During medical school I’ve had the privilege of using Urdu, Hindi and Punjabi with patients who were less confident with English.
Speaking another language in the UK can sometimes feel intimidating. Am I fluent enough? Is my accent okay? Do I need permission to speak in another language that isn’t English? These are also questions I asked myself in the healthcare setting when I started using my second language to communicate with patients.
The multilingual medic
I’m in my final year at medical school and the founder of The Multilingual Medic, where I run a series of podcasts with doctors from different specialties and linguistic backgrounds. The aim is to address stigmas and challenges in healthcare settings, such as language stereotypes, gender inequality, racial bias and cultural identity.
The idea for this came about when I saw an elderly male patient from Indian heritage in hospital looking blankly at the doctor speaking to him. He had no idea what the doctor was saying, and no translator had been requested. I decided to sit on the chair next to the patient and greet him in Punjabi. Immediately, he smiled and sighed in relief. Before I could say another word, he told me how uncomfortable he was with having female staff wash him and did not know how to communicate this to anyone. It was important to understand his worries from a cultural perspective as it would help us provide him with better care. He was also very distressed that his family were not aware that he was in hospital. In response, I explored his concerns and discussed how best we can resolve this with the team.
Was I nervous when I first spoke Punjabi with him? Absolutely. I wasn’t sure if he could speak Punjabi and had no idea where the conversation was going to go, but thought it was worth trying as he looked very confused and seemed low in morale. I wanted to build a rapport with the patient and explain medical ideas jargon-free so that, ultimately, he’d feel at ease.
The purpose of communicating in another language is to understand each other. You don’t have to be completely fluent. Verbal communication is just one aspect of building a bond with patients – 70% of communication is through non-verbal cues. Collectively, this is what helps to strengthen the doctor-patient relationship.
I wanted to build a rapport with the patient and explain medical ideas jargon-free to help him feel at ease.
In situations such as breaking bad news and consent, clear communication is hugely important. I highly recommend reading the GMC’s Good medical practice (2013) section on communication. This highlights listening to the patient, providing information in a way that they can understand, as well as making arrangements to meet their language needs.
Every patient has the right to have information explained to them without the use of abbreviations and terminology. Clinical noting must also be clearly documented in English, so that other doctors and staff can read the notes without your help. If you’re not comfortable communicating complex topics in another language, get advice from a senior and consider using the ‘interpreter’ service, which is available in all NHS institutions.
It's also important to check whether the organisation you’re working in has a specific policy on using interpreters, meaning there may be occasions where an independent interpreter must be used.
The NHS is the fifth largest employer worldwide and more than half of doctors who join the UK workforce are international medical graduates. Statistically, 70% of employers prefer individuals who can speak a second language. The availability of linguistically diverse doctors in the UK appears to be increasing.
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Why is this important? Stereotypes associated with cultural backgrounds and languages is the main driving force behind the reluctance of individuals to use their second language and express their culture. This reinforces the barrier between patients, doctors, and their colleagues.
Here are my tips for using your second language in a healthcare setting:
- build your confidence – use language apps and practise with family and friends to improve your fluency
- break stigmas – talk to others about stereotypes and bias within healthcare
- give it a go – if you feel it is appropriate and will put the patient at ease.
It’s not about being a native speaker when you communicate in a language that isn’t English. It’s about getting the message across to the patient, building a rapport with them so they understand better and feel at ease. Good communication helps people express themselves comfortably and relate to someone who may understand their cultural background.
It’s important, however, to ensure that you communicate your discussions with patients to your colleagues so that vital information isn’t missed that may be important for ongoing care.
Use your linguistic skills if you can – medicine is not just one type of language.