Lynda Katz Wilner knows that communication problems between doctors and their patients are the major cause of hospital errors.

The numbers back her up.

According to a study conducted by the Joint Commission of Accreditation of Healthcare Organizations, more than 60 percent of deaths and over 50 percent of medication errors at hospitals were caused by a problem with communication.

One major communication hurdle for many patients is dealing with foreign-born medical professionals whose accents are so thick they cannot be understood.

Wilner, an Owings Mills speech and language pathologist for the past 28 years, is trying to remedy that problem.

Working from an office in her Owings Mills home, Wilner has built a practice dedicated to helping doctors and other medical professionals overcome their heavy accents. Her program, Successfully Speaking, helps doctors with heavy accents to communicate more effectively.

Accents are a problem, she said, because more doctors who have studied medicine outside the United States are arriving here to practice.

According to a report by the American Medical Association, of the 910,755 doctors working in the United States, 24 percent are international medical graduates, or IMGs. The association defines IMGs as "physicians who graduated from medical schools outside of the United States or Canada."

While these doctors are highly proficient in medicine and are required to pass American medical board exams, Wilner said, they are not always aware that their accents affect what the patients, nurses or others they work with hear.

This lack of communication, she said, can lead to medical information relayed incorrectly, a misunderstood diagnosis or erroneous prescriptions.

Wilner uses the numbers 15 and 50 as example.

If a doctor with a thick accent says 15 it could easily be misunderstood by a pharmacist or a nurse as 50. That small difference in pronunciation could become life-threatening if that misunderstanding happens when dosage is concerned.

Wilner uses mirrors so clients can see themselves speaking. She uses video and audiotapes so clients can hear themselves, and she uses repetitive CDs so they can practice. Wilner teaches the professionals noun-verb agreement, the rhythm of American English and idiomatic phrasing, as well as pronunciation.

Phrasing and American English are particularly important for doctors educated at English-speaking schools, such as those in India or Nigeria.

Many of these doctors and health professionals, Wilner said, already speak English, but most learned British English, which has different phrasing and emphasis.

"I began this program reluctantly because I felt I had no problem with my speech," said Charles Ulinfun, safety director at Penn State University's Milton S. Hershey Medical Center and College of Medicine.

Ulinfun, from Nigeria, worked with Wilner for three months. She helped him learn which words to stress and how to use pitch to effectively communicate meaning.

The program, he said, "enabled me to assume the burden of making myself clear."

For these doctors and other professionals like Ulinfun, Wilner said, she is teaching "American English as a Second Language."

Part of the problem with doctors and their accents can also be laid at the feet of a doctor's staff and the patients themselves, she said.

Because of their stature, Wilner said, people are often afraid, or even intimidated, by doctors, and that prevents them from simply saying, "I don't understand you."

This trepidation, she said, lets many doctors believe there is nothing wrong and that the patient is following what is being said.

Since she can't work with the individual patients, a component of Wilner's course is teaching the doctors to watch a patient's facial reactions for telltale signs that their message is not being communicated clearly.

If the doctor can see a patient is not following what they are saying, she said, then they can stop and clarify instead of barreling forward.

In some cases, she even recommends a doctor pull out a piece of paper and write down for a patient what they have to say. She even encourages drawing a picture, just as long as the patient understands.