1. Introduction
In today’s era of globalization, clinicians have to deal with a diverse patient population, coming from a varied range of cultural, linguistic, and socio-economic backgrounds. Modern-day medicine emphasizes shared decision making that mandates active discussion between the clinician and patients. The clinician’s choice of speaking his patients’ language is of paramount importance in building a healthy clinician-patient relationship and overall better patient experience [Citation1].
Communicating across linguistic barriers is a challenge for clinicians and healthcare workers all over the globe. Both clinicians and patients face problems because of language barriers. Sometimes, the patients are unable to understand the language of their clinicians and clinicians too find it difficult to gauge the extent to which their patients understood what was conveyed to them. Not just the use of different languages, but partial language barriers such as difficulty in finding words, problems with pronunciation or understanding of utterances, or just a different accent can make a clinician-patient conversation ineffective.
The barriers and challenges encountered in medical interactions are highly context-specific. Many clinicians, mainly the budding medical practitioners, tend to ignore the patient’s level of understanding and their ability to process the information given to them. They often overlook that ‘How’ information is being communicated is as important as ‘What’ information is being communicated. The ground condition and challenges of medical practice and consultations are, in reality, quite different from communication models described in medical textbooks. As each patient is unique and has his/her way of expressing their health problem, they communicate essential information in different ways.
2. Components of effective communication: all are important
A clinician’s conversation with his/her patient is not just about the choice of words or language. The attention with which the clinician listens to his/her patient, along with his/her non-verbal clues such as the body language, posture, gestures and para-verbal components such as tone, pitch and volume, all convey a strong message. Active listening is also a vital component of clinician-patient communication. It is essential for patients to feel that the clinician is actively attending to them and they should not be interrupted while explaining their problems. It is an excellent practice to ask the patient if he/she would like to add anything before closing the conversation/interview. Patients might not fully understand the nature, course or prognosis of the disease or the required treatment due to intellectual or linguistic barriers. Still, they sense the style of communication, which directly impacts their level of satisfaction, adherence to treatment and clinical outcomes [Citation2].
3. Linguistic barriers in medical communication: impact and consequences
When patients and clinicians speak different languages, the whole process of treatment, including the signing of consent forms, reading disease-related printed material, understanding treatment-related expenses etc. becomes even more complicated for the patients. It has been seen that many clinicians often end up making crucial treatment-related decisions on their own without involving the patients due to language barriers. If a language barrier prevents doctors from ensuring that their patient understands the warnings or risks of a medication, those clinicians may be liable in tort for breaching the duty to warn [Citation3]. Miscommunication due to linguistic barriers has been regarded as one of the common precursors for workplace violence in hospital settings [Citation4]. A research study done in South India shows that one of the significant reasons behind patients filing lawsuits against clinicians is due to the inability to understand the nature of medical procedures to which they gave their consent. This is why so much emphasis is given to take informed consent from patients in understandable non-medical terms, preferably in the local language. The diagnosis, nature of the treatment, risks involved, prospects of success, prognosis if the procedure is not performed and alternate treatment options should all be well explained to the patient, in the language that he/she comprehends well [Citation5].
4. Benefits of talking in the patient’s language
“Patients do not remember the doctor’s prescription; they remember the doctor’s communication”
- Prachi Keakar.
Talking to the patient in the language that he/she understands increases their confidence in the clinician. Not only does a common language facilitate comprehension of medical information, but it also allows for better assessment of patients’ needs, perceptions, and expectations [Citation6]. The patient feels comfortable in sharing his/her personal information about the disease without the fear of getting judged by the clinician. The two-way communication improves the diagnostic accuracy of the clinician, as they can extract crucial information from the patients. Not just the ease in diagnosis, even treatment compliance can be significantly improved through effective communication with the patients. Studies suggest that clinician-patient interactions if done in the patient’s language enhances compliance with the treatment plan [Citation7].
5. Strategies for learning skills to communicate in the patient’s language
Medical aspirants in many parts of the world are selected based on national level entrance examinations which score them based on their subject-related knowledge. Soft skills like language, communication skills, attitude, etc., although important, are not an essential determinant for admission to medical schools in many parts of the world, especially in developing countries. Students from one region of the country take admissions in medical colleges in far off areas based on their ranks and choice. As a result, many clinicians end up working in areas where they are not familiar with the mother tongue of the local people. In situations like these, it becomes essential to train them at a young age, using questionnaire-based training modules to pick up the locally spoken language. At an individual level, such clinicians should make conscious efforts to involve themselves with friends and colleagues who belong to that area to be able to learn the key terms of the local language.
Not just learning the language, there are many patient-friendly communication strategies that clinicians should adopt to increase their efficiency in providing patient-centric care. It is always better to ask the patient what language he/she is comfortable with. A doctor should not assume that a multilingual patient can process his/her language well. Even while speaking the patient’ language, the clinician must avoid the use of medical jargons. Instead, he/she should use simple terminologies/layman language that is well understood by the patient. For example, instead of using the term ‘myocardial infarction’ the clinician can use the word ‘heart attack’, similarly instead of ‘hyperlipidemia’, the term ‘high cholesterol’ can be used. A clinician can also use similes to make his/her patients understand complex information. It is also a good idea to ask the patient to repeat the given instructions. If the patient fails to do so, then the instructions should be provided in a simpler language.
Along with the delivery of information, it is equally important to master the art of active listening. This skill can help a clinician sail through the linguistic barriers to quite an extent. With experience and training, physicians are often able to understand the patient much better just by paying attention and listening to them carefully. To further enhance the communication process, a clinician should go beyond words. He should make use of drawings, pictures and illustrations which may help the patient in comprehending complicated health issues better. Visuals, models, videos can also be used to make patients understand about surgical procedures. A clinician must also acquire the knowledge, attitude and skills for meeting the cultural competency of the patient as this would help them resonate better with the values, beliefs and concerns of the patient. Hospitals and medical colleges must try to have time to time questionnaire-based assessments to evaluate the communication skills of their clinicians and healthcare staff to ascertain barriers to excellent communication and work on improving them [Citation8].
6. Expert Opinion
Effective doctor-patient communication lays the foundation for a successful doctor- patient relationship. It is essential not only for correct medical diagnosis but also ensures adherence to treatment as well as patient satisfaction. Doctors all over the world face various hurdles while communicating in the patient’s first language, which complicates the treatment process and sometimes may become precursor to violence in the hospitals. Learning the native language of the area where the doctor works, helps in facilitating doctor patient communication. Active listening is a strong pillar that supports communication across linguistic barriers. It is important that medical graduates appreciate the value of effective communication with the patients and invest time and energy in polishing their verbal and non verbal communication skills.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewers disclosure
Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.
Correction Statement
This article has been republished with minor changes. These changes do not impact the academic content of the article.
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References
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