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Medicine

When doctors don't understand their patients

Thousands of doctors from outside Germany are employed in the country's hospitals. But what happens when the language barrier affects their work? The German medical sector is seeking solutions to this problem.

Andrea Staniszewski knows how things work in a hospital - until five years ago, she herself was a nurse. Today she is an advisor at the German Patient Protection Foundation. She described her main function as "being a good listener." People call her and visit her in person. A lot of them are seniors who want a medical check-up or help with their documents. They want to talk, and they tell Staniszewski their stories. Stories about their experiences in hospitals, how they have been treated by doctors, and what situations have made them feel afraid or uncomfortable.

"What you notice is that communication problems between the doctor and the patient are a recurring topic - many patients do not feel understood," said Staniszewski.

The doctor-patient relationship is sensitive issue. As healers, doctors are put on a pedestal by a lot of people and treated as demi-gods with special powers. How disappointing must it be for a patient, then, when their doctor's language skills make it difficult to communicate.

Stuck for words

"Naturally, we cannot rule out that there are some people with stereotypes about foreign doctors," said Staniszewski. But the numerous conversations she has had she said paint a different picture. One where patients ask nurses to act as interpreters and where diagnoses are delayed when a doctor may not fully understand the patient's description of symptoms.

Andrea Staniszewski 
Photo: Deutsche Stiftung Patientenschutz

Staniszewski knows the significance of clear communication in the patient-doctor relationship

"Especially in the field of internal medicine, diagnoses are communicated verbally," said Staniszewski. "How difficult must it be for a doctor when they don't have the vocabulary they need."

The matter is also of personal importance to Staniszewski. Some years ago, on the evening before her father's scheduled bowel cancer operation, the anesthetist - a young foreigner - came into his room.

"Instead calming my father down and explaining the procedure, he simply handed him a piece of paper," recalls Staniszewski. "He apparently said, 'Here risks, here sign.'"

An isolated incident or a reflection of the everyday reality in German hospitals? It is difficult to say. No reliable statistics are available in this area and the German Patient Protection Foundation offers no estimates.

German courses for doctors

Georgios Godolias came to Germany from Greece 37 years ago and is now the manager of the St. Anna Hospital in the western town of Herne. A quarter of the doctors on his team have a foreign background - as he said is the case in the region's other hospitals.

"Germans need to accept the fact that foreign doctors are necessary for sustaining the German medical sector," said Godolias. "It is important that the right approach is taken to integrating these doctors into the hospitals' routines."

He said all doctors have to show a basic command of the language before working in German hospitals. During his time as head of St. Anna he said he has not come across any cases of medical malpractice caused by language barriers. Nevertheless, he added that something needs to be done to improve communication between foreign doctors and German patients.

At St. Anna, language courses for foreign medical practitioners have been offered since October 2012. They not only cover everyday conversation but also medical terms. There is also a coach who visits the hospital and gives support to the doctors during their appointments with patients.

"The courses have been running for half a year and we have the impression that everyone is happier," said Godolias, referring to both the doctors and the patients.

Improving interaction for all

The Marburger Bund, a German doctors' union, would like to see similar programs implemented across the country - with certified courses and standardized tests.

"We have submitted written requests to both the Kultusministerkonferenz [the assembly of German state education ministers] and the health ministers' conference asking for their assistance," said Rudolf Henke, head of the Marburger Bund.

The problem needs to be tackled or it may have far-reaching consequences. In a recent survey, 70 percent of Germany's doctors said overtime hours and being constantly on-all had a negative impact on their health. In such conditions, the additional burden of acting as interpreters is undesirable. But, if all goes according to the Marburger Bund's plan, standardized language courses and tests will make life for both patients and doctors in Germany easier in the future.

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