We are all patients. At some point, every single one of us will see a doctor, enter a hospital, or otherwise spend time being cared for medically. But, unlike vacation in an exotic country, visiting Susan Songtag’s Kingdom of the sick is not a journey we usually look forward to. The Kingdom is full of unknowns. It’s fraught with fears. And then there’s the language barrier.

Don’t fret!

You don’t have to be fluent in patientese to visit the kingdom of the sick. With this handy travel guide, you too can make the most out of your journey. You’ll see the sights, speak to locals and dine on the finest orange jello.


The Waiter and the Teen

string around my finger

When I lived in Paris, there is a great cafe on the Boulevard St. Germain. Ok, there are like a hundred great cafes on the Boulevard. But this particular one was my favorite. Every morning I’d sit outside, pretend I could read Le Monde and have un espresso, double s’il vous plaît, et un croissant. Waiting tables in France is a well regarded profession. In fact, there is a tradition of leaving smaller towns to seek restaurant work in Paris. It pays well, it’s well thought of and it’s hard work.

One morning, a quintessential American teenage tourist appeared, as if out of central casting; ripped jeans, backwards hat, earphones in ears… you get the picture.

Yo man, where’s the Looov-rah?

Our waiter continued to set someone else’s coffee and croissant down on a table.

Yo yo, the Louvre?

The waiter straightened up, adjusted his waistcoat and with this right arm straight out, pointed South.

The Louvre was two blocks due North. If the teenager had craned his neck around the cafe’s terrace, he would have seen it.

Here’s the thing about this transaction, neither side was wrong. Neither was right. It was a classic culture clash. Both sides had expectations, stereotypes and their own agenda.

To the French waiter, the American teen was rude. He was interrupting him at his place of work. Would you walk into a business office and ask someone at a computer where the Louvre is? No? Then why interrupt me? And, by the way, why do you assume I speak your language? You are, after all in my country. (In addition to contriving our waiter’s thoughts, I’ve liberally translated them for us here.)

The teen knows waitstaff in America to be, generally, helpful. In America, even with the disaffected yo dudes of a teen, most people will tolerate an interruption and at least point the right direction. Hey, how much effort does it take? Besides, they told me everyone in France speaks English anyway, right? How about a little hospitality for a visitor to your country buddy?

When we travel in the kingdom, there’s a high likelihood or running into the language culture clash. Healthcare providers, even with coaching and training on patient experience, are largely there to do a job. They are French waiters, doing their well respected, well paid jobs.

Patients have a lot in common with the American teen. I’m not suggesting patients are rude and culturally ignorant - there’s a lot the teen could learn about basic manors. But it’s reasonable to expect some eye contract and basic courtesy from your hosts, even if you speak a different language.

The native tongue


So are have been NPO since midnight, right? Ok good, when we’re done here, you’re going to go down that hall, past PT and mamo and turn right at the sign for the ED…

Those of us who work in healthcare don’t mean to speak our own language. It’s where we work. We’ve just picked it up. But to the visitor, the tourist in the Kingdom, it might as well be gibberish.

Sometimes it’s not even the foreign tongues which pose a problem. Sometimes it’s simply pointing in the wrong direction.

Listen, I’m a little worried about about this procedure…

It’s ok sweetie, the doctor knows what he’s doing

For a patient, that first line can be code for something like: I have questions and don’t know how or when to ask them. Maybe it means I’m really scared, seriously, I’m freaking out here!

For a nurse, a little reassurance about the doctor’s skills may be all they have time for. If I probe, I may have to document something —who as time for that? —and, I honestly know everything is going to be fine, we’re following our protocols…

You don’t need to be fluent

Here’s the good news, you don’t have to be fluent to visit. Seasoned travelers know this trick well. It’s the trick which would have thawed the icy divide between the American teen and the French waiter: be human.

A friend, herself a retired inpatient dietitian, once told me about her experience taking her entire family around the world for a year. She said the key wasn’t memorizing phrases or words of foreign languages. The secret was smiling and using names. Everyone smiles. Everyone knows what a smile means. Everyone has a name. Smiling, pointing to my children and saying their names was the best icebreaker in the world. It got us through customs in Siberia, through an Asian rain forest and across all of Africa.

Salespeople know this trick well. If you strike up a personal relationship, even if for a fleeting moment, the other party is more likely to care about you and your cause.

Here’s what I do when I find myself traveling in the kingdom :

Mr. Dawson please come to registration booth number 6… Insurance card and ID please?

Here you go Marie…Marie, how long have you worked here? Yeah? Is this a good place to work, it seems like it would be and that you’d meet a lot of neat people….

When I meet nurses and patient care staff I use the same techniques. I always try and call them by name. I invite them to use my first name. In short, I do whatever I can to make our exchange personal. I want them to care about me, not just as a medical record number, an OR case or a bill —really, about me as a person.

I smile a lot. More than my displeasure at waiting for 40 minutes in the waiting room would normally allow. I make eye contact. I do everything to make it clear that I’m a person. I do it so when this happens:

So Joan, I know you’ve seen a lot of these procedures. I gotta tell you, I’m pretty scared. Can you walk me through everything that’s going to happen today?

I get a real answer. I get more than it’s gonna be ok. I get a genuine play by play. Joan and I are now friends and she’s not going to let anything bad happen to me. She’s not going to blow past a question in the EMR. She’s not going to miss my drug allergy.

I do it so I get pointed in the right direction for the Louve.

Less than ideal

Is this a perfect solution? Far from it. We shouldn’t have to resort to tricks to sell ourselves as patients. And, fortunately, it’s not always required. Increasingly, providers are recognizing the importance of empathy —putting oneself in the shoes of the visitor.

It’s hard to see your own work through fresh eyes. You have to remember what you call an ED is written as “Emergency Room” on the sign in the hall. You have to think maybe, if it were me, I’d want someone to walk me there instead of pointing to the signs…

Regrettably, some providers and healthcare organizations haven’t yet made room for empathy in their business model. In those cases, as patients and visitors to the Kingdom, we can help trigger an empathetic response by simply making human connections. It works for world travelers! _____________ Last week, I visited the Kingdom. ACL reconstruction on my right knee. It was the third time I have had an ACL reconstruction and the second time on this particular knee. I elected to have the procedure an hour away from the large academic medical center we, quite literally, live next door to. I chose the hospital and doctor because they are the best hosts in the foreign land of the sick. This post is by no means a critique of their service or care. Rather, it is inspired by those experiences. I never have to translate in that hospital.