Psychiatric symptoms masking pituitary adenoma in Spanish speaking immigrants

Barriers to clear communication, such as culture, language, and other aspects of self-presentation may have an important impact on the doctor-patient relationship. When not addressed, cultural and linguistic issues can result in unreliable clinical histories, noncompliance with medical treatment, misinterpretation of data, poor continuity of care, less preventive screening, miscommunication, and inadequate analgesia. Lack of access to competent interpreters and failure to take a full history may result in inaccurate assessment of presenting complaints leading to a delay in initiating necessary treatment. In addition, the presence of psychiatric symptoms can interfere with the medical diagnostic process, leading sometimes to premature closure of the differential diagnosis and attributing all presenting complaints to psychiatric illness. When both language barriers and psychotic symptoms present together, the risk of inaccurate diagnosis is multiplied. We report two Spanish-speaking patients with primary central nervous system tumors who had delayed diagnosis and treatment due to triage personnel focusing on presenting psychiatric complaints without attention to co-morbid medical symptoms. In each case, the patients initially presented to non-Spanish-speaking medical providers who did not have access to trained interpreter services. Physician attention to primary psychiatric symptoms led to referral for psychiatric care, delaying treatment for obvious neuro-endocrinologic problems.