Communication is a key element in the relationship between doctor and patient. If it is not accurate, medical information may be relayed incorrectly, diagnoses might be misunderstood, and prescriptions could be taken improperly. Language difficulties also can result in increased tensions in the relationship, as well as legal ramifications if a doctor's instructions are misinterpreted, according to Lynda Katz Wilner, MS, CCC-SLP, an accent modification specialist.

Each year more and more doctors who study abroad enter the United States to complete their residency. Many continue to practice in this country following their residency. They may open a private practice or join a hospital staff where they will come into contact with hundreds of patients.

If doctors have a heavy accent or speak English as a second language, communication problems can arise with their patients and colleagues, said Wilner, director of Successfully Speaking in Owings Mills, MD. Speech-language pathologists have the opportunity to assist foreign-born doctors and other medical professionals in modifying their accent and improving intonation and pronunciation. This will ease tensions and foster effective communication.

Accent modification is aimed at highly educated professionals who often have excellent written communication skills. They may not realize there is a problem with their speaking skills.

Often the first indication is that patients or colleagues constantly will ask them to repeat themselves.

"I want to emphasize that these doctors have excellent medical training and knowledge; but when they speak, they are being misunderstood. It's unfair to them as well as their patients," Wilner told ADVANCE.

"They have all the knowledge and the skill, yet the communication is going to hold them back," she said.

Among her clients, doctors who speak with an Asian accent may have difficulty with grammar such as noun-verb agreement, saying, for example, "she walk" instead of "she walks." Often, they do not use the articles "a," "an" and "the" when speaking; and they may have difficulty pronouncing the /r/ and /l/ sounds.

Doctors from India who often learn English with a British influence may lack the melody and rhythm of American English, or they may stress the wrong syllable in a word. Doctors of Spanish descent may have a good command of the English language but speak so quickly that it is difficult to follow them.

The doctors that fall into these categories also may have trouble with idiomatic expressions and slang. For instance, they may be confused by phrases such as "the patient kicked the bucket" or "the patient passed away."

If doctors speak too quickly, Wilner addresses issues like rhythm and intonation. Initially, she specifically focuses on words and then builds up to simple sentences, teaching her clients along the way that one syllable in a word and key words in a sentence should be stressed.

"Working on the melody and intonation makes a big difference," she said. "It tends to slow them down and improves their intellligibility."

When working on pronunciation, Wilner identifies the particular sounds that someone with a particular accent may have difficulty with. For example, people with a Spanish accent may have difficulty pronouncing the /v/ sound, saying "berry" instead of "very." Other problematic sounds are /l/, /th/, and /r/. It is important to include a core vocabulary that physicians use in their daily communication. Exercises can be employed that highlight particular sounds.1

When working on accent modification, she cautions, the goal is not to eliminate a person's accent but just to improve how well the individual is understood.

Wilner often conducts group sessions comprised of medical professionals. She asks them to read a list of words and a brief paragraph, which she tape-records. After evaluating the tapes, she offers feedback on what skills they need to address during the course of training. Specifically, she looks at whether they are stressing the correct syllable or saying the word flat. The tapes also are used as a baseline so students can hear the difference in their speech as they progress.

The true gauge of success, however, is when clients tell Wilner that they no longer have to repeat themselves because their patients are now able to understand them the first time.

"They feel like they are connecting with their audience," she said. "I had one doctor actually say that when he used to counsel patients, they looked at him like he had two heads. Now he knows to speak slower, and he's using the correct pronunciation and stress patterns on the medical terms and saying it so they understand him the first time."

Group sessions are good for providing feedback, she noted. Many times a client will make a mock phone call of relaying lab results or procedures to a patient. Other members of the group can offer feedback on the exercise. By critiquing others they can learn to detect their own mistakes.

Individual therapy is appropriate for individuals with specific problems that cannot be addressed in the group setting. If a client is preparing a presentation, Wilner will make sure the medical terminology can be easily understood and will address general speaking skills, such as voice projection, eye contact, body language and speech rate. Videotaping the client speaking will help in critiquing the presentation.

In addition to helping foreign-born doctors, accent modification can assist physicians who have heavy dialects from regions around the United States, such as Boston, MA, or Brooklyn, NY.

Accent modification is a sensitive subject, Wilner pointed out. Many medical professionals may want to improve their accent but be embarrassed to ask for help. Speech-language pathologists should market their services to this population so they know help is available.

Because many speech-language pathologists do not receive extensive training in the area of accent modification, she encourages interested clinicians to enroll in a program that offers additional training. Among the programs available are the ones developed by Lorna Sikorski, MA, CCC-SLP, of LDS and Associates, in Santa Ana, CA; Arthur Compton, PhD, director of the Institute of Language and Phonology in San Francisco, CA; and Daniel Dato, PhD, in Washington, DC.

Reference
1. Wilner, L.K. (2002).Medical Speaking: Accent Modification for the Medical Profession. Owings Mills, MD: Successfully Speaking.

For more information: *Lynda Katz Wilner, Successfully Speaking, (410) 356-5666, website: www.successfully-speaking.com, e-mail: LKWilner@Successfully-Speaking.com

Nicole Klimas is Assistant Editor of ADVANCE.