THE r.::::==SUNAN ACCENT ON UNDERSTANDING

Foreign-born doctorsuse speech therapyto aid communicationBY KAllEN BLUM(SPl!CIAL ro THE. SUN I

Doctor-patient communications have been thesubject of jokes for years. But if a physician's accentis so strong that patients or colleagues can't under-stand his instructions, it's hardly a laughing matter.Lynda Katz Wilner, an Owings Mills speech pa-

thologist, first observed this 25 years ago, when aforeign-born neurologist in a Philadelphia hospitalwas delivering a grand rounds lecture, ostensibly todemonstrate a patient's inability to comprehend di-rections after a stroke.There was only one problem: the audience

couldn't understand the doctor's instructions ei-ther. "His whole presentation was sabotaged be-cause ofhis accent: Wilner says.Today, Wilner runs a home-based business called

Successfully Speaking that helps foreign-born doc-tors and other professionals modify their accents tomake themselves easier to understand. So far, shesays, she has trained about 100 clients.With the number of foreign-born doctors increas-

ing, programs such as Wilner's are on the rise na-tionwide. In 2004, a quarter of the 884,974 physi·cians practicing in the United States were graduatesof foreign medical schools.Last year, 22,931 foreign-schooled doctors regis-

tered to take the u.s. Medical licensing Examina-tion, an increase of 9 percent from 2004, accordingto the Educational Commission for Foreign MedicalGraduates.Since 1998, the commission has tested doctors'

command of English as part of overall doctor-pa-tient communication during a mock physical examin which actors portray patients. Doctors must take

a medical history, ask and answerquestions, write a note on the pa-tient's chart and list what teststhey would order:"Accentper se is not a problem,"

says Dr. Gerry Whelan, the com-mission's vice president for as-sessment services. "It has to dowith intelligibility and the qualityoflanguage exchange."Nearly 7,000 doctors with for-

eign degrees are based in Mary-land, where MedChi, the statemedical society,is working to pro-vide continuing medical educa-tion credits for physicians whotake accent modification courses.Although foreign-born physi-

cians may have excellent medicaltraining and comprehension ofEnglish,WIlner says, patients andco-workerswho struggle to under-stand their speech are often re-luctant to call attention to theproblem.For example, the numbers 15

and 50 can sound similar in someaccents, as do the words "breath-ing" and "bleeding." This in-creases the potential for medicalerrors, WIlnersays."People are frustrated when

they get in this situation: shesays. "Others, especially elderlypatients, may be intimidated andnot want to ask questions."

Main problemsThe biggest issues, she adds, arerhythms and intonations thatdon't match American English.Doctors from Latin America mayspeak very quickly; for example,or have difficulty pronouncingthe American "v" sound, saying"berry" instead of "very.» Otherproblematic sounds for some for-eigners are "I,»"th" and "r."Physicians born in India, who

learn British-influenced English,may speak all in one tone, orstress a different syllable thanAmericans, as in the word hospiTAL.

To deal with these issues, WIIn·er developed a training manualwith exercises that target intona-tion and pronunciation. She alsogoes over common medicalterms as well as slang doctorswon't fmd in a dictionary, suchas, "The patient kicked the buck-et" or "Catch 40winks."Wilner uses mirrors, video and

audiotapes so clients can see andhear themselves, and providesCDs for practice at home. Anevaluation and 12 to 16 sessionsaverages $2,500,which is some-times covered by a doctor's ern-ploverOne satisfied client is Dr. Gabri·

el Soudry, director of nuclearmedicine at Franklin SquareHospital Center. He signed up forindividual sessions with Wilnerafter hearing her speak at amedical convention."1thought I had to improve my

accent: says Soudry, who grewup in Marseilles,France. "In gen-eral, people understand most ofwhat I say but occasionally theywould ask me to repeat a word,or when I would dictate reports,the transcriptionist would occa-sionally miss a word. Also, be-cause I give a lot of conferences,didn't want people to be dis-

tracted by my accent."Soudry says working with Wiln·

er taught him which syllables tostress. Now "the transcriptionistmakes less mistakes, and usuallynot due to my accent:As the number of foreign-born

physicians has increased, so hasthe demand for accent rnodtfica-tion programs nationwide. Forexample, over the past threeyears, the American Speech-Lan-guage-Hearing Association hasfielded an increasing number ofcalls from speech therapistslooking for training in this area,according to Claudia saad, theorganization's director of multi-cultural education.

Lynda Katz Wilner is a speech pathologist inOwings_Mills who works with [crelqn-bcrn phy-sicians to help them modify their accents so thatthey are easier to understand.ANDRE r. CHUNG!SUN PHOrOGRAPHERI

And Lorna Sikorski, a Califor-nia speech therapist who hastrained more than 500 col-leagues in accent modificationtechniques, says she has "a con-tinually expanding group' of stu-dents.Greater Baltimore MedicalCen-

ter started an accent modifica-tion program about a year ago.Of the three to five clients it seeseach week, up to a third aremedical professionals, says Melis-sa Walker, senior speech patholo-gist at the hospital. s

"I'Vehad a lot of patients whohave made tremendous stridesin gaining a more-traditionalAmerican accent," she says. "Buta lot depends on their follow-through. As professionals, theirlives are just so busy" that theymay not have time to practice.Beyond traditional speech ther-

apies, Walker says, the hospitaloffers electropalatography, atechnique for determiningtongue/palate contact duringspeech.Patients first have a stone mold

of their palate made at a den-tist's office. The mold is used toconstruct a retainer-type device,worn on the roof of the mouth,which is outfitted with elec-trodes. During therapy sessions,the device is connected to anelectronics unit that collects con-tact data from the palate andpasses it on to a computer, sospeech therapists and patientscan see on a monitor whetherthe tongue is positioned correct-ly for certain sounds. ."Most patients would benefit

from this approach," Walkersays, "but it usually is recom-mended for individuals whohave greater difficulties withAmerican English vowels and/orlow visibility consonants such asrand s."

Lynda Katz Wilner, M.S., CCC-SLP3905 Esgarth Way

Owings Mills, MD 21117(410) 356-5666

www.successfully-speaking.corn

The Medical College of Wiscon-sin in Milwaukee started its pro-gram about 20 years ago when adoctor from another hospitalcalled wanting help modifyinghis accent, says Joan Kuhn, man-ager for the college's Center forCommunications and Swallow-ing Disorders. Seventy percent ofclients are medical professionals.Kuhn says she frequently

works with laboratory research-ers, who may speak their nativelanguage at home or in the labwith colleagues from the samecountry "but they present pa-pers at conferences and can't beunderstood." In those cases, shehelps them use their data to-ward a coherent presentation."People coming from other

countries may say the rightwords, but their intonation isvery foreign: she says.Impact surveyThere have been no publishedstudies looking at the impact ofhealth care providers' accents, soWilner and two speech therapistcolleagues last year started an on-line survey to investigate commu-nication breakdowns faced by in-ternational medical graduates.Ofthe 160respondents so far, 36

percent of non-native Englishspeakers said they had been per-ceived or treated differently bypatients, colleagues or others be-cause of language, accent or cul-tural differences.Fifty-nine percent reported dif·

ficulties building rapport with pa-tients and colleagues, while 35percent reported difficultieswithdictation and communicatingwith colleagues. Some 23percentsaid they had problems with trustand credibility, providing test re-sults and recommendations, andcommunicating with patientsand familymembers.Thomas LaVeist,director of theCenter for Health Disparities So-lutions at the Johns HopkinsBloomberg School of PublicHealth, has conducted studiesthat examine the "health encoun-ter" between patients and doctorsof different races.Though the work hasn't specifi-

cally looked at physicians' ac-cents, he says,anecdotal evidenceshows that "some patients feltlike the doctors were practicingmedicine in a secondlanguage.""It's an issue, especially in the

inner city," says LaVeist, notingthat these patients didn't under-stand the doctor's recommenda-tions. "Weneed to do something:

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