Communications consultant Douglas Leonard, PhD, advised Richard H. Bailey, MD, medical director of Inpatient Care and Hospitalist Services at Saint Clare’s Hospital in Wausau, Wis., to create a brochure to introduce new members of the hospitalist team. Dr. Bailey leads a team made up entirely of hospitalists who are foreign-born IMGs. He had received complaints about his hospitalists’ English skills from other specialists at the hospital and hired Dr. Leonard to perform a needs assessment of his team and other staff members with whom they interface.
Dr. Leonard found that nursing staff, because they liked the hospitalists and wanted to help them, had begun to act as interpreters between physicians and patients.
“Because these hospitalists had such good attitudes, the staff had learned to understand their accents and had really made an effort to work with these doctors effectively,” Dr. Leonard reports. Part of that effort was that nurses would often step in to interpret for the hospitalists when patients could not understand their accents.
Dr. Leonard recommended that the hospitalists become better communicators with patients—even if that means softening their accents—and that they avoid reliance on nurses interpreting with their patients. The latter, says Dr. Leonard, “makes the hospitalists seem like second-class citizens in the world of doctoring.” Although the nurses were happy to provide the service, he says “the hospitalists have got to establish their own ability to communicate with their patients.”
In a case like this, the medical director can work with hospital administration to provide language training. Dr. Bailey has been exploring the possibility of working with local outside resources, including a local technical college, for this service.
The technical college is willing to schedule classes at night or when the hospitalists overlap on changing shifts. In addition, “Classes might alternate with on-site, one-to-one coaching sessions in speaking skills,” says Dr. Leonard.
Two-Way Street
IMGs will continue to be a valuable resource and an increasing presence in hospitalist programs. The challenge for hospital medicine group leaders is to ensure that their talents are nurtured and respected.
Dr. Bailey sees his job as that of champion and advocate for his team. For one member of his team, he solicited involvement from his congressman to help resolve complications with visa and immigration issues.
He has also seen tensions erupt when his hospitalists interact with other physicians or patients who have misperceptions about their medical skills. “I’d put my physicians up against anybody—they just don’t speak as well,” he says.
There are times when Dr. Bailey becomes concerned about the welfare of his team. “My job as medical director is to create an environment in which they can be successful—and that’s a two-way street,” he says. “That means I have to help them to be able to communicate, but it also means that I have to back them up when their professional competency is being questioned by preconceived notions about their language and their accents.”
Dr. Rajput underscores this message. “Acculturation is a two-way street,” he agrees. “As international doctors get acculturated, we as a society also need to adjust and help these well-trained physicians to understand us as well. In the interests of providing the best possible patient care, education and training will be needed for both sets of stakeholders [the IMG physicians and their employers].” TH
Gretchen Henkel is a frequent contributor to The Hospitalist.
References
- Hart LG, Skillman SM, Fordyce M, et al. International medical graduate physicians in the United States: changes since 1981. Health Aff. 2007 July/August;26(4):1159-1169.
- Association of American Medical Colleges. Help wanted: more U.S. doctors. Available online at www.aamc.org/workforce/helpwanted.pdf. Last accessed Sept. 11, 2007.