Ever hear the idiomatic expression, “he engages in a delicate dance’? Here is an example of its usage: “He engages in a delicate dance, trying to keep some children stable while treating the sickest.” In medicine, this metaphor implies the doctor’s great “skill, meticulousness, and balance” (English.stackexchange.com).
“He engages in a delicate dance, trying to keep some children stable while treating the sickest.”
Such is the case for English Second Language (ESL) International Medical Graduates (IMGs) in building relationships with their patients where accents may be a communication barrier. When speaker-listener channels of communication are garbled by accent decoding challenges, expectations and unconscious biases surface impacting the most important factor in the doctor-patient relationship, TRUST. Deciphering differences of language sound (accents) through individualized filters results in a ‘delicate dance’ of meaning and understanding (see below for hyperlinks to three studies).
Does accent really matter?
What are the implications for non-native speaking doctors? How important is credibility in building trust in the doctor-patient relationship?
Particularly important for IMG doctors is the building of credibility and trust. The communication channel between doctor and patient is not a one-way interaction. It is a two-way exchange. The back-and-forth conversation means there are, at the very least, two speakers and two receivers of information where both are actively processing meaning. Communication between non-native and native speakers comes with unique nuances: both speaking with an accent and both processing meaning; both switching on their communication filters complete with their unconscious biases. Incomplete processing can lead to information gaps, or even misunderstanding. Realize that your native-speaking patient may not even register that they have an accent too. It is a delicate dance. Sometimes an ‘accent toe’ gets stepped on; hurtful stereotyping, overt racism and/or classism and possibly discrimination can result. This could lead to a feeling of language and culture shock.
So, what are the implications for non-native speaking doctors? How important is credibility in building trust in the doctor-patient relationship?
In education we have a saying, "meet your stduents where they are at"
Look, we know that EVERYONE has an accent. Our accents make our world a ‘coat of many colors’ - every piece small, but all sewn together and worn with pride. It makes us who we are. But to believe that accent does not matter, that it does not challenge and affect the communication dynamic in a clinical setting, is to ignore the research, and reality.
How important is credibility in building trust in the doctor-patient relationship?
Julia Spratt | TESOL, IELTS, M. Ed.
References to studies:
“Why don’t we believe non-native speakers? The influence of accent on credibility”, Shiri Lev-Ari, 2010
“Comprehending non-native speakers: theory and evidence for adjustment in manner processing”, Shiri Lev-Ari, 2015
“To believe or not to believe? How voice and accent information in speech alter listener impressions of trust”, Jiang et. al., 2018
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