Accent on clarity: Doctors seek classes to Americanize their speech

Psychiatrist Fabien Tremeau, MD, originally from France, no longer has to repeat himself to be understood.

He credits professional coaching with strengthening his American pronunciation, leaving him with just a mild French accent.

International medical graduates such as Dr. Tremeau are among myriad immigrants working in the United States who find clear communication crucial to their work. For physicians, there's an added urgency, because a patient's health and life may be at stake.

One out of every four practicing physicians in the United States is an IMG, though there are no data on how many speak English as a second language. Nevertheless, as the number of IMGs rises, anecdotal information shows that whether it's to improve patient interactions or to boost their own self-confidence, there are more doctors taking steps to tone down their accents. They're turning to speech experts and dedicating an hour or more a week for 12 weeks and longer to polish their American pronunciation.

Dr. Tremeau, who's been in the United States for 11 years, decided to get formal speech training when he realized he was no longer making headway on his own. "[My accent] wasn't too much of a problem, but there were times I was not sure how to pronounce words. Sometimes I had to repeat myself," Dr. Tremeau said.

He also found that his accent could be a distraction.

"When I was with patients, asking them questions about themselves, they'd answer back, 'Oh, you are French. Where are you from?' " Dr. Tremeau said.

Seeking out speech professionals

Everett Leiter, a speech language pathologist with Confident Speech in New York City, said teaching foreign-born individuals how to speak with less of an accent means working on speech patterns such as intonations and rhythms.

"When you learn a second or third language, you tend to use the sound rules of your native language and the grammar of how to put words together," said Leiter, who coached Dr. Tremeau. "To speak with less of an accent, you need to unlearn that."

Few, however, entirely lose their accent, he said.

Common obstacles in the English language are the "th" and "r" sounds, as well as the "l" at the end of words, Leiter said.

"The English 'r' is infamous," he said. "A great many languages have an 'r' of some sort, but it's very different." In English, the "r" has no trilling, no friction. It's more like a vowel, he said.

The final "l" sound is particularly tough for those from Asia. Most Asian languages don't have the "l" sound and have no consonant sounds at the end of words. Latinos also have problems with final "l" sounds, because only five consonant sounds in Spanish end a syllable, Leiter said.

General internist Hangnga Vu, MD, is working on those areas to temper her Vietnamese accent. She immigrated 16 years ago when she was in her 30s and had little formal training in the English language. She worked her way through medical school, graduated from residency this summer and started her first job this month at the Jewish Home for the Aging near Los Angeles. She's concerned her elderly patients might have a hard time understanding her, especially if they are hearing impaired.

"It's better for me to have [an] accent-reduction course to be a better doctor," Dr. Vu said.

One of her challenges is learning when to raise her voice at the end of a sentence or word; Vietnamese is spoken in a monotone.

Not being understood is "very embarrassing," Dr. Vu said. "Hopefully, I will get better. I thought it would be very hard to change my accent, but after just a few weeks, I was surprised."

Marcia Mathason, Dr. Vu's speech therapist at ExecutivExpression in Sherman Oaks, Calif., said that for non-native English speakers, learning when to stress words can make a world of difference.

"You can say, 'The White House in Washington is an important place,' or 'There's a white house over there.' The subtle change in stress is very important," Mathason said.

Requiring residents to get training

Sometimes it's not the physicians, but their employers, who pinpoint accents as an issue and recommend speech classes.

International medical graduates represent 25% of medical residents. They must pass a clinical skills exam, which includes written and verbal communication. Yet this is not always enough to determine a resident's ability to articulate.

In Ann Arbor, Mich., Seth W. Wolk, MD, general surgery residency director at St. Joseph Mercy Hospital, found that one of his residents from overseas was adept at understanding spoken and written English but was not so fluent with speech.

"She's very bright and hard working, but within six months of her being here it became obvious that others were having a difficult time understanding her," Dr. Wolk said.

He worried that a nurse might confuse her orders, a fellow resident might make wrong assumptions about a patient, or that her patients and their families might not fully comprehend her. Her professional advancement also was an issue, so he referred the resident to a speech therapist. While the program paid for her accent-reduction sessions, the resident attended them on her own time.

Dr. Wolk said he's been impressed by the resident's willingness to work on her accent and can hear the progress she's made.

At William Beaumont Hospital, Royal Oak, Mich., Michael Barnes, MD, internal medicine residency director, said he refers residents with even mild accents to the hospital's speech language pathology department, which has a program specifically for residents.

"To be able to communicate well is a huge part of being a successful physician," Dr. Barnes said. "I don't want people to graduate and end up struggling because of something that could have been identified and improved three years before."