English among doctors : What has gone wrong?


Recently there had been a report in the press about the poor proficiency of the English Language that led to a lot of doctors leaving the profession. Link to article here.

So the question that is begging to be answered is, how well should a doctor or even other healthcare professionals know English? What’s the minimum requirement in a country, where English is not the main spoken language?

For a start, most medical schools are conducted in English. In Malaysia, all medical schools are taught in English. Most medical schools that are recognised by the Malaysian Medical Council, are also taught in English. It would also be rather quite difficult to pass your medical qualifying examination without having a satisfactory level of English competency both written and oral.

The problem lies in the fact that some medical schools are not conducted in English. In particular medical schools in Indonesia. They are taught in Bahasa Indonesia. Many of the medical texts have been translated to this language. It is rather perplexing why this would be so, considering that a large majority of the medical texts and journals are in English. Almost all international medical conferences are in English. Indeed, the international language to communicate amongst doctors is English. Perhaps, Indonesian medical schools are trying to create doctors competent enough for their local environment.

However, they form only a small fraction of medical graduates. So why are medical graduates leaving because of a poor grasp of English? This shouldn’t have happened.

Countries like Japan and China have long understood the necessity to master English in order to compete in a globalised world. Japan requires English be learnt as part of their educational system. In China, teaching English is widespread, especially in more urban communities. The question is, how are their doctors surviving with a still poorer command of English as compared to those from English speaking countries?

Humans have the capacity to learn and master at least 3 different languages. So understanding English and the local language should not have been a problem.

Having good language skills for a doctor has 3 main important purposes.
1. To communicate well with your patient
2. To communicate well between colleagues and healthcare professionals
3. To understand the field of medicine better

One would think that Malaysia, being a former British colony and where English is still part of the education system, would not have problems. Thus, reporting on Malaysian doctors leaving the profession because of poor English should ring alarm bells for those responsible for  the education system in Malaysia. What has gone so very wrong with our standard of English?

Back to our original question of what is the minimum requirement of English? There has been many reports worldwide of medical errors and negligence due to a poor command of English. In Malaysia, English is still the dominant way of communicating and documenting notes. So if the command of English is poor, what is presumed straightforward may be unnecessarily misunderstood leading to medical errors. This may sometimes put the patients’ lives at risk.

Limited English proficiency is a barrier to medical comprehension and increases the risk of adverse medication reactions. Access to language-concordant physicians substantially mitigates but does not eliminate language barriers.‘ [1]

The best answer to our question is that the higher the proficiency in English, the better it would be. This is especially so among doctors and doctor wannabes. Putting the bar too low during the admission process will allow doctors with poor knowledge of the language to sieve through. The mushrooming of medical schools, especially private ones, where passing grades may be the difference in students’ choices, is a worry, where standards may be compromised to ensure high passing rates.

Hence the graduation of doctors, ill-equipped with a language that will help them survive in the medical world and keep abreast of important developments and launching them into the cutting edge of medicine.

But the error actually started when the first seeds were sown during the early years of education as a child. If Malaysia has Malaysian doctors leaving the service after many years of sacrifice because of a poor command of English, then some things have gone very wrong with our current education system, from primary level right up to tertiary institutions.

What we are witnessing now is the result of irresponsible tampering of our education system from decades before. It is now emerging as a growing threat to our competitiveness in an already globalised and connected world.

1 Elisabeth Wilson, MD, MPH, Alice Hm Chen, MD, MPH, Kevin Grumbach, MD, Frances Wang, MS, and Alicia Fernandez, MD, Effects of Limited English Proficiency and Physician Language on Health Care Comprehension, J Gen Intern Med. 2005 Sep; 20(9): 800–806.doi: 10.1111/j.1525-1497.2005.0174.xPMCID: PMC1490205

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