What was the question?

In this article and video, Sam McCarter, author of Medicine 1 and 2, considers the importance of clinical communication skills.

When doctors or nurses are non-native speakers of English, which basic skills do they need for effective communication with their English-speaking patients?

A basic skill for medical personnel, which is often not completely mastered, is asking questions.

A skilful doctor can balance closed questions (‘Does the pain spread anywhere else?’) with open questions (‘Can you tell me a little more about the pain?’) and then cope with a large amount of information in the answer. A doctor who cannot do this risks losing the patient’s confidence.

Yet the very simplicity of the questions may lead students not to take this language seriously enough. This means such questions are often not mastered, because students focus on the more medical doctor-to-doctor communication.

The same applies to counselling a patient, using a very small bank of words to explain a vast array of medical information, while at the same time being able to talk appropriately to other health professionals.

Cue recognition and response are other essential techniques which students need to learn. A patient may hint at something indirectly through stress:

Patient: ‘I don’t take any prescribed drugs’
Doctor: ‘Do you take any other drugs? Like recreational drugs?’

The ‘cue’ may be in the sound of the voice: the patient sounds hesitant. But it may also be non-verbal.

Students need to learn to read and use appropriate body language, which can be open to misinterpretation. For example, looking away to think may be misunderstood as being unsure about the answer, or as being afraid to tell the patient the outcome of a disease.

Teaching doctors and nurses to interpret exactly what the patient is saying is also crucial – for example, when the patient says, ‘I don’t smoke very much’. According to Holt’s Law, people generally like to present themselves in a positive light, so ‘not very much’ might actually be 10 cigarettes a day, which in turn might actually mean 20!

Conversely, ‘I’m not feeling very well’ might mean ‘I’m in agony’, as the pain threshold for one person might be very high, or the patient may not have the language to describe the pain.

All of this – questioning, cue recognition, acknowledgement, correct interpretation, etc. – shows that there is more to patient-centred consultations than language per se, and that needs to be reflected in what teachers teach. Language alone is not enough.

To be effective communicators, students need to learn competence in skills which help them understand what a patient means, rather than simply what a patient says.

Watch the authors of Medicine and Nursing talk about teaching English in medical and nursing contexts.