Lost in Translation

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Advances in medical science have transformed how we detect, monitor and manage disease, but knowledge alone does not guarantee understanding.

In this personal essay, Nguyen Do, third-year medical student at UC San Diego School of Medicine, shares in his own words how his experiences across cultures and clinical settings reveal a central truth of evidence-based medicine: medical knowledge only improves outcomes when it is clearly understood by patients.

In Ho Chi Minh City in the late 1990s, life moved at a slower pace, full of scooters, street vendors and the hum of the city. When my mother was pregnant with me at age 30, prenatal care was very straightforward. The few doctor’s visits she had focused on blood pressure checks, fundal height measurements and an occasional ultrasound. Everything was explained in Vietnamese and there were few decisions to navigate. She understood her care.

More than a decade later, in the modern United States of the 2010s, life felt faster and more complex. My mother was pregnant again at age 43. Her high-risk pregnancy required frequent hospital visits and expanded testing: serum screening, noninvasive prenatal testing (NIPT), serial ultrasounds and counseling about diagnostic procedures such as amniocentesis. She was scared. She worried the tests would show something wrong with her baby. She feared that the amniocentesis might “kill the baby.” The medical English was overwhelming, the care felt advanced, but intimidating.

As a preteen, I became her interpreter. For serum screening and NIPT, I compared them to early weather forecasts, signals that could suggest storms ahead but not guarantees of rain. I explained amniocentesis as a procedure performed only when necessary, emphasizing that the doctors took every precaution. Translating both language and medical concepts in Vietnamese, I hoped to make her feel less afraid and more in control. My mother’s pregnancies taught me early in life that advances in medical care do not guarantee patient understanding. I learned how critical clear communication and cultural context are in helping patients navigate complex decisions.

These lessons resurfaced during my OB/GYN clerkship on the gynecologic oncology service. In clinic I saw a perimenopausal Vietnamese woman who had a uterine mass the size of a football. There was concern for malignancy. A hysterectomy with biopsy was the clearest clinical choice. I took her history as best I could, but since she was asymptomatic, she did not understand why she would need surgery for something that was not causing problems. Even in Vietnamese, her medical literacy was limited. She did not understand that these masses, while usually benign, could possibly be malignant.

My attending was incredibly patient, answering questions at every turn. The virtual interpreter, however, struggled to convey the emotional nuance of her questions. When the patient asked whether a hysterectomy would affect her appearance as a woman, she feared she might lose secondary sexual characteristics. The interpreter miscommunicated that the patient was concerned about experiencing gender dysphoria, which refers to distress related to incongruence between gender identity and sex characteristics. I quickly corrected this and clarified the patient’s concern for my attending physician. He explained that the uterus does not produce estrogen, the ovaries, which drive these characteristics, were actually preserved in the surgery. She was visibly relieved. Recognizing the limits of virtual interpretation, my attending scheduled an in-person Vietnamese interpreter for her next visit. It was clear that only through direct, nuanced communication was the patient able to understand and accept the recommendation for surgery.

This experience reinforced what I had learned as a child sitting beside my mother. Patients may feel overwhelmed, fearful, or mistrustful, even in the most advanced medical systems. True patient-centered care requires not just expertise, but the ability to communicate clearly, empathically, and with cultural sensitivity.