Learning a language is full of excitement, frustration and many times, embarrassment. This was perfectly illustrated to me one day when a coworker of mine, Clara, who was in the process of learning Spanish, was doing her best to make small talk with a Spanish-speaking family. Frustrated by her mispronunciations she said “estoy embarazada!” Estoy embarazada, in Spanish means, “I’m pregnant.” What she meant to say was “I’m embarrassed.” When she told us this story after the fact, she was mortified. “I know that that wasn’t the right word, I was just so nervous that I kept making mistakes.” Language learners will often make linguistic mistakes, and one of the easiest pitfalls is the one that Clara made, a situation involving what is commonly known as false cognates.
False cognates are linguistic terms used to describe pairs of words that sound similar in two languages but have different meanings. False cognates can cause novice language learners to use words incorrectly, like in the case of Clara. However, in healthcare, confusing these words can be more than embarrassing – it can also be dangerous. The most well-documented example is the case of Willie Ramirez. Willie was 18 years old when he went to the hospital with a complaint of being “intoxicado.” As an English reader, you probably immediately associate the word “intoxicado” with the English word intoxicated. However, in Spanish, “intoxicado” means that the person consumed something that made them sick. This term derailed Willie’s treatment and he was misdiagnosed and treated for opioid intoxication. Willie became paraplegic as a result of the misdiagnosis. Willie’s case demonstrates that in healthcare, a single misinterpreted word can dramatically alter a person’s course of treatment and outcome.
American Spanish Adds Complexity
False cognates are increasingly difficult to identify as Spanish in the United States evolves. As of 2011, there were approximately 37 million people in the United States that spoke Spanish at home. There are more Spanish speakers in the U.S. than the population of Honduras, El Salvador and Guatemala combined. This makes the U.S. the second-largest Spanish-speaking population in the world, after Mexico. The Spanish spoken in the U.S. has taken on its own dialectal form, a mixture commonly known as Spanglish, a hybrid language that combines words and idioms of Spanish and English and a sort of “American Spanish”, a variation of Spanish that incorporates words and idioms from many different countries, predominantly those of Latin America. This “American Spanish” has no standardization. It varies regionally based on immigration trends and settlements that go as far back as colonial times.
As Spanish in the U.S. has evolved alongside English, many Spanglish words have become a part of everyday speech. Words like “parking” are used in place of the Spanish word “estacionamiento.” Spanglish words have even bred other words like “parquearse and parqueadero” (park, parking lot). These words have become so popularly used that they have been officially accepted into the Spanish language.
This is also is true in healthcare. As American Spanish evolves, words have taken different meanings and false cognates have become a part of everyday speech. A study done to assess linguistic competence of bilingual staff found that medical staff commonly confused the meaning of words that look and sound similar in English and Spanish. For example, they often confused the Spanish word “constipado”, which means congested, with the English word “constipated”. Even though confusing these words is technically incorrect, false cognates like these are often used interchangeably by healthcare workers and patients alike. In American Spanish, the lines between correct and incorrect are often blurred.
The Importance of Qualifying Linguists
False cognates have become so ingrained into everyday speech that strict linguistic rules and classifications are no longer of practical use. Deciding if a word is correct or incorrect is subjective and contextual. Healthcare workers communicate with patients of many different national and cultural backgrounds, each with their own linguistic mutations and regional variations. Words that are common in some Spanish-speaking circles, are foreign in others. The question remains, how to do we manage the reality of American Spanish when misusing or confusing a word can result in a case like Willie’s?
The answer lies in proper language proficiency. Language proficiency is related to an individual’s ability to comprehend and communicate in a particular language. Language proficiency assessments test an individual’s holistic understanding of language, not just their understanding of individual words. A proper language proficiency test should assess individuals’ ability to search beyond the literal translation of words, as well as measure their awareness of semantic aspects of language, such as accuracy and context. Proper levels of language proficiency are important to maintain patient safety and decrease the likelihood of another case like Willie’s. In his case, there were no qualified medical interpreters or vetted bilingual staff to grasp the nuance of the false cognate used. Language proficiency testing ensures healthcare workers can communicate effectively, by assessing their ability to identify linguistic nuances, to manage registers, accents, idioms and false cognates. This is increasingly important as American Spanish continues to evolve.
American Spanish is representative of the United States itself: it’s dynamic, clunky, and make shifted together by population of people with different cultural backgrounds. Ensuring proper language proficiency for healthcare workers maintains patient safety and promotes a linguistically competent healthcare system for the 37 million Spanish-speakers in the United States.
Nicole Tavarez writes about the relationship between language and healthcare. She works at ALTA as a Language Access Advisor, collaborating with healthcare organizations to improve language access for patients that are Limited English Proficient.