The Hazards of Medical Spanglish

By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer

“Constantly talking isn’t necessarily communicating.”

-Charlie Kaufman, playwright/screenwriter

A Spanish-speaking patient calls her primary care health center, and talks with a triage nurse who speaks Spanish. She says her 5 year old son was seen in an emergency room in Southern California and told that her son has Monkeypox. She was given an appointment, the patient was roomed and the medical assistant recorded the chief complaint of Monkeypox.

It turns out, that the patient had infectious mononucleosis (this was what was diagnosed at the emergency room). How did this get misinterpreted?

The answer: Medical Spanglish!

The medical translation of Monkeypox is viruela del simio, but a more colloquial translation is viruela del mono. Viruela is the Spanish translation for Smallpox, so viruela del simio means Smallpox of the simians, and viruela del mono means “Smallpox of the monkeys.”

In contrast, the medical translation of infectious mononucleosis (or acute Epstein-Barr virus infection) is mononucleosis infecciosa or infeccion por el virus de Epstein-Barr. If the emergency physician had used one of these terms, there would not have been the confusion that ensued.

However, the emergency room physician spoke a little Spanish, and so mixed that Spanish with an English language shortened term for infectious mononucleosis: mono.

“Su hijo tiene el virus de mono”  which means to the parent: “Your child has the monkey virus,” which is pretty close to Monkeypox.

Early monkeypox presents with fever, fatigue, headache, and muscle aches, which is also the prodrome for COVID, infectious mononucleosis, influenza, and a hundred other illnesses so the lack of the characteristic rash is not sufficient to make a definitive diagnosis in the early stages.

Decades ago, Chevrolet had great difficulty selling a particular car model in Mexico and South America: the Nova. Nova in English is reminiscent of the French word for new, “nova” as in Nova Scotia. However in Spanish, “No va” means “no go” as in “the car that will not function.”

Providers with a little Spanish language capacity often have such miscommunications when they attempt to talk to their patients without a translator. They mix in English words, speaking Medical Spanglish.

Just as clinicians need to be precise and careful in their diagnostic process, this diagnostic information must be communicated to the patient in a way that they can fully understand, or the diagnostic process has failed. Communicating clearly with non-English speakers is a critical part of our professional responsibility as health care professionals.

For information on PHC provided video and telephonic interpreter services, see our website.

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