If foreign doctors have a limited knowledge of German, this can have serious consequences. An initial study into authentic doctor-patient consultations highlights the problems and provides useful information for German lessons.
A study of doctor-patient consultations
During German courses for doctors, it emerged that there was interest in a study focusing on the linguistic challenges associated with doctor-patient consultations. It became clear that the materials and concepts available for occupation-specific German teaching revealed considerable shortcomings and that these in turn point to a lack of research in this area.
The objective of the study was to analyse doctor-patient consultations with a view to ascertaining how such conversations between a doctor and a patient can be affected in practice if the doctor has only a limited knowledge of German.
For the purposes of the study, nine patients were filmed while foreign anaesthetists explained the possible risks of surgery to them in a normal hospital environment. The term foreign is used here to describe anaesthetists who speak German as a second language and who did not acquire their professional qualifications in Germany. At the time of the survey, the participants had already been working at German hospitals for three to five years.
A revealing example
It was shown that linguistic limitations resulted in considerable confusion in some cases in the discussions. In the following example, the anaesthesiologist (A) is explaining to her patient (P) that she will need to come to surgery with an empty stomach. The patient asks three questions about her medication:
A: schluck wasser trinken dürfen sie bis vier uhr morgens und das wars
P: ähm (Zeigt auf ihre Medikamentenliste.) gucken sie muss ich
A: (Spricht kurz gleichzeitig mit P.) die tabletten
P: ein oder zwei medikamente davon nehmen oder kann ich alles weglassen
A: eigentlich ähm lassen sie bitte am obetag [Anm.: gemeint ist der Operationstag] alles weg
P: aber ähm mein asthmamittel das tu ich ja so sprühen (Deutet das Sprühen an.)
A: das spray? ähm kein broblem da können sie ganz normal einnehmen
P: und augentropfen sicher auch nehme ich an
A: es auch ja hauptsache der magen leer ist das ist ähm sehr wischtig
Transcripts of doctor-patient consultations, Borowski 2018
The patient wants the doctor to tell her which of her regular medication she is allowed to take on the day of the operation. This question dominates the entire conversation. Right at the start, the patient draws the doctor’s attention to her list of medication. Once the doctor has finished asking the questions relevant to the anaesthesia and has proceeded to give instructions about how the patient should behave on the day of surgery, the patient again refers the doctor to her list of medication and asks her directly about it. The doctor replies that she should “alles weglassen” (“leave it all out”) on the day of surgery. The patient then asks two follow-up questions. She wants to know whether she should really “weglassen” (“leave out”) her eyedrops and asthma spray. Towards the end of the discussion, the patient asks one further question. She wants to know whether she should use her thrombosis injection on the day of the operation. The doctor says she should, adding that “auf jeden fall das ist sehr wischtig” (“definitely, that is really important”).
Analysing doctor-patient consultations in German lessons
During a German lesson, a transcript excerpt such as the one given above can be read and reflected upon by the class. The following questions relating to the example above could be discussed:
- Which misunderstanding is revealed by the doctor’s answer “lassen sie bitte am obetag alles weg” [DT5] (“please leave out everything on the day of surgery”)?
- What would have happened if the patient had not asked so persistently for further clarification?
- What could the doctor have done better?
Discussion of these questions should lead to the following conclusions:
- The misunderstanding is that the doctor means only medication that is taken in the form of pills. The patient, on the other hand, is referring to any form of medication (spray, eyedrops, injection). The doctor and the patient are talking about two different things: the patient wants instructions about her medication, while the doctor wants to tell the patient to come with an empty stomach on the day of the operation.
- It is possible that the patient would not have taken any of her medication in the morning before surgery. Not using her thrombosis injection could have had considerable consequences. By way of providing background information, it could be added that the patient had formerly been a nurse, so it is probably only for this reason that she asked so persistently for further clarification.
- The doctor could have responded better to the needs expressed by the patient. Following predefined consultation procedures and learning texts by heart may be helpful at first and lend a certain sense of security. Nonetheless, it is important to ensure that sufficient time is provided for patients to ask their own questions. This can significantly reduce the risk of overcomplicated discussions, repeated requests for further clarification, and misunderstandings.
Besides the possible consequences in terms of the patient’s health, misunderstandings of this kind in doctor-patient consultations can reduce the ability of the patient to give informed consent
(Borowski et al. 2019).
Recommendations for language lessons
The doctor-patient consultations transcribed in the study are a source of authentic material for use in German lessons. In addition, they can be used as the basis for recommendations on how to structure, design and organize language courses for doctors:
- Doctors should attend not only general language courses (B2 to C2), but also courses with a specific medical focus.
- They should take language courses both in preparation for working in their professions and while in service.
- Medical language courses should be based on the actual language challenges that participants will encounter in practice. This can be achieved by observing the following points:
a. In-service language courses should take place at the workplace and concentrate on that specific context.
b. In-service language courses should offer additional language coaching at the workplace (see list of further reading).
c. Medical language courses should be based on authentic materials. One possibility is the use of transcribed doctor-patient consultations.
This will allow language learning courses to be related closely to professional practice. This is the only way in which to address the language challenges that genuinely arise in the various professional communication situations in which doctors will find themselves, and to take concrete steps to improve their language skills in such settings.
(2018): Sprachliche Herausforderungen ausländischer Anästhesisten(inn)en bei Aufklärungsgesprächen. Eine gesprächsanalytische Studie zu Deutsch als Zweitsprache im Beruf. Berlin: Frank & Timme.
(2014): Dokumentation und kritischen Reflexion des berufsbegleitenden Kurses "Deutsch für Ärzte/innen im Krankenhaus". IQ-Landesnetzwerk NRW.
Borowski, Damaris; Koreik, Uwe; Ohm, Udo; Rahe-Meyer, Niels; Riedmer, Claudia
(2019): Informed consent at stake? Language barriers in medical interactions with immigrant anaesthetists: A conversation analytical study. BMC Health Services Research.
Ferber-Brull, Rosa (2018): Sprachcoaching. Hilfe zur Selbsthilfe. Hamburg: IQ-Netzwerk.
Passage gGmbH (2015): Praxisguide Deutsch im Krankenhaus. Die sprachliche Integration internationaler Ärztinnen und Ärzte. Eine Handreichung für Klinikleitungen, Deutschlehrkräfte und Bildungsfachleute. Hamburg: IQ-Netzwerk.
Weissenberg, Jens (2012): Sprachbedarfsermittlung im berufsbezogenen Unterricht Deutsch als Zweitsprache. Ein Leitfaden für die Praxis. Hamburg: IQ-Netzwerk.