Communicating with Physician Populations Judy Ravin, President Accent Reduction Institute (ARI), Inc .

1. Communicating with Physician Populations Judy Ravin, President • Accent Reduction Institute (ARI), Inc.

2. ARI: Brief Company Profile Mission: Eliminate language barriers while maintaining unique cultural identities What we do: Accent Reduction…Accent Acquisition; DFA What we don’t do: Accent Elimination Who we are: Applied Linguists; Speech Pathologists, Vocal Professors Who we serve: NATO, U.S. Dept. of Defense, Fortune 500 Companies, Healthcare providers

3. Current Climate Demographics: • Of the roughly 853,000 health care professionals employed as physicians and surgeons in 2010, more than one-quarter (27%) were foreign born, the percentage higher in rural areas 1 • IMG’s: 30% of all primary care doctors2 • The number of U.S. born medical students entering this specialization has dropped by more than 25%3 • India, China, Philippines, Asian Pacific Rim, Latin America4

4. How do they fare? Health Affairs : “Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.S. citizens at the time they entered medical school had significantly lower mortality rates than patients cared for by doctors who graduated from U.S. medical schools or who were U.S. citizens and received their degrees abroad.” 5

5. And yet… Top Complaint: “I can’t understand him/her”

6. Accents Mask Superior Clinical Skills One night during my training, over dinner in the hospital cafeteria, a fellow resident and I had a discussion about the situation of one of our professors. Known for his blistering teaching sessions, this senior surgeon possessed the uncanny ability to sniff out lapses in memory or judgment among doctors-in-training. Early on in my internship, I showed up at one of his practice trauma resuscitations blissfully unprepared. I left an hour later with his booming and rapid-fire admonitions still ringing in my ears. “You call yourself a doctor?” he had thundered. “This patient may just be a dummy, but you are killing her!” Nonetheless, this surgeon soon became a favorite of ours. He was brilliant in the operating room, gentle at the patients’ bedside and, as I quickly learned, highly effective in the classroom. What continued to vex me, however, was not the peculiarity of his teaching style; it was his inability to attract patients. While other, less-skilled senior doctors had waiting rooms that were overflowing, his was not.

7. Accents Mask Superior Clinical Skills – con’t “If I were sick,” I said to my fellow resident that night, “I know which surgeon I would ask for.” “But you can understand why some patients and referring doctors don’t go to him,” she replied matter-of-factly. “Other guys wear Brooks Brothers, have recognizable last names and carry a degree from the ‘right’ medical school. But when a potential patient or referring doctor sees our guy, all they might notice is a foreigner with an accent and a strange name who graduated from a medical school in some developing country.” Our professor had been born abroad and immigrated to the United States after medical school. But despite clinical accomplishments and professional accolades in this country, I knew, like my fellow resident, that there were patients and physicians whose initial impulse was to dismiss him or any other doctor with an accent or an international degree. From: http://www.nytimes.com/2010/08/12/health/12chen.html

8. A word about accents… Accents and Trust Trusting the Meaning of a Person • Accents Blur the Message6 • Built-in Survival Kit Trusting the Credibilityof a Person • “You’re not from here…You’re not one of us.” • Lack political sway; important professional networks; the power to get things done7 The heavier the accent, the lower the trust.

9. Accents: Impact Physician-Patient Relationship • Physician as authority figure: patients hesitate to ask for clarification (diagnoses, prescriptions, personal role in recovery) • Misunderstanding and intonation: Spanish and French vs. Russian, Cantonese, and Punjabi8 • Accent barriers may cause physicians to limit communication to bare necessities, thus wrongfully interpreted by patients as a lack of concern or empathy • Accents and Physicians confidence are directly proportional: impacts the quality of his/her communication with patients Organizational: • Patient surveys; higher rates of return to primary physicians • Physician Recruitment and Retention

10. Prospective Solutions De facto • How accents are born, and die Accent Reduction • Mastering English Pronunciation Inclusive Speaking • How to talk so people listen Inclusive Listening • Global Accent Comprehension: Tuning Your Ear to Accents

11. Accent Reduction: MEP Why is English Pronunciation Challenging? • English is Not Phonetic • 26 Letters: 21 vowels and 26 consonants • The Letter “o” • English Grammar and Pronunciation • Nouns and Verbs: Use/Use; Object/Object • Word Endings: Grammar • Singular vs. Plural: exam/exams • Tenses: work, worked • Personal Pronouns: work/works

12. Accent Reduction: Methodology • Visual: What does it look like • Tactile: What does it feel like • Auditory: What does it sound like • Some examples: “th”, “r”

13. The Speech Apparatus • Gum ridge • Hard palate • Soft palate

14. Inclusive Speaking: Nine Critical Techniques

15. Idiom: An expression that means something other than the literal translationof its individual words. Avoid idioms They’re a dime a dozen Drop someone a line Get down to business I’ve got your back Window of opportunity He’s a loose cannon Weather the storm Well-oiled machine Roll with the punches Dressed to kill Get down to brass tacks Open door policy Hit the rack Out of juice Running on empty Etched in stone Elbow grease Read the Riot Act Let’s go Dutch In the loop

16. More American idioms I’ve got you covered Off-the-cuff Make waves My hands are tied Show you the ropes Sitting duck Be there on the dot Over my head Drive home On the back burner What’s he have up his sleeve? Shoe’s on the other foot Time and again Set in stone On the fence Step on it Off the wall Asleep at the wheel Crash course Out of the blue

17. Still more American idioms Give him the green light Don’t beat around the bush Ballpark figure Come clean Jump on the bandwagon Jump the gun Call your bluff Under the weather Have the upper hand Cold feet Chew the fat Keep your ear to the ground Stay on your toes Take a nosedive Spill your guts He has it made Keep me posted Take a turn for the worse Think outside the box Takes guts

18. American idioms ad infinitum Throw in the towel Off and running Slipped through the cracks Start from scratch Draw a blank Give me your all Armed to the teeth Sink your teeth into Down to the wire Level the playing field Push the envelope Pull your weight I’m running behind Play with fire Ball’s in your court Bite your tongue Across the board Call the shots Get the ball rolling Take a shot at it

19. Phrasal Verbs: When a verb is combined with a preposition to create a new phrase. They function like idioms. Don’t use phrasal verbs! Break break in break down break up Make make it up make it out make it through Blow blow up blow over blow out Callcall around call off call up Look look over look into look up Gogo ahead go after go back

20. Question words: who, what, where, when, why, how Never begin a statement with a question word How you get there is … What you need to do is … Who you need to talk to is … Get there by plane. You need to arrive by 1:00 pm. Talk to Dan in HR. Dari, Pashto, Urdu: “I don’t know where does she live.” “I can’t remember what did he say.”

21. Can&Can’t Use “cannot” instead of “can’t” We can be there by noon. We can’t be there by noon. We cannot be there by noon. We cannot take exit 23. We can take exit 23. We can’t take exit 23. Can Can’t

22. Informal speech: Conversational speech characterized by simple grammatical structures • Connected speech: Whaddaya, Whodaya Eliminate connected speech Wanna Kenya Cudja Doncha Dunno Useta Didja Howzie Cancha Sbin Gonna Shudja Wudja Woncha Whadarya Supposta Hafta Lemme Hasta Lecha

23. Don’t even think about it, ok? • Tag Questions: Confirmation vs. information Avoid tag questions Where is Habiba from? I believe Habiba is from Herat. Is my information correct? You don’t know Sandra, do you? You know Sandra, don’t you? Habiba is from Herat, isn’t she? Habiba isn’t from Herat, is she? Do you know Sandra?

24. Humor: Avoid sarcasm Riiiiiigggghhht!

25. Inclusive Listening: Global Accent Comprehension

26. Sources • http://www.migrationinformation.org/USfocus/display.cfm?id=898#4 • http://www.nytimes.com/2010/08/12/health/12chen.html • http://www.laprogressive.com/foreign-born-doctors/ • http://www.migrationinformation.org/USfocus/display.cfm?id=898#4 • http://www.forbes.com/sites/stuartanderson/2012/12/02/doctor-doctor-why-wont-america-let-in-more-doctors/ • http://wisdomresearch.org/forums/t/1088.aspx# • http://psycnet.apa.org/psycinfo/2013-28924-001/ • http://www.business2community.com/strategy/cultural-awareness-accents-affect-professional-credibility-and-communication-even-if-you-dont-have-one-0206116#sCu5MF6MageXHGOU.99