GP Stories - Lost in translation?

As a GP Trainee, I took a call from a middle-aged lady from Eastern Europe who had some problems urinating for several days, associated with some lower abdominal pain and back pain. She spoke very little English so she had made her young teenage daughter call in and translate over the phone. This is one of the issues of phone consultations, how can things like this be kept confidential? GPs don't have an easy way to get translation services for phone consults, and not one that would be quick to get. Asking about vaginal discharge is bad enough for a male GP, let alone getting a young daughter to ask her mum. 

With difficulties such as these, I was taught it is better to bring the patient in for a face to face consultation. What you lose in time, you gain non-verbal cues such as body language. I was worried that the mum was more unwell than her daughter was making out as well. I asked the mum to come down so we could examine her. She came down with her daughter which wasn't ideal as a translator but in a busy GP surgery, I'm not sure how anyone can arrange a 3rd party translator. It did make things slightly easier however.

After making sure mum didn't have signs of pyelonephritis (kidney infection), I asked her for a urine sample. Or at least I thought I did. I held out the white topped tube, which to anyone who has seen one, has the diameter of your index finger, and asked "Can you go outside to the toilet and give me a sample?", raising my voice slightly in the mistaken belief that it makes it easier for non-English speaking people to understand. She seemed to get the idea and went out to the toilet. 

I was having some small talk with the daughter as I typed up my examination, when we heard a rap at the door. "Come in" I shouted, and the patient walked in. I told her to leave the sample by the sink, which is by the door. She had wrapped it in some thick white absorbable towel. I put some gloves on and unwrapped the sample so I could do a urine dip test. However inside the white topped tube, was not urine but a glorious stool sample. As I stood by the sink holding this specimen tube, I could overhear the teenage daughter burst out laughing and say something very quickly in her native language. Mum turned a bit red and said "sorry sorry". I told her to not worry, that it happens "all the time" and can just give a new urine sample in a bit.

This episode taught me to be very specific with instructions to patients. I wrote a good reflection about it in my portfolio. What I was impressed about however, was how the patient managed to get her poo into the tube so cleanly and also how she was able to produce one so quickly on demand. Unfortunately, I never got round to asking her, probably because it was awkward enough as it was, without having to ask specifics. Nevertheless, it was an impressive feat.