Wednesday, September 19, 2007

Welcome to ESL Hell

My first experience in ESL Hell occurred back in 1975, when I was confronted with dictation from a physician who had recently arrived from a remote island in the Philippines. I did not pass “Go!” Nor did I collect $200. Instead, I spent about 20 minutes desperately trying to transcribe a three-minute piece of dictation that was totally unintelligible. A Filipino colleague in the hospital’s Medical Records Department politely explained that, because Dr. A’s dialect did not conform to those from people who spoke more traditional versions of Tagalog or Ilocano, his dictation might be a little difficult for me to understand. That was the understatement of the century. On a good day, one out of ten words was translatable.

A year ago, I ran into a medical transcriptionist who now works at that same hospital. During our conversation, I described how the transcriptionists used to be located in a converted hospital corridor that had no ventilation and asked if Dr. A was still on staff. As I joked about the trouble I had had transcribing his reports a quarter of a century ago, I saw the blood drain from her cheeks and a look of pain cross her face.

“Don’t even ask,” she groaned. “He’s still there.”

Because transcription is performed out of sight and out of mind from so many people in the medical profession, most folks have no concept of what ESL Hell involves. The worst cases result in “Swiss cheese” reports that are so full of holes they endanger patient care. Some ESL doctors don’t even bother to review their reports and fill in the blanks – they just assume that any words missing from their dictation must be the transcriptionist’s fault. When called on the carpet during a quality assurance review, some will resort to indignant temper tantrums.

“I received a voice mail from a physician who turned out to be interested in pursuing our online HIT program,” writes one frustrated soul. “I could not understand any part of his voice mail except his phone number. When I called him, I could not understand or hear anything he was saying. I repeatedly had to ask him to speak up and repeat what he was saying. He had to dictate his email address to me repeatedly because every time I entered it and hit send, it bounced back. We finally got it right on the fourth try and, you guessed it! He was annoyed with me because I could not understand him or get his email address right .... as if his poor diction and fading-in-and-out-voice were my fault!”

About twelve years ago, my partner and I were transcribing for a large national service where we shared a hospital account. One of our favorite doctors was a Vietnamese cardiologist who would dictate “Pesh! Pesh! And a new pawagwaf!” Once we had figured out that a “Pesh” was actually a period, that word became a private joke. On occasion, we would use it for a password, figuring that no one in their right mind would ever be able to determine how we had arrived at that combination of four letters.

As we continued to struggle with dictation from foreign doctors, we learned to tune our ears to accommodate the worst imaginable assaults on the English language. Whether it was the Chinese doctor who tried to dictate in English while screaming in Mandarin at an elderly patient who was hard of hearing -- or the Russian physician (who could have done the voiceovers for Natasha in the Bullwinkle cartoons) who dictated that “Dehr pyatient iss heving trahbull pwhronouncing voordz...” – we struggled through one report after another.

Ask any experienced medical transcriptionist for a war story from ESL Hell and your ears will be soon be stinging. One MT merrily recalls a Spanish OB/GYN physician who had a common diagnosis of “jeest infections.” Another complains about Canadian doctors who say “aboot” instead of “about” or “olecranian” instead of “olecranon.” A third describes a Nigerian physician who frequently adds an "O" to his abbreviations, so that MRI becomes M-O-R-I. And let’s not forget all those references to the patient’s clavicule!

“Speaking of Indian ESLs -- a group with which I am entirely too familiar,” writes a veteran medical transcriptionist, “that ‘W’ for ‘V’ and vice versa (wice wersa?) thing drives me crazy. I get so tired of patients womiting that I could just womit myself. I can't help but feel sorry for the patients with wasowagal syndromes!”

As medical language specialists, we frequently wonder why supposedly well-educated people (who could make it through medical school) simply cannot pronounce words properly. Isn’t communicating with patients and other medical staff a critical part of a doctor’s work? Shouldn’t an ability to speak proper English be an important consideration for getting through medical school?

The answers are not as simple as one might expect. A speech therapist recently explained to me that by the time a child is eight or nine years old he will have mastered all the basic sounds of his primary language. But some languages do not contain the same sounds as others and, unless the muscles are trained at a very early age, it becomes much harder to pronounce certain sounds. My mother recalls that, when spending a summer in Israel, her throat hurt from trying to pronounce so many guttural "kh”sounds. When my parents spent time in France, her upper cheeks hurt from the frequent use of the “eu” vowel sound.

As a medical transcriptionist, I have always been fascinated at how people can look at the same word on a piece of paper and yet pronounce it so differently. About two years ago, a burgeoning friendship helped me gain a much better understanding as I watched a fascinating process of assimilation take place. When my friend Yuki arrived in the United States he could barely speak English. As much as we enjoyed each other’s company, communication was extremely difficult. Not only would he speak very softly but, because of the way he pronounced certain English words, they were totally unintelligible. Sometimes our conversations involved a slow and painful process as I asked Yuki to repeat a word over and over again until I understood what he was saying. Often, he would reach into his school bag for a Japanese/English dictionary.

Cultural differences affected our communication as well. Although Yuki denied that his Japanese background was an inhibiting factor, it was obvious that at times he could not bring himself to say something which could cause embarrassment. As we tried communicating more frequently by email, I noticed something amazing. Whereas many Asians will transpose the letters “R” and “L” in their speech, Yuki also did this in his writing! I would get messages stating that “I was at the airport and this lady gave me a free drink coupon when her fright was canceled.” Or he would ask “Is there a traditional way or foods to cereblate Memorial Day?” Often, Yuki’s “th” sounds would be pronounced as an “S” (“I have a crass in programming on Sersday....”).

Once, while eating lunch in the park, Yuki told me that he was going to have to study very hard for an upcoming examination. When I asked what the subject was, he smiled mischieviously and said “Grammar. I should do well!”

Several weeks later, my friend asked me to look at his website and tell me what I thought of his writing. After trying to make my way through his narrative, I was faced with a tough challenge. At our next meeting, I carefully explained that I didn’t want to hurt his feelings but that, if he wanted to major in communications, he would need to be able to communicate in a way that people could understand. His garbled syntax, frequent misspellings, atrocious grammar, and unwitting use of the wrong words were already causing problems in his communications with people who cared about him. What would happen with people who couldn’t understand his writing?

“Is no problem,” Yuki smiled. “On the Internet, I write from the heart. It’s called Engrish. I can write different for technical.”

In the months that followed, Yuki’s English slowly improved. During that period I also met two new friends who were Korean born but had been adopted during infancy into Irish-American families. Unlike many Asian Americans (who grow up in a household that is both multilingual and multigenerational), these men did not have a foreign language spoken in their home. As a result, they spoke no Korean and (“like totally!”) had no problems with the English language.

As a child, I had listened to my parents converse with my grandparents in Yiddish. Often, I thought it was because they didn’t want the grandchildren to understand what they were talking about. But as I grew up, I learned that because Yiddish was my grandparents’ primary language, it was simply easier for them to converse in their native tongue.

Decades later, when my mother came across some letters from my grandmother, she couldn’t help but chuckle at Grandma’s spelling. The word “olwisodn” meant “all of a sudden.” The sentence “Rutie ess a tutie” meant that my cousin Ruth (when she was an infant) had just gotten a new tooth.

An Armenian friend recalls that, when her children were growing up in Ohio, they were unable to pronounce the names of certain traditional Armenian foods. When they asked the local grocer for “kayma” instead of “kheyma,” he would often wonder if the kids were really Armenian. She and her husband often conversed in Armenian in their home because “there are some words or phrases in Armenian that would require too many words to translate into English. The meaning wouldn’t come out as effectively and the translation would lack the nuance it had in the original language,” she explained.

My friend Yuki’s difficulties with the letters “R,” “L,” and the “th” sound can probably be traced back to his childhood. But cultural assimilation is a truly fascinating process. Several months ago I ran into him in front of a neighborhood dance club. By that point, Yuki had dyed his hair blond so that he could look like “a real Californian.” As we caught up on recent events, I noticed that he was speaking with much greater fluency. I couldn’t help but laugh when he explained why he had recently broken up with someone who was British. “I couldn’t understand him on the phone!” he sighed. “He had his UK way of speaking. I have my Japanese way of speaking. We’re both trying to live in the United States, but we make no sense at all.”

Let’s just hope and pray that these two don’t decide to become doctors!

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