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Teachable Moment
June 2018

Hemoptysis or Hematemesis?—The Importance of Professional Medical Interpretation: A Teachable Moment

Author Affiliations
  • 1Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
JAMA Intern Med. 2018;178(6):841-842. doi:10.1001/jamainternmed.2018.0697

A 55-year-old man from Bhutan presented to the emergency department, accompanied by his nephew, with a complaint of “black cough.” He did not speak English, and his chief complaint and history were interpreted through his nephew, who spoke limited English as a second language. He interpreted for the emergency physicians that his uncle had diffuse weakness lately, along with fatigue and a “black cough” in the last day. The patient had a history of tuberculosis that was previously treated, with records available to confirm completion of therapy. He was admitted to a negative pressure isolation room to reevaluate for pulmonary tuberculosis. He had difficulty producing sputum, even with induced sputum. The patient expressed, through his nephew, confusion about why sputum induction was being attempted. All communication about his history had taken place through interpretation by his nephew at this point in his hospital stay, therefore a professional medical interpreter was obtained. Through the professional interpreter, it was discovered that the patient had not experienced hemoptysis, but rather was having melena and an episode of coffee-ground emesis at home, which had been translated to “black cough” by his nephew. He underwent esophagogastroduodenoscopy, which revealed peptic ulcer disease. His melena resolved and he was discharged to home.

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