The irony was both sad and humorous. In 1980, during a Grand Rounds at a university hospital in Philadelphia, the presenting neurologist brought in an aphasic woman and read off various verbal commands to her with no response, demonstrating her inability to follow even simple directions. But what should have been an outstanding demonstration was less than convincing, since the physician’s thick foreign accent prevented even his colleagues from understanding his English!

With the number of International Medical Graduates practicing in the United States currently on the rise, accent modification programs for foreign born speakers have increased. To those unfamiliar with the field, a distinction exists between speech pathology and accent modification. The emphasis for the speech pathologist is on diagnosis and treatment of speech, language and voice disorders, such as neurological impairments, voice problems and other disorders.

However, accent modification is aimed at well educated people with medical degrees, doctorates or other advanced training who speak fluent English, many of whom have been living in the United States for ten or twenty years. Some have published papers in English. Their written communication is usually very sophisticated so they often do not realize their verbal communication is being misunderstood.

Lynda Katz Wilner, a licensed speech and language pathologist, works on accent reduction through her consulting company “Successfully Speaking.” Because of her familiarity with physicians and their requests, she has recently added a special class in medical terminology pronunciation for foreign-born physicians.

“I’m sure that the presenting neurologist at the Grand Rounds had no idea that his audience couldn’t understand his aphasia demonstration,” Wilner says. “Sometimes people realize there is a problem when they are continually asked to repeat themselves. But that is not often done to physicians.”

“If you’re talking to someone who has a thick accent in a social setting, you acan surmise the information you need. If you miss a word or two, you can generally figure out their intent by context,” Wilner continues, “but when you’re discussing medication or emergency room situations, It’s too important to just “glean.” Misunderstandings can be life threatening.”

Wilner chooses to call her program “accent modification” instead of “accent reduction” because she views her classes as a process of helping people become better understood. “We aren’t eliminating the accent. We are modifying the speech patterns,” she explains.

Rarely do people learn to speak a second language like a native, but that is not the goal of the training. Rather, accent modification helps people pronounce English in a way that enhances their speech, rather than detracting from their message.

Reactions to accents are highly subjective and depend largely on the situation. A loan officer with a distinct accent commented wryly, “When I tell applicants they will not be approved for their loan, all of a sudden, my accent seems to be an issue. They’ll start complaining to me that they can’t understand what I’m saying.”

Perhaps the general public should be more tolerant and receptive to new people, cultures and accents. In reality, though, few people will change and foreign born physicians are finding it easier to work around the provincial or insular public reaction, rather than fight it.

Understanding the message behind the accent may relate to the listener’s willingness to try to “hear” someone who speaks just a bit differently from what they consider the norm. Recently, a business colleague was overheard complaining about shopping for physicians. The “Marcus Welby” physician he’d gone to for years had retired and a foreign born physician had taken over the practice. “I went once, didn’t understand the guy at all and never went back,” related the man.

The most vulnerable area for foreign physicians and their hospitals is emergency room communication. In 1990, a “Dear Abby” column addressed this issue. A patient who had recently suffered a miscarriage became extremely upset when the ER attending repeatedly asked her if she was still “breathing.” With an angry tone, the woman wrote, “I wondered why he would ask when it was so obvious that I was wide awake. Then I realized that what he actually asked was “Are you still bleeding?’. Her letter stirred up many responses detailing similar situations.

Patients are often intimidated by their physician, so it is not surprising that they rarely ever mention problems in communicating to their doctors. Nurses and administrative staff are also often not comfortable mentioning communication problems to physicians for fear of insulting or inadvertently criticizing the physician. In many cases, while transcribing a physician’s dictation, secretaries will go so far as to correct the noun and verb agreements and the grammatical errors without the physician ever realizing it has been done.

Dr. Olga Gatewood, a radiologist at Johns Hopkins, decided to take accent modification classes when she was considering running for political office. A native of Lebanon, Dr. Gatewood was educated at the American University in Beirut, and has been living in the states for twenty years. Her accent was not a problem before she took the classes, but now Dr Gatewood feels she has more of an American intonation and no longer rolls her ‘R’s’. “My goal was to sound as clear as people I heard on the radio,” says Dr. Gatewood. “This was something I had been considering for a long time.”

Students work on the clarity of their speech, rhythm, voice projection, rate and breathing pace. With audio and video techniques, students hear the distinction between their pronunciation and the standard American speech, and learn the pronunciation of consonants and vowels, and intonation and rhythm patterns.

Audiotapes are an important part of the lesson because students often think they are pronouncing words correctly and need to hear an objective “instant replay” to recognize the discrepancy. One Spanish physician kept saying, “cop of coffee.” Even with “cup” recorded on the tape, he repeatedly questioned which was the right pronunciation before successfully saying “cup.”

Wilner finds both audio and videotapes extremely revealing and useful. Physicians with particular problem areas – patient rounds or courtroom sessions – can use videotape for role-playing and reinforcement. “The video is fascinating because of the objective feedback it provides.” She says. “I had a student who would raise his eyebrows every time he pronounced a particular sound because it was difficult for him. Without my reminding him, he could see clearly on the videotape what he was doing with this body language.” Wilner admits that her simple reminders of what to watch out for are not as personalized or effective as watching the tape.

One homework assignment is the development of a personal “hit list” – troublesome words that arise in daily routines. Words such as “general anesthesia,” “recovery room” and “gastrostomy tube” have appeared on lists in the medical terminology class. In this condensed program for physicians, the class participants bring in words that are used in their daily instructions, which caused them difficulties.

The interplay between various non-English languages seems to fascinate many students. In fact, some students prefer the group lessons precisely because they want to hear other accents. Questions in one language may also pertain to another.

The group sessions do provide more training to hear various accents, but for some professionals, the individual classes are preferred. With physicians’ busy schedules, the individual classes focusing on very special needs (like preparing to present a paper or getting ready for court depositions) may be more efficient. In addition, Wilner often schedules half-day medical terminology seminars at physicians’ offices. This is attractive to many physicians, especially if more than one member of the practice can benefit from the instruction.

“I just want people to remember what I say, not how I say it.” --Accent modification student