An accent on understanding

Foreign-born doctors use speech therapy to aid communication


Doctor-patient communications have been the subject of jokes for years. But if a physician's accent is so strong that patients or colleagues can't understand his instructions, it's hardly a laughing matter.

Lynda Katz Wilner, an Owings Mills speech pathologist, first observed this 25 years ago, when a foreign-born neurologist in a Philadelphia hospital was delivering a grand rounds lecture, ostensibly to demonstrate a patient's inability to comprehend directions after a stroke.

There was only one problem: the audience couldn't understand the doctor's instructions either. "His whole presentation was sabotaged because of his accent," Wilner says.

Today, Wilner runs a home-based business called Successfully Speaking that helps foreign-born doctors and other professionals modify their accents to make themselves easier to understand. So far, she says, she has trained about 100 clients.

With the number of foreign-born doctors increasing, programs such as Wilner's are on the rise nationwide. In 2004, a quarter of the 884,974 physicians practicing in the United States were graduates of foreign medical schools.

Last year, 22,931 foreign-schooled doctors registered to take the U.S. Medical Licensing Examination, an increase of 9 percent from 2004, according to the Educational Commission for Foreign Medical Graduates.

Since 1998, the commission has tested doctors' command of English as part of overall doctor-patient communication during a mock physical exam in which actors portray patients. Doctors must take a medical history, ask and answer questions, write a note on the patient's chart and list what tests they would order.

"Accent per se is not a problem," says Dr. Gerry Whelan, the commission's vice president for assessment services. "It has to do with intelligibility and the quality of language exchange."

Nearly 7,000 doctors with foreign degrees are based in Maryland, where MedChi, the state medical society, is working to provide continuing medical education credits for physicians who take accent modification courses.

Although foreign-born physicians may have excellent medical training and comprehension of English, Wilner says, patients and co-workers who struggle to understand their speech are often reluctant to call attention to the problem.

For example, the numbers 15 and 50 can sound similar in some accents, as do the words "breathing" and "bleeding." This increases the potential for medical errors, Wilner says.

"People are frustrated when they get in this situation," she says. "Others, especially elderly patients, may be intimidated and not want to ask questions."

Main problems

The biggest issues, she adds, are rhythms and intonations that don't match American English. Doctors from Latin America may speak very quickly, for example, or have difficulty pronouncing the American "v" sound, saying "berry" instead of "very." Other problematic sounds for some foreigners are "l," "th" and "r."

Physicians born in India, who learn British-influenced English, may speak all in one tone, or stress a different syllable than Americans, as in the word hospiTAL.

To deal with these issues, Wilner developed a training manual with exercises that target intonation and pronunciation. She also goes over common medical terms as well as slang doctors won't find in a dictionary, such as, "The patient kicked the bucket" or "Catch 40 winks."

Wilner uses mirrors, video and audiotapes so clients can see and hear themselves, and provides CDs for practice at home. An evaluation and 12 to 16 sessions averages $2,500, which is sometimes covered by a doctor's employer.

After finishing her coursework, Wilner says, clients "usually feel much more confident, and that people are understanding them better."

One satisfied client is Dr. Gabriel Soudry, director of nuclear medicine at Franklin Square Hospital Center. He signed up for individual sessions with Wilner after hearing her speak at a medical convention.

"I thought I had to improve my accent," says Soudry, who grew up in Marseilles, France. "In general, people understand most of what I say but occasionally they would ask me to repeat a word, or when I would dictate reports, the transcriptionist would occasionally miss a word. Also, because I give a lot of conferences, I didn't want people to be distracted by my accent."

Soudry says working with Wilner taught him which syllables to stress. Now "the transcriptionist makes less mistakes, and usually not due to my accent."

As the number of foreign-born physicians has increased, so has the demand for accent modification programs nationwide. For example, over the past three years, the American Speech-Language-Hearing Association has fielded an increasing number of calls from speech therapists looking for training in this area, according to Claudia Saad, the organization's director of multicultural education.

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