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Communicating with Physician Populations Judy Ravin, President Accent Reduction Institute (ARI), Inc . ARI: Brief Company Profile. Mission: Eliminate language barriers while maintaining unique cultural identities What we do: Accent Reduction…Accent Acquisition; DFA

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Communicating with physician populations judy ravin president accent reduction institute ari inc

  • Communicating with Physician Populations Judy Ravin, President

  • Accent Reduction Institute (ARI), Inc.


Ari brief company profile

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


Current climate

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


How do they fare

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


And yet

And yet…

Top Complaint:

“I can’t understand him/her”


Accents mask superior clinical skills

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.


Accents mask superior clinical skills con t

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


A word about accents

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.


Accents impact

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


Prospective solutions

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


Accent reduction mep

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


Accent reduction methodology

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”


The speech apparatus

The Speech Apparatus

  • Gum ridge

  • Hard palate

  • Soft palate


Inclusive speaking nine critical techniques

Inclusive Speaking: Nine Critical Techniques


Avoid idioms

  • 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


More american idioms

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


Still more american idioms

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


American idioms ad infinitum

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


Don t use phrasal verbs

  • Phrasal Verbs: When a verb is combined with a preposition to create a new phrase. They function like idioms.

Don’t use phrasal verbs!

Breakbreak in

break down

break up

Makemake it up

make it out

make it through

Blowblow up

blow over

blow out

Callcall around

call off

call up

Looklook over

look into

look up

Gogo ahead

go after

go back


Never begin a statement with a question word

  • 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.”


Use cannot instead of can t

  • 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


Eliminate connected speech

  • 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


Avoid tag questions

  • 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?


Humor avoid sarcasm

Humor: Avoid sarcasm

Riiiiiigggghhht!


Inclusive listening global accent comprehension

Inclusive Listening: Global Accent Comprehension


Sources

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


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