“Hoe kan ik u helpen?” I asked a Dutch physician communications teacher, playing the role of a patient. “How can I help you?” was one way I greeted patients in primary care practice. But her response communicated, “What do you mean?” Language translation is often fraught with such nuances where literal translation loses cultural context and leads to confusion or the wrong message. On occasion, it can garner a laugh and shared realization of the awkwardness of communicating across cultures and linguistic boundaries.
Language concordance is essential to ensure patient understanding of their diagnosis among other positive outcomes.1 However, in clinical practice and academic medical careers, translation is needed well beyond the linguistic task. Physicians are experts on human health and disease and have expertise in the contexts and drivers of those conditions (think: social determinants of health). In short, physicians translate constantly for patient care—complex pathophysiology and more into digestible and actionable care plans for patients.
Translation happens elsewhere beyond the clinical encounter. Basic science researchers translate their findings into discoveries that benefit human health (translational science). Implementation and system scientists translate organizational and system issues into improving health services delivery and patient care outcomes (implementation science). Clinical informaticians translate clinical practice and workflow needs into information system changes that improve efficiency and work satisfaction or drive health service innovation (applied clinical informatics). Physician-advocates translate clinical practice into actionable legislative points to drive policy change (health policy). These are only a few examples. General internists span numerous healthcare and societal boundaries to achieve their many aims.
Translation work also involves community and network building, bridging traditional and new boundaries. In non-healthcare industries, such boundary spanning work drives innovation and creativity.2 The same also applies to general internal medicine: boundary spanning work is essential to being an effective general internist. Hybrid roles create new opportunities, new ideas or approaches, and positive societal change.
In this issue, SGIM members share their experiences in their boundary-spanning roles as physician-advocates, physician-educators, and physician leaders. Physicians have multiple identities that are inseparable from their professional identity. When one walks into the hospital, clinic, or nursing home, or dons a white coat of any length, leaving one’s non-professional identities at the door is not an option—and we individually and collectively are better for it.
SGIM’s physician leaders continue to pave a pathway for the academic general medicine community to evolve and make societal progress together. Monica Lypson, SGIM president, reflects on SGIM engagement as a pathway towards addressing collective burnout. Eric Bass, SGIM CEO, provides a vital update on recommendations from a National Academies of Sciences, Engineering, and Medicine report on high-quality primary care.
Physician-educators Orr, et al, and Achuonjei, et al, describe interprofessional educational programs for learners of different disciplinary backgrounds, aiming also to deliver virtual team care during the COVID-19 pandemic. Physician informaticians Hernandez, et al, describe a unique pathway for residents to develop expertise as clinical informatics scholars. Physician-mother and fellow Mahrer Owen reflects on receiving her COVID-19 vaccination during pregnancy. In the spirit of SGIM Forum’s March theme issue on climate change and health, physician-advocates Balaban, et al, offer a reminder of physicians’ roles in environmental and climate health advocacy, especially in combination with the ongoing COVID-19 pandemic, to advance population and public health.
At the core of general internal medicine is treating a patient as a whole person, recognizing factors in their lives as the context in which to understand and promote their health and well-being. General internists are constantly translating and bridging boundaries for patients, communities, and systems of healthcare, education, health and public policy. Let us be sure to be the most precise and effective translators that we can be!