Accents as Safety Issues Part II: Healthcare

According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), more than 60% of the deaths and injuries and more than 50% of the medication errors that occur in hospitals are due to communication problems. While many different types of communication issues are responsible for these problems, one type of communication issue is created by the accents of foreign-born medical professionals whose speech is difficult to understand.

The American Medical Association (AMA) has reported that about one out of four of the physicians in the United States was born and trained in a country other than the United States or Canada. In an article that was written for American Medical News, Myrle Croasdale pointed out that among the many immigrants working in the United States who find that “clear communication is essential to their work,” there is an added sense of urgency for physicians since “a patient’s health and life may be at stake.” An increasing number of doctors are seeking out speech professionals who provide accent modification classes. One doctor described his problems pronouncing words and explained that his accent has been a distraction for some of his patients. Another doctor expressed her concern regarding the ability of her elderly patients – especially those who are hearing impaired – to understand her, and stated that not being understood has been “very embarrassing.” Sometimes physicians are referred for speech classes by their employers. International medical residents are required to pass a clinical skills exam that includes written and verbal communication. However, the individual’s articulation skills may not be measured. One residency director was concerned about a foreign-born resident in his program who was difficult to understand: “He feared that a nurse might confuse her orders, a fellow resident might make wrong assumptions about a patient, or that her patients and their families might not fully comprehend her.” He also felt that her chances for professional advancement were being hampered by her pronounced accent.  Another residency director stated that he even refers his residents with mild accents to speech-language pathologists because he feels that the ability to communicate well is such “a huge part of being a successful physician.” He prefers to intervene early so that his residents will not end up struggling with a problem after graduation that could have been resolved sooner (“Accent on clarity: doctors seek classes to Americanize their speech,” September 18, 2006).

According to the Pennsylvania Patient Safety Advisory, “Verbal orders – those that are spoken aloud in person or by telephone – offer more room for error than orders that are written or sent electronically. Interpreting speech is inherently problematic because of different accents, dialects, and pronunciations.” The ability to interpret verbal orders can also be impaired by factors such as background noise, interruptions, unfamiliar drug names and terminology, and sound-alike drug names. Drug names and the numbers that are used to indicate dosage amounts are some of the words that might be misinterpreted. In spite of the risks that verbal orders present, their use will continue to be necessary in situations such as those requiring urgent care and during sterile procedures. There are ways to minimize their risks. One way is to require providers to enunciate verbal orders clearly. A technique that was recommended by JCAHO involves writing the order down, reading it back, and receiving confirmation from the individual who gave the order that it is correct (“Improving the Safety of Telephone or Verbal Orders,” 2006 Pennsylvania Patient Safety Authority). 

A survey that was conducted by the American Board of Medical Specialties (ABMS) found that bedside manner and communication are the skills that patients value the most when they select a doctor (“Although Ranked Highly, Certification Understanding Limited,” Change Board Recertification 2010). It is not surprising that poor communication is a contributing factor in a large percentage of medical malpractice lawsuits.

In order to provide the best quality of care for their patients, it is crucial for physicians to communicate effectively. The inability to be understood can impair a doctor’s ability to accurately assess their patients and to convey information regarding their care. Tragic consequences can occur.  

Participation in an accent modification program can provide foreign-born physicians with the skills that they need to be more easily understood. The doctor, his or her patients and their families, and the other medical professionals who he or she interacts with can all benefit.