Thread: A Controversial but Serious Question

This is becoming a very interesting thread. I am a medical doctor from a foreign medical school, so I guess this does apply to me to some extent (though I am involved more in research and not in clinical care directly). 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. Where I come from, the medium of instruction in med schools is English so I haven't faced these issues over here in the US. The only reason I am replying to your post is because I have a few concerns about it.

Originally Posted by treydampier

JimR
First, their English is not even close to mine, either written or verbal. The problem is the institution is getting bad reviews based on a University of Wisconsin survey because the residents don't understand fully what they are filling out. It is a problem if the residents can't fill out a survey in English and then be expected to understand a patient giving a history.

Is this something that you can generalize to the entire resident population in your hospital because it is kind of hard for me to believe that they would be able to make it through USMLE steps 1, 2 CK and CS with decent enough scores to be able to match without knowing English. What I have come across more often are problems with different accents rather than lack of understanding of English.

CommieCat.
Obviously you don't know much about the students I am referring to. Many may not be qualified, but some of them have the scores and grades, but Daddy wasn't a doctor or doesn't have the pull to get them in the back door. The school I attend is better than 1/3 of the US schools in both MCAT scores and entering GPA. We go overseas because politics or some twerp keeps us out. Also, the students outscore most of these international grads from foreign countries adn in my school's situation we have the same number of 99th percentile test takers as Harvard on the USMLE. The reason they get hired is because the department heads themselves are foreign, NOT because the quality is better. Plus these US students who leave, have bachelor's degrees where most foreigners do not. That is why a US doc can practice the world over, yet a foreign trained doc must train in the US to practice.
I was asking a question and the same people advocate against anything that might demand responsibility out of people.

Again I am not sure if your statement on foreign head of departments is generalizable. I have seen how resident selection committees work and I don't see how the department head alone can have a say in the final selection of residents. For argument's sake lets assume that they can have a major influence on resident selection, I am not sure if they would want to select a poor candidate and end up blemishing their credibility.

I am a bit confused by the second highlighted sentence in this paragraph. Are you suggesting that because US med docs have a bachelor's degree, it entitles them to practice anywhere in the world ? There are licensing requirements for all foreign docs in the my country, which includes a licensing exam. I have a feeling that this might be true for many other countries.

Gugi,
BTW, yes, I observe language barriers daily where I am at and get to witness many mistakes because the docs can't understand the patients, and the truth is that the translators aren't that much help. Yes, I am protectionist. But, no I don't care who practices because if people want substandard care, they can choose it. However, docs training in the US should be able to fill out a survey about their program of study without having a language barrier.
Sorry to all the people whom I may offend. Everyone has their own opinion and its equal or better than mine.

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.

All said and done, IMO practicing medicine is more about understanding your patient's symptoms, providing a close enough or accurate diagnosis and treating the medical condition correctly based on set guidelines/ protocols.

They should speak the Queens English. I feel much more confident about my doctor when he has an English accent.

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 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 dpl2

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!

I was a bit of a science nerd, yet I enjoyed my childhood as well. Went out a lot, partied in college, etc. And I also finished my masters degree with honors.

The problem in the US is that education is not equivvalent with social status. A college quarterback on a 'communication degree' is a hero that everyone looks up to. The people from the science department as often labeled nerd, freaks, or other things.

But make no mistake. The rest of the world is already overtaking the US in scientific progress and manufacturing. In this generation, the US is still reaping the benefits of the hard work of the previous generation. Next generation there will be no more need to go to the US to study at prestigious universities.

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 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.