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Why culture can trump grammar

Communicating effectively with patients means more than just a high Ielts score when working in Britain’s NHS, explains Ros Wright

Changes in policy guidelines mean that both non-EU and EU-trained doctors are now required to obtain Ielts 7.5 to register for the GMC (UK’s medical accreditation board). However, given the nature of the Ielts exam, to what extent does this enhanced score actually ensure overseas doctors are fit to practise in a UK hospital? The obvious lack of medical content is only one aspect where this exam falls short.

Four areas in particular pose problems for new NHS recruits. Greeting trainees at Nottingham’s QMC recently with the local expression, ‘Hey-up me duck!’ I was not entirely surprised by the sea of blank faces. Understanding and responding appropriately to the language of the patient is essential in establishing and developing rapport. Unlike most other areas of language training, preparing overseas doctors to work in the NHS involves teaching the entire range of lexical components, from medical terminology and sub-technical vocabulary to colloquialisms and euphemisms. Knowing that a deceased relative is ‘pushing up the daisies’ as opposed to ‘smelling the radishes from below’ (as in Germany) may avoid unnecessary tension at an already emotional time.

Intonation is another cause for concern. Research carried out by King’s College London in 2014 found that ‘rhythm and intonation of speech’ had a negative impact on the information and attitudes conveyed by international medical graduates. Devoid of the appropriate intonation and tone, expressions of empathy might not be demonstrated to full effect to those already feeling distressed and vulnerable. While asking about her father’s treatment recently, my mother’s perception was that although the doctor demonstrated an accurate level of English, his delivery was ‘adversarial and dismissive’. Patients and relatives are far more likely to forgive the odd grammar mistake than an intonation pattern that lacks warmth and compassion.

Medical recruiters and healthcare professionals all highlight the need to gain a working knowledge of NHS culture before hitting the wards. This includes an appreciation of the patient’s role in decisions made on their care and treatment, as well as the need to obtain patient consent regardless of intervention, be that routine physical examination or organ donation. It also involves understanding the multi-disciplinary nature of the NHS and working relationships with other healthcare professionals, which may differ greatly from the doctors’ own experience.

Lastly, introducing the use of frameworks to enhance effective communication with patients and colleagues is another area where medical English trainers can help prepare new doctors. The ‘Spikes’ model for breaking bad news is used systematically across the NHS. Trainees can develop language to Set the scene, determine the patient’s Perception of their condition, obtain the patient’s Invitation before delivering the preferred amount of Knowledge, while providing Empathy and finally Summarising and laying out a Strategy for the future. Communication frameworks such as this not only ensure NHS policy is adhered to, they also offer the overseas doctor guidance from a language perspective.

While not all of these areas are language-related per se, they all impact significantly on the level of communicative competencey required to comply with the standards of good practice set out by the GMC. The fact that none of them can be tested by the Ielts does seem to invalidate this exam as a successful means of benchmarking proficiency in a context so dependent on effective communication.

Ros Wright is an applied linguist specialising in medical English. She is author of English for Medical Professionals, a course developed with The London School of English preparing doctors new to the UK for work in the NHS. She is currently General Secretary of EALTHY, an association for English teachers working with healthcare professionals.