A Controversial but Serious Question

I was sitting in a meeting of physicians in training (resident physician) where an attending came in and said that surveys being taken for research were causing the institution to get bad reviews. Her reasoning was that the residents did not speak strong enough English to understand the survey. Now most of these residents are training here on visas and will be dispersing into other under served communities in order to keep their visas. Now, there are American citizens who attend foreign medical schools who can't get residency positions despite their parents paying taxes and yet these residents are getting the positions and can't even speak English. Then to top it off, I have a classmate who defends them and says its not their responsibility to know the language (obviously she was not born in the US).

Am I wrong in assuming that you should be able to speak the language in order to practice medicine? Should you expect your doctor to understand complex language skills since medicine uses complex language? This is a serious question that I am ashamed has to be asked. The US has completely lost touch with reality. Healthcare reform without tort reform? Illegal citizens being able to file medical malpractice and given legal standing? People getting residency training without even being able to speak proper English?

English is a must.
I have to communicate with a lot of Chinese students and they frankly are completely oblivious about the meaning of many common terms that we use.
I had the ridiculous experience to talk to a person that has no idea what Acetone is, and can't make the difference between a pump and a valve...
I wonder how they passed their TOEFL/GREs???
I guess learning the dictionary by heart is not good enough, I have heard that's the common practice in China. I am not a native speaker either but most Americans understand me just fine when I talk.

Should a pilot know how to operate a jet before being able to fly it?

Should a nuclear plant employee know how to operate equipment at a plant properly?

Should physicians have a complete grasp of the language spoken in the country they're in in order to communicate effectively and comprehend their patients? Quite simply, it sounds like an absurd question, period.

Maybe "diversity" and "political correctness" really are more important as concepts than human life. At least it seems to be for some.

Chris L

I think this is a very complex question. If you are talking about private universities/hospitals, no one can tell them what do to. When it comes to public hospitals/universities, well, personally I would want the best doctor possible, though I agree that communication with me and other hospital staff is vital.

To focus in on the question in the poll, as long as the person is able to speak well enough to sufficiently communicate or always has a qualified translator available when necessary, my answer is no.

Since English is the lanague used most often in America, it makes sense that its doctors should speak it.

What if a doctor wants to practice in a mostly Spanish-speaking area, though? Should he or she be allowed to skip on learning English in that instance?

to put it very simple: if i can't understand him or her, they ain't working on me...

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Originally Posted by Blade Wielder

Since English is the lanague used most often in America, it makes sense that its doctors should speak it.

What if a doctor wants to practice in a mostly Spanish-speaking area, though? Should he or she be allowed to skip on learning English in that instance?

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This area is mostly spanish, but everything being documented is in English so ABSOLUTELY NOT! If they want to speak spanish, then they should go to a Spanish speaking country to practice medicine. I also feel hospitals should not have to bear the expense of translators, patients who are not responsible enough to learn the language should have to pay cash for the translation service. If you can't speak then language then you should have no legal standing to file medical malpractice since the patient history is the most important part of making a diagnosis (85% of the diagnosis in fact). I especially feel this way because everyone coming to this hospital is either on medicaid or government subsidized insurance that taxpayers are being raped on. They won't even take United Health Insurance or other private decent insurance because they can't blatantly over bill them.

As a linguist, a language teacher AND a language learner, let me tell you it ain't that simple.

You say "They can't speak the language" but can I ask you, have you talked to them? Do you know their actual linguistic ability? They can't understand the survey--but as you said, that was their "reasoning". It wasn't, in fact, what they know to be true (unless you misused the word "reasoning." English is hard, innit?)

Language is not a simple thing, and to say that they have to be able to speak English is, in fact, misleading. Deep understanding of medical English is NOT equal to conversational English. In fact, nearly every doctor in the world is going to have a good understanding of Medical English--but not conversational English. Why? Because the textbooks/research documents/journal articles they have to read and write all have to be in English (and, at least in Japan, German...). I have been to several doctors in Japan, and while most of them are unable to speak English conversationally, they were certainly able to write Academic articles in English and tell me "grbrbrbrbra risk of Spinal Meningitis grgrgrgr possible Allergic reaction grgrgrgr twice a day after mealsgrgrgrgrrgrgrOverweight..."

In one real sense, their English is probably better than yours--but not spoken. These doctors may be very well capable of discussing your medical problems and making an accurate diagnosis, while at the same time be unable to ask where to find a paint roller at the hardware store. As for the surveys--what are they about? Medical problems, or facilities, or what?

And can I ask, have you, yourself, had a doctor who didn't speak English? I bet you didn't. Cause the people who hire doctors don't conduct interviews in whatever language these people you're talking about DO speak.

This is a fake problem, I bet. And as for the other stuff--Unrelated nonsense.

Jeez, Trey - starting to reconsider your choice of profession? Illegals have standing in med. mal. suits? I didn't know that and it's RIDICULOUS!

Being able to communicate with a patient is absolutely vital to providing proper treatment. Having a translator is no where near an appropriate solution. You'd have to have a translator for doctor, in each language, in each ward, of each hospital. And don't forget what Trey is discussing - residents! These are, forgive me Trey, doctors in training. Why should a hospital pay someone else so they can allow a resident to practice? It's absurd! These aren't top flight surgeons bringing in the big bucks, they are the guys on the front lines, usually serving in the higher pressure, time-sensitive areas of a hospital, such as emergency rooms. Let's play this out with a translator:

A patient comes in with an non-obvious condition and the doctor is asking questions, which are translated by whom, a non-MD translator? Sure, why not! But the patient is in pain and doesn't understand and the translator says that to the resident, who asks the same question a different way, which is translated, answered, translated. Then another attending resident who speaks a THIRD language comes in to assist, asks for an update and that question is translated to the first translator, then translated again to the other resident, who answers, gets translated twice, and finally 2 residents are on the same page for ONE QUESTION. And after, what, 10 questions we're starting to get some basic info on the patient... To top it off, who is gonna write up the patient's sheet? In what language? Who's gonna translate that?

And forget about surgery - 10 people in a room and nobody knows who's saying what... What a mess! At this rate your best bet is being a plaintiff's attorney in a med. mal. practice. Then again, who would you be suing? Immigrant first-year residents who still haven't paid off med school? I think I'll tattoo my DNR on my chest....

You asked many different questions in this thread, I shall now answer them for you:

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Originally Posted by treydampier

Should practicing US physicians be required to speak fluent English?

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no

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Originally Posted by treydampier

Am I wrong in assuming that you should be able to speak the language in order to practice medicine?

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Anytime you start with "Am I wrong in assuming" then the answer is yes.

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Originally Posted by treydampier

Should you expect your doctor to understand complex language skills since medicine uses complex language?

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No I shouldn't. But maybe you should if it is a concern depending on the situation.

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Originally Posted by treydampier

Healthcare reform without tort reform?

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Sometimes

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Originally Posted by treydampier

Illegal citizens being able to file medical malpractice and given legal standing?

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Sometimes

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Originally Posted by treydampier

People getting residency training without even being able to speak proper English?

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Sometimes

If I want a doctor who speaks fluent English, then I will get one who does. If I want a doctor who cannot speak at all, then I will get one who cannot. My body, my language, my choice

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Originally Posted by BingoBango

...snip lots of over the top scenarios...

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This is exactly why I think this ISN'T a problem. Because it's impossible. Seriously, has anyone ever been in a situation like this?

The world is not nearly as insane as you seem to assume...

If they want to be my personal doctor yes please. Sadly my only
language is English and I am not that good at that....

If they want to practice medicine and serve parts of the community
that do not speak English that is a different topic.

With engineers and doctors language is always
an issue. For example, I do not have a medical degree and
formal medical language is not a language I know.
When I present myself to my doctor I work hard to
communicate what I know. With engineers and doctors
the dialogue that bridges formal language to what
I say is a task I work hard at.

To point my dogs' vet does not speak dog.
A good doctor or vet can transcend language.

Most apropos the lady next door when I was growing
up had a strong command of English and command
of her doctor. She told the doctor that her gall bladder
was acting up and demanded gall bladder pills, which
she got. A year later she demanded surgery for her
gall bladder -- when they opened her up the cancer
unrelated to her gall bladder was so advanced that
they looked and then closed.....

The point is that I demand a GOOD doctor and I will
work through language issues. The best doctor I have
encountered in the last 25 years was a Chinese speaker
with an accent so thick that I needed a #2 cleaver
to cut it. However he always gave a full assessment
and full evaluation of me AND my complaint. Because
English was his second language he listened with care
and asked pointed and clarifying questions.....

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Originally Posted by ChrisL

Should a pilot know how to operate a jet before being able to fly it?

Should a nuclear plant employee know how to operate equipment at a plant properly?

Should physicians have a complete grasp of the language spoken in the country they're in in order to communicate effectively and comprehend their patients? Quite simply, it sounds like an absurd question, period.

Maybe "diversity" and "political correctness" really are more important as concepts than human life. At least it seems to be for some.

Chris L

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Should a pilot have to know English in order to fly a plane?

I think it'd be crazy to have mandatory proficiency in a certain language in order to practice. If you have an issue with the language your doctor speaks, choose a different one. Assuming a basic level of English, I don't think I can envision a scenario in which a doctor's office could not find some level of communication with a patient. I'd also imagine that a doctor who couldn't speak English would hire someone who could adequately translate.

I don't believe that you need to know any specific language in order to understand the human body. I'd rather have the best doctor speaking mediocre English than a mediocre doctor who spoke perfect English.

Trey, I don't know much about the quality of medical schools but I'd like to think that US schools are top notch. If a US student doesn't qualify for medical school here in the States they can go overseas where some places have lower requirements. I have no problems with the better doctors getting residencies regardless of what language they speak. Being a citizen, knowing English, and having tax-paying parents doesn't mean you should automatically get residency.

I've ran into US forum members with english supposedly their mother language fail over and over at understanding very simple words. Like 'offend', 'insult', 'unwelcome', and even 'do not'. More importantly there is so much communication failures in this section that I have to question the importance of the actual language being used.

I have lilved in several countries that I didn't speak the local language, or at the time even very good english, and have managed perfectly fine, including in relating to doctors.

I think you have failed to explain the problem, if there is any. Do you have any observations about your colleagues being impaired in performing good medical job due to their subpar English skills (somebody's displeasure with the rating of an institution is a strange argument to say the least)?
Or are you advocating some sort of protectionist policies for US citizens with regards to practicing medicine in US, and are looking for something to support it?

I haven't read Any of the posts. ... just voted in the poll. Of course they should speak English. IME, most people who have that much education and are from a country other than the USA will speak their native tongue, English and a few more languages but there are exceptions.

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Originally Posted by JimR

This is exactly why I think this ISN'T a problem. Because it's impossible. Seriously, has anyone ever been in a situation like this?

The world is not nearly as insane as you seem to assume...

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EMERGENCY ROOMS!!!!

What, we all walk into ERs calm, cool and collected and politely ask for the nicest new MD with perfect English, a Southern accent and a side part in his pompadour? People are freaking out! Families are freaking out! When you get wheeled into a trauma center things get crazy. And the last thing someone should worry about is, "Am I making myself perfectly clear to the guy who should know more than me?" The only thing you might possibly be able to understand and answer correctly is, "Can you hear me?" or "What's your name?" "Do you have any allergies?" Even that's tough when someone's got a bullet wound or is ODing on whatever kinda dope he picked up off the street.

But yeah, this is all over the top. A strange pain that some guy without medical training can't explain? Pssh. That never happens! Two MDs need to work together? Another metaphysical impossibility. And doctors who talk during surgery? Why on Earth would that ever happen?!?!

You folks wanna talk about going to a dermatologist for a rash and whether or not it's fine if English isn't his first language, that's one thing. And that one thing is not what Trey asked.

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Originally Posted by ChrisL

Should a pilot know how to operate a jet before being able to fly it?

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This one is interesting...

The answer is YES because that is the
language the tower and air traffic controllers
speak. English is a requirement for pilots!

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Originally Posted by JimR

This is exactly why I think this ISN'T a problem. Because it's impossible. Seriously, has anyone ever been in a situation like this?

The world is not nearly as insane as you seem to assume...

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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.
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.
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.

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Originally Posted by treydampier

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.

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Well are we talking about students in general, or the specific ones that you know? I'm speaking in generalities; there are some US students who go to school overseas because of lower requirements.

Patients are responsible for choosing their doctor. Just because I don't want to shift the onus of communication from patient to doctor doesn't mean I'm anti-responsibility. Choosing to become a doctor is asking for probably the most-demanding responsibility possible. On the list of things I look for in a doctor, their fluency in English is well behind education and experience.

Again, not all patients have the option of choosing their doctor. Particularly in emergency situations or when insurance coverage limits options. Fluency in English should be part of their education and experience. The point going further - there need to be stricter guidelines on what qualifies as fluency. Being able to spell a few choice words or figure their way through a conversation should not qualify. Doctors, necessarily, are placed in demanding situations and we should not allow for trivial communication errors that can easily be avoided - let alone facilitate them.

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Originally Posted by treydampier

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.

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Ok, while the emphasized text is at odds with your thread title, from what I understand so far you don't care much about the actual practice of medicine, but instead you have a serious issue with people not understanding survey questions which results in poor rating of an institution. My take on this is that I simply don't believe the story you've presented. From what I see it's just as likely, if not even more likely that the poor rating is actually a true reflection of these people's perception.
Obviously you've been to medical school and I haven't, but I have friends who have been and I've also seen plenty of international students first hand to know that your generalizations are completely unfounded.

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Originally Posted by BingoBango

Fluency in English should be part of their education and experience. The point going further - there need to be stricter guidelines on what qualifies as fluency. Being able to spell a few choice words or figure their way through a conversation should not qualify. Doctors, necessarily, are placed in demanding situations and we should not allow for trivial communication errors that can easily be avoided - let alone facilitate them.

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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.
Being a non american in US I have taken various tests and they actually are well beyond spelling few choice words. Incidentally my performance on that 'words' test was pathetic, I was in the bottom 15%. That didn't matter much though, apparently a phone interview was enough to alleviate whatever concerns had arisen from that one score. I suppose I may have gotten the interview because on another test I had a pretty standard score, so given that they wanted me based on my other qualifications it's a matter of figuring which was the representative one.

And, yes I agree that some admissions may be driven by administrators, but I don't think the medical school ones are such. At least not at the top schools. I know this from my friends who went to interview there and their interviews were with faculty, not with administrators.

I think that you should be able to speak the language of the country you live in, if you have decided to actually stay there. I can sort of understand about not being fluent if you work ex patriate and only stick around for a year or 2.

If you live in the US and work in the US, you should aim to be fluent in English. And depending on where you live, Spanish can be helpful as well (though optional of course).

And frankly, being a doctor is a public function so talking to him / her should be possible without problems, and not like talking to the HP helpdesk in mumbai.

I dont think its controversial, its just common sense.

If you dont have the skills (technical or language) to do your job correctly, then you shouldnt be performing that job.

If a Doctor cannot understand their patients, or miscommunicates a prescription or treatment then they could misdiagnose, treat incorrectly or possibly kill their patient.

It doesnt matter what the job is, its common sense that people have ALL the necessary skills to do it, and do it right.

Only if you have medicare otherwise they can run their private practice in any language they like, can't they?

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Originally Posted by commiecat

Should a pilot have to know English in order to fly a plane?

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They are required to know some in order to deal with ATC. AFAIK ATC is conducted in English, globally.

Anyway, I think it's important that people learn the language of the country they are choosing to reside in. In my experience, some people really get into it and some people don't. I guess if they want a job at the end of their what ever it is, they'll need to learn some english in order to get one.

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Originally Posted by gregs656

They are required to know some in order to deal with ATC. AFAIK ATC is conducted in English, globally.

Anyway, I think it's important that people learn the language of the country they are choosing to reside in. In my experience, some people really get into it and some people don't. I guess if they want a job at the end of their what ever it is, they'll need to learn some english in order to get one.

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I was speaking in the most literal of terms. The plane operates the same no matter what language you speak. It might be required for certifications and licensing by whatever agencies, but it's not required to actually operate the plane.

I was also assuming a basic level of English. The original question was about fluency, which I don't think should be mandatory. If you only know certain terms specific to your field then I think that's good enough to practice.

I am considered to be a slightly liberal person, and as such no one has ever understood why it is that I think people who live and work in a country should speak the language native to that country. Apparently that goes against the liberal handbook.

But it's really very simple, to me.

I won't even go to a country as a tourist without being able to count to 20, say please, thank you, "I'd like a room," "How much does this cost?", "I need help," "Pleased to meet you," and a couple other useful things, in the language native to the populace.

Because if I don't, I feel a little embarrassed with myself. How selfish of me, to walk into someone else's country and expect them to speak my language. That's just very inconsiderate and rude.

I would sure a hell never expect to be allowed to LIVE in a country if I can't speak the language. It is not everyone else's responsibility to cater to me. If I want to move countries, and stay there, it is MY responsibility to suit myself to the laws of the land, which were there long before I got there.

So yes, I think people who want to live in America should speak English. The same way I think people who want to move to France should speak French, or those who want to move to Brazil should speak Portuguese.

The idea that we would entrust the livelihood of others to someone who can't even understand their patient's description of symptoms is ludicrous to me.

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Originally Posted by commiecat

but it's not required to actually operate the plane.

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Just take off and land at the right time, in the right place ;)

Arguably, when it comes to dealing with patients, the certain terms specific to your field would be fluency, or at least, approaching it.

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.

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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.

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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.

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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.

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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.

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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.

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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.

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! :beer2:

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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.

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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'.)

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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...

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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?

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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?

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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.

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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.

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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.

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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.

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Ah! So then it's already being done... That wasn't so hard, was it? :D 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.

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Originally Posted by BingoBango

Ah! So then it's already being done... That wasn't so hard, was it? :D 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.

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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.

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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.

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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.