-N-C-E means eleven. He was taking his pills eleven times a day as opposed to one. Luckily, we caught it, but this highlights why there are higher rates of drug complications due to language barriers. Because of these stats, it is highly likely that you will encounter a Spanish-speaking patient in your career at some point as an OT.
In 1999, the Office for Civil Rights of the Department of Health and Human Services, so HHS, issued the following memorandum under Title IV of the Civil Rights Act: "The denial or delay of medical care because of language barriers constitutes discrimination and requires that recipients of Medicaid or Medicare funds provide adequate language assistance to patients with limited English proficiency.”
This is saying that everyone who accepts patients, who receives Medicare or Medicaid funds, has to provide language assistance interpreters for patients. As we know, this is most healthcare providers, except for fee-for-service and cash-only practices. Currently, only 13 states provide third-party reimbursement through Medicaid and the State Children's Health Insurance Program. This is called different things. I know here in Georgia, it is called S-Chip (State Children's Health Insurance Plan), or Peach Care. Most states, with the largest number of non-English speakers, have not followed suit. This means that the other states can decide what to do with their pot of money. Only 13 states currently follow this federal law and provide interpreters. Hospitals, that do not want to get sued for discrimination, often will provide their own interpreters. Remember that every patient has the right to an interpreter. Your hospital may provide them, or they may do language lines.
Interpreters
One-to-one interpreters are ideal, but they are not always available. Language line interpreters are where you call a number and you have someone come on speakerphone. There are language translation apps you can get for your phone. Family members can help, but might be unreliable. If you have no interpreters available, you still must make sure that patient can communicate adequately for safety. As per my earlier example, you want to make sure that your patients are understanding what you are saying.
Cultural Values
Healthcare is a cultural construct. Ideas about disease pathology, prevention, intervention, how illness is perceived, and attitudes towards healthcare providers are all involved with this. Some cultures think healthcare providers are these gods and goddesses that know everything, and they really defer to them. In certain other areas, there may be a mistrust of healthcare providers and attitudes of healthcare providers from within that culture.
Modifying Assessments/Interventions
For example, I teach in a DPT program. I tell them that English does not equal hard of hearing. Hopefully, everyone knows what I am talking about. I know we have all seen people trying to scream and shout at people in English that do not speak English. It will not make them understand English if you speak louder. Again, be familiar with your institution's resources. Inpatient OTs should have hospital interpreter services available. Outpatient clinics can be a little trickier, but in these cases you can use the language lines, which are great. If ad-hoc or family member interpreters must be used, quote on quote, listen carefully. If a patient gives a really long answer in their own language, and the family member says, "She said yes," you may want to get some assistance. You can also always look at body language, but you want to avoid charades.
Alphabet and Grammar
This will probably be a review for some of you, but we will go ahead and start with the Spanish alphabet and grammar.
Alphabet
This chart shows the pronunciations of the alphabet (El Alfabeto) in Figure 1.
Figure 1. Spanish alphabet and pronunciation.
The J sound is like an H sound. So the word for ham is J-A-M-O-N, and you pronounce it ha-mon. This is like the name Jose , J-O-S-E. It does not have the "J" sound, but rather the "H" sound. I also want to point out the double L. If you think about the word quesadilla, there is a L-L-A at the end of the word. It is quesadilla, with a "Y" sound, not "L". When you see a double L, it is pronounced like a Y. Then, the next thing in the Spanish alphabet that is different from the English alphabet is this Ñ with the tilde. This sound can be heard in the word El Niño, the weather pattern. Everything else is pretty standard.
Numbers
Números are important as we are asking people about pain quite frequently, like from zero to 10. Figure 2 displays the correct pronunciation.
Figure 2. Spanish numbers and pronunciation.
Vowels
- A = ah (as in yacht but a little shorter) taco
- E = eh (as in met) or ay (as in clay) quesadilla
- I = ee (as in keep) lima
- O = oh (as in open) loco
- U = oo (as in moon) luna
"A" is like the word taco. Everyone can say taco. E is pronounced "ay" like quesadilla or an eh as in met. "I" can be confusing as it is pronounced "ee." The word lima (leema) means lime in Spanish, the little green fruit. "O", like loco, has a long O sound. Finally, "U" is a long sound for luna, actually the word for moon.
Hints
Here are a couple more hints. The H in Spanish is silent so hablar is to speak. You do not say "H"ablar, you say "Ablar." The double "L" sounds like a long "E." Again, this is like the word quesadilla. Ahora means now.Finally, another important word is "el/la terapista (terapeuta) ocupacional". There are two words for therapist, terapista or terapeuta. I say "terapista", as it is a little easier to pronounce, and it is a lot like the word therapist in Spanish. If you are a female OT, you would say "la terapista ocupacional". If you are a male OT, the word "terapista" stays the same, even though it has an a at the end, but you would say "el terapista ocupacional".
Greetings
Once you receive the referral, you will need to greet your patient. Here are some common greetings in Spanish.
- Buenos días Good morning
- Buenas tardes Good afternoon
- Hola Hi (informal)
- ¿Cómo se llama? What is your name?
- Me llamo Sara My name is Sara
- Mucho gusto. It’s a pleasure to meet you.
- Igualmente. ‘likewise’
- Soy ________el/la terapista (terapeuta) ocupacional. I am ________ , the occupational therapist.
You have probably heard some of these already, even if you do not speak Spanish. To say good morning, you say, "Buenos días." To say good afternoon, the phrase is "Buenas tardes." "Hola" is hi. To say what is your name, you would say, "¿Cómo se llama?" Translated directly, this means how are you called. For example, to say in Spanish, "¿Qué es tú nombre?" is like Spanglish. You can say it, but most of the time you will hear "¿Cómo se llama?" Then to say my name is Sara, I would say, "Me llamo Sara." "Mucho gusto," means it is a pleasure to meet you. The word igualmente means likewise. If I am saying to someone nice to meet you (mucho gusto), they would say back, "Igualmente." To introduce myse lf, I would say, "Soy Sara, la terapista ocupacional," as I am a female.
Now take a minute and practice these phrases (see Figure 6). It is like riding a bike, the more you practice something, the better you get at it. One of the great things about Spanish and living in this country is that you hear it everywhere, especially in cities. Some cities, like Miami or New York City, you hear it frequently. I live in Atlanta, and I still hear it a good amount.
Here are some more greetings:
- ¿Como esta hoy? How are you today?
- Yo estoy bien. (good)
- Yo no estoy bien. (bad)
- ¿Como se siente hoy? How do you feel today?
- Me siento bien. (good)
- No me siento bien. (bad)
How are you today? "¿Cómo esta hoy?" Or you could just say, "¿Cómo esta?" "Yo estoy bien." This means, "I am well." "Yo no estoy bien" means I am not well. In some languages you change the whole sentence if you are saying a positive or a negative, but in Spanish it is really the same, you only stick a no in there. Yo estoy bien. Yo no estoy bien. To say, "I feel well," you would say either, "Me siento bien" or "No me siento bien." Now, of course , your patients may not say the whole sentence. You may say to them: "¿Cómo se siente hoy?" or even, "¿Cómo esta hoy?," and they may only say, "Bien," or "No bien." They may say that instead of "Yo estoy bien."
Now, try these phrases a few times. These are answers to the questions ¿Como esta? and ¿Como se siente?
- Excelente, gracias: excellent, thank you
- Bueno: good
- Bien: well
- Muy bien: very well
- Mejor: better
- Mas o menos: so-so, “more or less”
- Un poco: a little bit
- Mucho: a lot
- Malo: bad
- Peor: worse
There is a lot of different answers to the questions "how are you?" and "how do you feel?" "Excelente, gracias" is "Excellent, thank you." Bueno is good. Bien is well. Muy bien is very well. Mejor is better. Now remember, that letter "J" is tricky and sounds like an "H". Mejor is pronounced like ma-hor, not ma-jor. Mas o menos is so-so. Literally, it means more or less, or mas o menos. I hear that a lot in my Spanish-speaking patients. Un poco means a little bit. Mucho is a lot. Malo is bad. Peor is worse . If you say, "¿Cómo esta?" They could use any of these words to respond. If they wanted to say a little bit better, they would say, 'Un poco mejor." Take a moment and practice these words. You have access to the PowerPoint (see course handout), and I encourage you all to print it out and keep it in your desk if you think it would be helpful.
Important Phrases (Frases Importante)
The following are important phrases. We are going to learn a lot in the next two hours. In my experience, it is always extremely appreciated when you try to speak Spanish to Spanish speaking patients.
- ¿Habla ingles? Do you speak English?
- Hablo un poco de español. I speak a little Spanish.
- No entiendono/no comprendo. I don't understand.
- Repita, por favor. Please repeat.
- Mas despacio, por favor. More slowly, please
You can always say: "¿Habla ingles?" [Do you speak English?] "Hablo un poco de español." [I speak a little Spanish.] It is always fine to also say, "No entiendo or no comprendo." [I do not understand.] "Repita, por favor." [Please repeat.] And the old favorite, "Mas despacio, por favor." [More slowly please.] Sometimes understanding is just a matter of slowing things down.
- Lo siento. (verb: sentir): I am sorry.
- Ahora: Now
- Hoy: Today
- Pues….: Well…
"Lo siento" means I am sorry. Literally, lo siento means I feel it. You know in English we say I feel you. It is sort of like that. The word "ahora" means now. Today is "hoy." Lastly, the word "pues" means well. They can use this when they are thinking or are about to answer your question. In the box below, think about how to say these phrases or write them down.
Practice
Good morning. How are you?
Very well, thank you.
Do you speak Spanish?
Yes, a little.
I am the occupational therapist.
The first answer would be "Buenos días. ¿Cómo esta?" Good morning is buenos días. How are you is cómo esta. The second phrase would be, "Muy bien, gracias." Do you speak Spanish? "¿Habla español?" The answer may be: "Sí, un poco." Finally, how do you say I am the occupational therapist? If you are male, remember you say el, E-L, and as a female, you would say la, L-A. "Soy la terapista ocupacional or soy el terapista ocupacional."
I have made a few recordings of the phrases we have learned so far. Play them a few times to get the hang of it. As a disclaimer, these were made as a physical therapist to a patient, but the ones I have kept for this OT seminar webinar are the ones that would also apply to OTs, not just PTs.
Listen and Learn Review: Audio Scene 1: Introductions
I will have several of these voice recordings scattered throughout the webinar. You can hear it actually being spoken between two people and not just me.
Basic Anatomy
As OTs, knowledge of basic anatomy is very important.
Bones
Figure 3 shows the bones of the human body in Spanish.
Figure 3. Bones of the body.
- Cranium: el cranio
- Ribs: las costillas
- Sternum: el esternon
- Lumbar or vertebrae: verterbras lumbares
- Pelvis: la pelvis. Sacrum: el sacro
- Clavicle: la clavicula
- Scapula: la escapula
- Humerus: el humero
- Radius: el radio
- Ulna: el cubito (I tell my students they can remember because of the cubital fossa in your elbow.)
- Carpus or wrist: el carpo
- Metacarpus: metacarpo
- Phalanges: las falanges
- Femur: el femur
- Patella: lo rotula
- Tibia: la tibia
- Fibia: el perone (The mnemonic for me for that is their peronial nerves on your lateral ankle thus el perone for fibula.)
General Parts
The general parts of the body are:
- Shoulder: el hombro (Remember, the h is silent. You do not say "el hom-bro." You say "el om-bro." A very similar word in Spanish is for man, el hombre. It is a very common Spanish-student mistake to say things like, "Does your man hurt? Is your man broken?" So hombre is man, hombro is shoulder.
- Arm: el brazo
- Elbow: el codo
- Chest is el pecho
- Back: la espalda
- Hip: la cadera
- Leg: la pierna
- Knee: la rodilla
