Accent Reduction in the News
An Article from the American Medical News

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ACCENT ON ENGLISH

Language programs help foreign-born physicians improve their spoken communications

Foreign-born physicians face up to 28 communication problems every day - That's the number of sounds in the English language.

Each language has its unique sounds, and bilingual people unconsciously mix the sounds of their mother tongue with their adopted language. The result can be either a charming accent or a difficulty-to-understand speech pattern.

To reduce their heavy accents or otherwise improve their spoken English, some foreign- born physicians and medical students consult speech therapists who offer accent-reduction training.

William Beaumont Hospital, in Royal Oak, Mich., has offered accent-reduction training to physicians since 1987. "Primarily, physicians are concerned that people understand what they're saying, that patients understand the care of their illness and prescription instructions, that their colleagues - especially in a hospital during rounds - understand exactly what they mean." said Richard Merson, PhD, a speech-language pathologist who directs William Beaumont's foreign-accent reduction program.

He established the program for staff physicians and nurses, but it now serves a range of executives and professionals from the Detroit area. One of the program's graduates, Asadollah Shahideh, MD, speaks highly of the experience. He also speaks clearly.

In a telephone conversation, Dr. Shahideh's Middle-Eastern accent is evident but it does not impede communication. The accent is a cultural marker, not an obstacle.

Dr. Shahideh, an allergist, has practiced in the United States for 20 years. After 19 years, he decided to go through accent-reduction training. "It was difficult at first." he says. "I thought I was speaking fluent English, but when I was talking with patients, they couldn't understand certain words. I've improved a lot."

The official language of medicine may be Latin, but in the medical workplace, accented English is commonplace. As of 1989, there were 110,786 foreign-born, foreign medical graduates practicing in the United States. This group makes up 18% of all U.S. physicians, according to the AMA's Dept. of International Medical Graduates.

Because physicians are seen as authority figures, many patients won't tell them that their accents make them difficult to understand, so they can practice for years and not know they have a problem. "A person can be very competent in his field and assumes that others understand him. He may have no idea that he isn't communicating clearly," said Shellie Bader, a speech therapist who owns L.A. West Speech Communication, a California company that specializes in foreign-accent reduction.

Rather than broach the subject with individual physicians, some hospitals and health maintenance organizations make accent-reduction training generally available to interested staff physicians. When the program was first introduced at William Beaumont Hospital, it was free for staff members.

A foreign accent that is difficult to understand can limit where a physician practices, interfere with professional relationships, and affect the health of patients who cannot understand the physician's instructions. An accent also can erode self-confidence.

Continued on Next Column

Bridging the Language gap

It also can frustrate physician recruiters. Richard Glehand, executive director of E.G. Todd Associates in New York, says hospitals are looking for good communicators. “The name of the game in physician recruiting is to bring on doctors who can put patients in the hospital. If patients can't understand the doctor, they have a tendency not to go to that doctor," Glehand said.

"Almost 90% of hospitals are recruiting doctors, and in rural and semi-rural communities the needs are significant," Glehand added. "We are underpopulated for doctors, and accent reduction could open up a new market for hospitals to recruit foreign doctors with acceptable language skills."

In hospitals that have a large number of physicians with heavy accents, communication between doctors and nurses can become strained. Karen Campbell, a speech-language pathologist and owner of American Accent Training, in Redondo Beach, Calif., contracts her firm's services to a variety of institutions. At one medical facility, language problems led to anger between the two groups, and she was called in to improve accents, quickly.

Campbell also works with foreign-born medical students at the University of California, Los Angeles and the University of Southern California. Those students must be prepared to compete in the marketplace, she said.
"Nowadays, we can physician shop. If somebody doesn't give a patient a warm, fuzzy feeling, that patient will move on to the next physician."

SPEECH THERAPISTS offer individual and small-group training in special intensive workshops followed by three weeks of structured practice. Prices for accent-reduction training range from about $700 to $1,000.

Therapists choose from a variety of methods, including one - the STEP program (speech training in English pronunciation) - that includes practice with words from the client's profession. Physicians, for example, would go over common diagnoses and medications. Other approaches to accent reduction focus more on the rhythm and intonation of English. Many therapists use an eclectic approach, focusing on pronunciation, grammar, and vocabulary in accordance with a client's individual needs.

Therapists choose from a variety of methods, one of which includes practice with words from the client’s profession.

(The American Speech-Language-Hearing Assn. Operates a toll-free telephone number – (800) 638-TALK – that provides referrals to speech-language pathologists in a caller’s area.)

Learning the sounds and intonations of English is equally difficult, therapists say, no matter what the client’s country of origin. Much depends on an individual’s language skills. “Some people have an ear for accents, some don’t,” said Bader.

Without practice, no accent-reduction training can be effective. Dr. Shahideh made himself practice about 45 minutes a day. Sometime, he played a practice tape in his car.

“The complication with physicians is that they have quite tight schedules, and they have difficulty working this type of practice into their otherwise busy schedules,” said Phyllis Taylor, associate director of the Institute of Language and Phonology in San Francisco, a clinic which also trains speech-language pathologists in techniques of accent reduction.

Speech therapists have observed increased confidence and a more relaxed attitude among physicians who have reduced their accents. Campbell recalls one client: “You’d see him smiling much more because the fear of communication was gone. Another whole side of him came out. Because he could deal more effectively with people, he wasn't as angry all the time.”

When people learn to speak accent free, the sounds of their native language remain with them. “What I'm doing is expanding the capacity of these individuals,” said Taylor.

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9/23/03

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