Thread: A Controversial but Serious Question

I work with many FMG's (foreign medical graduates) and many speak with light to heavy accents; however, they do comprehend English, both spoken and written. The ones who can't fail the second part of their medical boards, which has a critical oral examination component, in English, that they have to pass in order to get a US license to practice medicine. The foreign physicians who can't speak English well enough to pass their orals end up working in laboratories or in other allied health fields. Some study English and pass on their second or third attempts, the rest never receive a medical license. I have trained a number of them in dialysis technology. For example; a family practice specialist from Ukraine, who was on the faculty of the medical school in Kiev, emigrated here because he was making approximately $17 per month there. Wonderful man and highly trained physician, but he had failed his oral examination twice, and I had to coach him intensely to pass my course in dialysis, due to his deficit in English.

Why don't we touch on a more important point IMHO: why can't we raise our own doctors? Now I know part of the influx of foreigners to our medical schools is because we SHOULD be training other countries' best and brightest to improve the quality of medicine worldwide and to show goodwill. That said, the vast majority of foreign medical students are here for two other reasons: 1) they have better credentials than our home-grown applicants (e.g., higher MCAT test scores) and 2) they usually pay full price rather than needing a scholarship (schools will tell you this doesn't play into the application decision, but that is complete BS - everyone operates to a budget). Maybe not much can be done about the latter, but it is shameful that we can't produce better students as a country. Now I can make the trite statement about it being sad that our kids are too busy doing things other things such as playing video games, sports, partying, blah blah vs. some counterpart in India or China whose nose is in his/her books since the age of 6. I believe there's definitely truth to that statement, but the question is do we really want to raise our kids like that? Do I want my kid studying all the time instead of enjoying life before becoming an adult and having to work until 65? Not me pal; I want my kid to enjoy life and party like hell in college, too! Life is too short to spend it working all the time... So I say, bring on the foreigners! They've worked for it since age 6 so let them have it. Maybe they'll drive a BMW and my kid a Honda. So what! At least my kid enjoyed his/her childhood!

Originally Posted by gugi

It appears to me you don't really know much about the current tests, although I'd be rather interested in your idea of how and by whom 'stricter guidelines' should be determined and enforced.

That's a bit bold, but OK - maybe "stricter" is a poor choice of words. If tests are already assessing fluency then they don't need to be "stricter," I was only emphasizing that there needs to be some minimum level being tested. How and by whom? Why wouldn't the current test-makers and administrators determine the guidelines and create testing by whatever standards are in place? The only thing that would change is adding questions or components specifically for fluency in English, perhaps as an oral exam or interview, and leave the remaining tests untouched. (The tone sorta implies that you expect my answer to be a little loopy... Just sayin'.)

Originally Posted by sachin

...IMO a doctor should be fluent enough in the local language so as to be able to communicate with the patient about his problems and the possible solutions...

I agree wholeheartedly that there is an increased likelihood of medical errors if there is mis-communication between the patient and his doc but that could be equally true for a fluent English speaker. I would guess that a well-trained doc (fluent or non-fluent English speaker) would try and understand the patient's symptoms correctly before prescribing anything to him/her. In my experience more often than not it is the patient who fails to make any sense of the doc's medical jargonistic crap. Even very fluent English speakers (US and non-US) forget that they are not yapping in a department meeting but are in fact talking to someone who simply is not familiar with medical terms...

This is exactly my point: While foreign-language-speaking doctors may be able to speak English in strict medical terms, we are taking for granted the requirement that medical knowledge needs to be reworded for laypersons during consultations. Sure, it's tough even for fluent English speaking doctors to translate medical jargon for patients. This only reenforces the point. How tough will it be for non-fluent English speakers?

Originally Posted by BingoBango

This is exactly my point: While foreign-language-speaking doctors may be able to speak English in strict medical terms, we are taking for granted the requirement that medical knowledge needs to be reworded for laypersons during consultations. Sure, it's tough even for fluent English speaking doctors to translate medical jargon for patients. This only reenforces the point. How tough will it be for non-fluent English speakers?

As far as I am concerned, "medical jargon to non-medical term" translation is more a matter of training and habit. It should have nothing to do with how fluent or non-fluent you are in speaking English. The exams that you are required to take to be able to apply for residency involve both a computer and a in person "dummy live patient" component. These exams test for medical knowledge and comprehension along with written and oral communication (to the patient) of one's findings from the patient physicals and your diagnosis. I guess such an exam format should be able to judge basic knowledge of the spoken language and ability to communicate with the patient.

Hence, I feel that the issue can be more about the accent rather than the content and comprehension of spoken and written English. And if it is about the accent than the point made by the OP in his post about bad reviews due to the survey, becomes moot because then you are challenging the comprehension of a person, when there is nothing wrong with the comprehension to begin with.

Originally Posted by dpl2

Maybe not much can be done about the latter, but it is shameful that we can't produce better students as a country. Now I can make the trite statement about it being sad that our kids are too busy doing things other things such as playing video games, sports, partying, blah blah vs. some counterpart in India or China whose nose is in his/her books since the age of 6.

Basically, you (as a country, not individual) are starting to reap what has been sown for decades.

First, there is the glorification of stupidity in the media and in society for the last decades. That glorification has been intensifying in the last couple of years, look at what passes for a role model nowadays. But the media aren't the only responsible party... parents have their fair share of responsibility.

Sometimes after the 80s, actually being a parent went out of fashion... it was easier to outsource everything to school or TV and to attempt to become the friend of "precious snow flake" instead of the parent of your kid.

Finally, there was also a change in education... somewhere, somehow, education switched from actually teaching things to preparing for a standardized test.

We are starting to see the same problem on this side of the Atlantic, thanks to successive education reforms.

Originally Posted by sachin

As far as I am concerned, "medical jargon to non-medical term" translation is more a matter of training and habit. It should have nothing to do with how fluent or non-fluent you are in speaking English. The exams that you are required to take to be able to apply for residency involve both a computer and a in person "dummy live patient" component. These exams test for medical knowledge and comprehension along with written and oral communication (to the patient) of one's findings from the patient physicals and your diagnosis. I guess such an exam format should be able to judge basic knowledge of the spoken language and ability to communicate with the patient.

Hence, I feel that the issue can be more about the accent rather than the content and comprehension of spoken and written English. And if it is about the accent than the point made by the OP in his post about bad reviews due to the survey, becomes moot because then you are challenging the comprehension of a person, when there is nothing wrong with the comprehension to begin with.

Ah! So then it's already being done... That wasn't so hard, was it? I'm sure most of the communication abilities do come from training, which is why there are residency programs. They're the middle ground from the classroom to full on practice. I'd also guess a big part of the learning curve is just becoming comfortable talking with patients in a clinical setting. That's where they are developing their "bedside manner."

I noticed the theme of accents running through the thread, but left it alone because I'm concerned more with comprehension than an accent.

Originally Posted by BingoBango

Ah! So then it's already being done... That wasn't so hard, was it? I'm sure most of the communication abilities do come from training, which is why there are residency programs. They're the middle ground from the classroom to full on practice. I'd also guess a big part of the learning curve is just becoming comfortable talking with patients in a clinical setting. That's where they are developing their "bedside manner."

I noticed the theme of accents running through the thread, but left it alone because I'm concerned more with comprehension than an accent.

Now, I am confused. Are you suggesting that you agree with my previous post?

I too am more concerned with comprehension than an accent. If its an accent issue, I can write it and explain it to the patient if it eventually gets to that.

It sounds like we're making a mountain of a molehill here. Personally I've never seen or heard of a PRACTICING physician who didnt speak enough english to communicate with his patients and needed a translator and I don't think a foreign born M.D would ever pass the tests here to be able to practice unless his english was pretty good.

However assuming there was an M.D who had a translator in his office to deal with his patients I don't think he would have many if he was in private practice. Like has been said most people like this would be in research or somewhere not having to deal with patients. As far as dealing with other medical staff that's another issue.

Originally Posted by sachin

Now, I am confused. Are you suggesting that you agree with my previous post?

I too am more concerned with comprehension than an accent. If its an accent issue, I can write it and explain it to the patient if it eventually gets to that.

Yes, I am agreeing that the ability to discuss medical situations in a manner that is understandable to patients is largely a matter of training and experience. I do not know what testing is being done, but my main contention was that there needs to be testing that requires a sufficient fluency in English to communicate with patients. I'm not concerned with eliminating accents (which may be impossible anyway) but I am focused on there being a clear method of communication. Apparently my idea is not so far-fetched since the medical community tests for that level of fluency already as you described earlier.

A doctor needs to be able to communicate effectively with her staff and patients.