It was in my third year of medical school when I had my first dream in English. The context of that dream has been lost in time, though what is clear is the moment I woke up, I knew a significant milestone in my journey had passed. I have been a native Spanish speaker all my life, and to be honest, I never thought I would be able to slay the dragon that is the English language. Today, I reflect upon my journey and the joy of knowing that my roots have played a key role in helping me develop my practice in research, education and ultimately neurosurgery [1].
As a bilingual and bicultural neurosurgeon, I have a unique outlook and opinion on the power of speech and communication and the role it plays in giving hope and in patient healing [2]. This background has helped me build bridges between people and countries across the globe and has even prompted research into ways of understanding how to better preserve language function in the operating room, particularly with bilingual patients [3,4]. I grew up in a small town near Mexicali, Mexico. Little did I know that I was going to go from my small clay house to the Mayo Clinic and that I would act as a bridge to my patients and their families from a myriad of countries and cultures. I grew up in a different culture with t traditions, mannerisms, foods, and holidays that are foreign to Americans. For some time, I viewed it as a disadvantage, and it took me many years to realize that it was perhaps maybe my greatest strength as a researcher, physician and surgeon.
Being bilingual has been linked to an increase in cognitive skills, social abilities, and cultural awareness in children. Research reveals that speaking two languages from early childhood delays age‐related dementia, including Alzheimer’s disease [5]. When we look at the brain during surgery, there is no anatomical difference between those who speak one or more languages—to us all brains look the same; there are no variations based on race, religion, or culture. However, despite the identical anatomy, we are not naïve to the fact that we need to provide culturally competent care to our patients. We can better serve them if we understand them. Some studies have shown racial, ethnic, and socioeconomic disparities in access to care and outcomes for various clinical conditions in neurosurgery [6-8]; but this is just the tip of the iceberg. Mead et. analyzed the shared decision-making processes in cancer care among racial and ethnic minorities and found that patients decline or delay care because of suboptimal patient-provider communication, perceived lack of culturally congruent care, and cultural competence among providers [9].
In my experience, patients are more likely to develop a strong relationship with us as physicians and surgeons if we speak their language and understand their background—and sometimes even if we just attempt to greet them in their own language. However, culturally congruent care does not require the physician to share the same roots with the patient and one can argue that there is no need to speak their language. Instead, it implies the physician is aware, sensitive, and open to learning about other cultures and understanding patients’ particularities in each interaction. This may help us improve the way we respond to cultural diversity and inclusion. As an immigrant, it is easier for me to empathize with patients who are not from the United States because of my similar journey. The ability to better understand our patients is an essential but an often-overlooked aspect of high-quality care [10].
A cultural shift is necessary in the way we train our future physicians. We need to equate history, language, and cultural competency with the same importance as we do cell biology and chemistry. Instead of referring the premedical student to take a few extra biology classes, maybe we need to encourage them to travel the world, seek out friends and colleagues unlike themselves, or do something that will push them out of their comfort zone. I have been trying to do this through our 501c3 Foundation Mission: Brain (www.missionbrain.org). Recently we began a chapter program consisting of undergraduates, medical students, residents, and young attendings to facilitate connections and interactions on a global scale. In this program, members learn from each other while helping those that are less fortunate gain access to state-of-the-art neurosurgical care. The skills that can be learned interacting with those from different cultures are equally necessary in medical careers as the science courses. Other approaches could include standardizing cultural training; this has been proven effective in improving awareness and providing better multi-cultural care [11]. These changes will not happen overnight, but it starts with every one of us as mentors, clinicians, and scientists to direct the future towards compassion and inclusion.
Little did I know that growing up in a different culture with humble beginnings was going to open doors for me I could never imagine. Today, I recognize the importance of my bilingualism and biculturalism and embrace it as a strength that has allowed me to build bridges from the United States to the rest of the world. I hope we continue to embrace these principles in our organization and our country and create the future we envision.
Acknowledgements: Michael Pullen B.S and Henry Ruiz-Garcia M.D for helping me put together the research and for helping me edit this essay. One of the secrets to success is to surround ourselves by people smarter and to recognize and acknowledge their talents.
Bibliography
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