Who has an accent? Everyone. Rhythm and intonation are inherent in native languages and necessary for accurate communication. However when speaking another language, one's native accent may cause confusion for the listener.
Communication in the Healthcare Setting
The Joint Commission, an accreditation agency for health care organizations in the US, in a November 2009 news release urges attention to language barriers:
“Ineffective communication between patients and providers can result in misdiagnosis, inappropriate treatment or medication errors,” says Amy Wilson-Stronks, project director in the Division of Standards and Survey Methods and principal investigator for Hospitals, Language and Culture study at The Joint Commission. “When a provider cannot communicate effectively about a disease or treatment, or when a patient cannot describe their illness, they lack the basic connection needed to result in appropriate care. Appropriate communication is necessary for ensuring quality and safety in health care.”
The Joint Commission sets industry standards for patient safety and has investigated sentinel events since 1995. A sentinel event is an unexpected occurrence involving serious physical or psychological injury, or the risk of such. Patient safety goals are set using the data collected.
In an article by Aggie Stewart in For The Record Magazine, she notes that of all Joint Commission reported sentinel events in 2002 (e.g., wrong-site surgery, medication errors, operative/postoperative complications), communication was identified as the root cause of more than 60% of the cases. These included errors of oral, written and electronic communication. Stewart stated that communication also surfaces as one of the top three root causes of four of the most frequently occurring sentinel events: medication errors, restraint deaths, wrong-site surgery, and operative/postoperative events. Patient assessment (more than 30%), availability of information (20%), continuum of care (more than 10%), and procedural compliance (more than 10%) were other communication errors listed.
Effects of American English as a Second Language in the Healthcare Setting
For healthcare professionals whose native language is not American English, the challenge is even greater. Foreign born speakers often understand English very well. However, if others do not understand their pronunciation, questions and instructions are at risk for misinterpretation.
Taking a patient history, explaining procedures and outlining a plan of care to a patient requires specificity. Combined with American idiomatic expressions and slang, the process can be difficult and can put the patient’s safety at risk.
Consider the question, “Do you have chest pain?” When pronounced “Do you hiv ches pin?” the patient might not understand. Embarrassment might lead her to just nod her head, to avoid asking the doctor to repeat the question. Now the patient’s symptoms are listed incorrectly and the plan of care will be inaccurate. Or when the patient says, “I’ve got sugar,” meaning “I have diabetes,” professionals who are unfamiliar with American expressions will be uninformed.
Twenty-six percent of practicing physicians in the US are International Medical Graduates (IMG). While communication requirements are part of the licensing process, further study in this area could make treating patients go more smoothly and effectively.
Accent Reduction Programs
A licensed speech-language pathologist who has specific certification in accent reduction, sometimes called accent modification, is most often the professional who offers these programs. Look for a program designed specifically for medical professionals.
In these classes, participants learn:
- to pronounce each sound in general American English accent
- to change the intonation of each sound or word when needed
- idioms and vocabulary specific to American English and to the medical profession
- to ask and answer questions to make your conversations go more smoothly
These programs are not designed to eliminate native accent, but provide the skills to modify it enough for clear communication with Americans, as needed.
Improving Communication Skills
Communication skills in healthcare are of prime concern to protect the safety of the patient. When needed, an accent reduction program can increase patient satisfaction, while reducing the chance of a sentinel event.
Sources:
Katz Wilner, Lynda, 2002. Medically speaking: Accent modification for the medical profession.
Physician Characteristics and Distribution in the U.S., 2008 edition; AMA, Chicago, Ill.
Stewart, Aggie. 2003 When words fail. For The Record Magazine, Website. Accessed 1/9/10.
The Joint Commission Sentinel Events. Website. Accessed 1/9/10.
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