I am a psychiatrist with an accent. I also have a designation: IMG. Most people see the two as going hand in hand, and people classify me as a foreigner because I have an accent. I have succumbed to the fact that as long as I live in the U.S., I am always going to be asked, Where are you from, doctor? This is a question often asked by a new patient.

The majority of patients I see at an inner-city psychiatry outpatient clinic are of Hispanic origin. The community is a lattice of patients who come from many countries in Latin America. They come into the office embarrassed about needing to see a psychiatrist. Back home they know that only "crazy" people seek help from a psychiatrist. They are aware of individuals who created scenes that brought the local police over to the neighborhood to accompany them to the psychiatric hospital.

Most patients consider themselves "normal," and when coming to a psychiatry clinic, they are timid and uncomfortable. We start the conversation with trivia: How are you? Why did you come here? Who referred you? When the interview turns into the evaluation of the chief complaint, I know that at a given moment they may ask the main question—They want to know where I am from.

It is extremely important for them to establish familiarity with the new doctor. They look for commonalities to decrease the anxiety of a new relationship. Language is the first bridge to cross, and if the doctor happens to come from their country of origin, it surmounts all expectations.

I know when a patient is ready to ask me the question that clarifies my looks, speech, and other concerns about me. I recognize the hesitant look on a patient’s face and the body language when they move to the back of the seat, cross their legs, take something in their hands, think for a while, and in a voice that is barely audible comes the question: "Dr. Bat-Avi, where are you from?" Anticipation follows.

During a moment that seems very long, they are hoping that I will say something that will resolve their anxieties about me. Maybe I will name a country close to their homeland or have family members that they know, and if nothing else, a hope that I visited their country.

I have a confession to make: I also have an accent when I speak Spanish. There is nothing that I can do about it, and my accents are forever enmeshed in my speech. Still, for those who speak Spanish, I can pass as a Latina. I have the look, the language, and knowledge of the culture. My accent is a result of learning the language in my early 20s, just like I learned English. For patients the important thing is that I can communicate with them, and they are grateful to hear the sound of Spanish, since most of them do not speak English. Yet they need to place me somewhere around the globe because my accent does not disclose my origin.

Many times I try not to answer, and I see the disappointment on patients’ faces.

They are not satisfied with just going on with the session. Perplexed, they need a ground on which to affirm the relationship with the new psychiatrist. Sometimes I am funny and answer, "I am from my mother." They laugh heartily, and another barrier is broken. They think that it is a mighty clever answer, and I wonder what Freud would say if he heard the conversation. But I do not have time to dwell on criticism from anyone; I have to conclude the interview and hope that I have established an initial rapport with the patient. For those who need a true answer, I tell them about the places that I know—the same villages and small towns that they come from.

In the opinion of my patients, I am able to pass their endurance test. I can speak their language, and I know about their towns, the foods they eat, and the music that emanates from the Spanish radio stations. For now I can become part of their "pueblo" even if I have an accent. They count me "in," and they will come back to see me. They will also call and leave me endearing and appreciative messages.

When they leave the office, I am thankful for being an IMG in a country where almost one out of five people has come from a different part of the world, and many carry with them a distinct accent for the rest of their lives. What makes me content is when a Spanish-speaking patient turns to me before leaving the office and says: "You are the nicest doctor."

I wonder if Freud would approve of such a statement.

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Dr. Bat-Avi is a PGY-3 psychiatry resident at Beth Israel Medical Center in New York.