I used to work for the NHS on the fabulous Change Day project. This campaign aimed to encourage all NHS members of staff to pledge to make small changes to improve their service, and to share their changes to spread good practice and inspire others.
Now I’m a TEFL teacher, living in Spain, and a new mum – and following my experience of giving birth in a foreign country, I thought it might be useful for me to share some of the things that I have learned and experienced as a foreigner using a foreign health service. Hopefully I’ll soon be writing a comprehensive article about giving birth in Spain as an English person (if Santiago lets me), but in the mean time I wanted to share some points about how to communicate well with foreign patients – something which I think would be really useful for British medical staff. I’m hoping that I can inspire and spread good practice, as we used to do with Change Day.
There’s also some advice below for patients on how to communicate with medical staff. And to be honest, all of these tips can be used in any situation and so could be useful for anyone.
This draws upon my own experience as a foreigner in a foreign health system and also my TEFL experience.
11 tips for medical staff
1. Communication involves two people. Listening well is just as important as speaking
There’s a lady in my local coffee shop who as soon as she knows you’re foreign, she goes to get the other server to help you. It doesn’t matter that I’m speaking to her in perfectly reasonable Spanish, as soon as she hears a foreign accent – she thinks she can’t listen. If she just took the time to listen, she’d understand what I am trying to ask her.
Some medical staff I met I could quite comfortably have a full conversation with in Spanish; some, as soon as they knew I was foreign, would immediately think that I didn’t speak any Spanish – and so wouldn’t try to listen.
Foreign patients might get a word wrong, or put words in the wrong order, but if you listen carefully you can usually understand what they are trying to tell you.
2. Speak simply – even if it sounds rude to your English ears
English is such a flowery language – it’s one of the great things about it. It’s also one of the things that makes communication much more difficult. When we learn a language, we tend to learn the important words first (verbs, adjectives and nouns) – and the connecting words later on. So if you said to me – ‘coat, off’ – I would understand. If you said to me ‘Would you mind taking your coat off?’, I would know you were talking about coats, but I’d have no idea what these other words are – and so meaning gets lost.
Don’t worry about sounding rude/blunt – keep it simple.
3. If the person doesn’t understand, try again using different words
This sounds really obvious but so often I don’t understand something and people will just repeat the same thing again at me. It might not be that I don’t understand everything, I might just not know the word you use for something (e.g. ache), but I might know another word which is similar (e.g. pain).
I’m more likely to understand general verbs and nouns rather than nuanced/more definitive versions, so best to try general words first.
4. One topic at a time
At our antenatal classes I could mostly work out what was being said by understanding key words and then combining that with my previously learnt knowledge, to work out what the hell people were talking about. What I really struggled with was when people would jump topics. So I would think we were talking about breast-feeding, but they’ve jumped to talking about delayed cord clamping – and I missed the segway from one topic to another, so I think we’re still talking about breastfeeding and wondering why clamps are involved.
If you can, try to talk about one thing at a time and when you do move on to a new subject – make it obvious that this is something new. Perhaps introduce it with a key word, so the patient knows what you are talking about.
5. Write stuff down
Spain is such an oral culture. So many times I try to communicate via email, only for people to insist on phoning me – which I find very hard to understand. If you write stuff down or give me leaflets, I can then translate this on Google translate. I also have something to refer to. If you just verbally tell me something, I might misunderstand and then get my treatment wrong.
Incidentally, I was shocked to find that they don’t write prescriptions down in Spain. Nowhere do they write down instructions for your prescribed dose of medicines – they just tell you in your consultation how much to take and when. Spain, if you ever do a Change Day, here’s something to look at.
6. Encourage the patient to ask questions
This is a good way to see if the patient has understood what you are trying to say and also gives the patient time to clarify any points they are not clear on.
7. If information is really important, ask the patient to repeat it back to you so you can check they have understood.
My midwife Maria does this with me, and though sometimes it can feel a little patronising, I do understand why she is doing it and it allows her to check that I have properly understood instructions. She does this for things like medicine doses etc. (She’s good – she also writes that information down).
8. Don’t forget the system is as foreign as the language
You work in this health system every day – you, and probably most of the local population, know when to go to a GP or when to go to the hospital. But not every health system is like yours. For example, often where a patient goes first is different, or how the system works is not the same. I didn’t know when I got pregnant that I had to go to a specialist women’s clinic, that wasn’t at my local GP’s surgery. I made an appointment with my local doctor, as I would do in the UK, then had to be redirected.
I had two miscarriages prior to this pregnancy and my friends couldn’t believe that I didn’t go to the doctor after the first; but the truth is, I didn’t know where to go and it’s scary trying to navigate a foreign system and this is why I stayed away and just got on with things.
For foreign patients in the UK, this is a basic guide to accessing health services.
9. You can communicate a lot through body language and drawing
Body language is pretty universal. You can communicate a huge amount without speaking. You might not be able to have complex conversations, but you can communicate the basics. Also, drawing is a viable means of communication too.
10. Understanding context is important
I did a lot of pregnancy research in English before going to meetings, so I usually could use this knowledge to give context to what we were talking about and thus understand what the midwife or doctor was trying to say to me.
11. Please be patient and don’t judge us
The first midwife I had had a go at me for not knowing enough Spanish. I’d lived in Spain for just under two years at this point and I knew enough Spanish to order food in a restaurant etc, but was nowhere near fluent – let alone had the language to deal with a pregnancy. I ended up in tears after that meeting – feeling judged and wondering what the hell I was doing and how we were going to be able to cope. In the end, we did fine and we had a successful pregnancy and birth – but that first appointment left me feeling really irresponsible and so full of guilt for thinking that we could have a baby in a country where we didn’t speak the language. The thing is, most people can’t be fluent in a language in two years – and had we waited till I was fluent, then Santiago would probably never exist.
We hear a lot in the news about health tourism and people moving to a new country just to get treatment; but for me and I’m sure many others, being a foreigner means I’m actually less likely to go to the doctors, as it’s scary trying to navigate a foreign system, explain what is wrong with me in a second language and to understand the diagnosis.
The patient, kind staff that I met while pregnant with Santi have encouraged me to get treatment when I need it. It’s still scary, trying to communicate, but with a little bit of patience, this patient knows that I can navigate a foreign system and there are techniques myself and the medical staff can use to ensure we are communicating well.
7 tips for patients
1. Look up key words and phrases before you go to your consultation and write it down
You might not need it, but having the words you need written down on a piece of paper can help you to explain your symptoms better. We had a pregnancy and birth key-word vocabulary sheet that we took to appointments with us. We didn’t really need to use it, but it was reassuring to have it there and it helped me to learn the key words and phrases I needed. (If anyone wants a copy, just email me).
You could even write down what is wrong, translate that and then hand the paper to your doctor.
2. You can get information and support in your own language online
Obviously this isn’t relevant for emergency situations, but you can find most medical information online these days and it might be worth searching for your symptoms and looking for information before you go to your appointment so that you better understand what the medical staff are probably trying to tell you. For a pregnancy, this was especially the case. Before I went to appointments I usually knew what we were going to talk about as I had already done my research in English.
While doing your research, it might also be worth making a note of any important words that you don’t know in the foreign language, so you can translate them for your vocabulary sheet (e.g. if you think you have tonsillitis, you could translate the words tonsils, swollen, gargle with salt water etc).
You can also get support online in your own language, and this is might be better than trying to explain your troubles to someone in a foreign language when you are already vulnerable. After my second miscarriage I reached out to the wonderful Miscarriage Association and they gave me email support. I communicated with one of their councilors by email and they helped to explain what had probably happened to me and they helped me to understand and feel better – something the Spanish medical staff hadn’t been able to do.
3. Write stuff down
In your appointment, write stuff down – this helps to slow down the consultation, helps you to clarify information so it is written down correctly and also gives you something to refer to later on.
4. Ask questions
Make sure you have understood properly by asking questions, if you can. Often when you ask questions it can highlight that you might have misunderstood something. Repeat information back to the medical staff and ask if you have got this correct to clarify.
5. Leaflets are your friend
You can type them into a translator so you have the information in your own language and you can learn some new vocabulary at the same time.
6. Don’t avoid services just because of language fears
We went to the pre-natal classes at our local surgery even though we knew we wouldn’t understand a lot of the Spanish. It was still useful and we were actually able to understand quite a lot as there were power point presentations, pictures, diagrams and exercises – and with pre-known context we could usually work out what was happening.
7. Be proud of yourself
Accessing medical care in a foreign language is really difficult! Medical vocabulary is really complex and you need a high language level to be able to discuss medical situations. It’s also scary having to deal with foreign systems and communicate with foreign staff, who might be judging you. Getting medical help in a foreign country is a very brave thing to do, so be proud of yourself for doing this.
So these are my top tips. If I think of any more I will add them to the list. If you’ve got any suggestions or experiences to share then please let us know in the comments below.