Medical English: understanding, intonation and being the bearer of bad news
“The true test of a doctor’s communication skills has to be the delivery of bad news”
In the UK’s recent general election, the National Health Service was a keenly debated issue – in particular, the trend for overseas doctors working in the UK and their language ability. In this blog, cross-posted from The London School of English‘s blog, Ros Wright, who delivered the school’s new English for Medical Professionals course to a group of doctors in the Nottingham University Hospitals NHS Trust, writes about the course and the importance of teaching tailored communication skills.
Greeting my trainees at the Queens Medical Centre in Nottingham with the local colloquialism – ‘Hey-up me duck!’ – I was not entirely surprised by the sea of blank faces. However, as a Nottingham lass myself, I felt duty bound to ensure that each and every one of these new NHS recruits were at least able to respond with a ‘Hi, how are you?’ by the end of the session.
Awareness of patient language (colloquial language, common expressions for medical conditions, etc.) is just one aspect of the new Medical English course – English for Medical Professionals piloted recently as part of a joint partnership with Remedium, specialists in the recruitment of overseas doctors for the NHS. The aim of EMP is to prepare qualified overseas doctors to function effectively in an English-speaking environment.
“Although highly skilled with a minimum of IELTS 7.5, of this group of Bangladeshi, Egyptian, Nigerian and Turkish doctors, fewer than half had followed medical communications courses in their own language”
Although highly skilled with a minimum of IELTS 7.5, of this group of Bangladeshi, Egyptian, Nigerian and Turkish doctors, fewer than half had followed medical communications courses in their own language; a situation that is not uncommon. Aside from an understanding of the local culture, other areas critical for effective doctor-patient communication include pronunciation (particularly word stress) and intonation, as well as an appreciation of the professional culture of the NHS which may differ significantly from their own experience. This two-day pilot course would feature an introduction to the NHS and the development of key skills in English, such as breaking bad news and participating in handovers.
The true test of a doctor’s communication skills has to be the delivery of bad news; a complex task often carried out several times a week. If delivered poorly, the experience remains with the patient long after the initial shock of the news itself. This is further compounded if the doctor needs to do so in a language that is not their own.
Beginning from the premise that ‘Bad news is any information, which adversely and seriously affects an individual’s view of his or her future’ (Baile et al, 2000), Day 2 focused on use of the SPIKES communication model for breaking bad news adapted for the medical English classroom. Trainees spent the morning developing language to: Set the scene, determine the patient’s Perception of their situation, deliver the preferred amount of Information, and Knowledge, while providing Empathy and finally laying out a Strategy for the future. The morning ended with a series of role-plays enabling the trainees to put their enhanced skills into practice.
While sharing a platform with the Medical Director of the QMC was a major coup during the pilot course, the icing on the cake was by far this quote from one of the trainees: ‘This is an excellent course, filling a void with regards to the introduction of overseas doctors to the NHS. The course has the potential to expand, develop and become a staple in trusts across the UK.” Indeed, it is hoped the pilot will result in the adoption of EMP as part of the induction programme for all overseas doctors recruited to work in the Nottingham University Hospitals Trust.
In the meantime, Nottingham’s popular greeting, Hey-up me Doc … sorry … duck, has since been made famous by the likes of Dolly Parton and Angelina Jolie. If you don’t believe me, google it!