Medical English Tips: Giving Advice Sensitively

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Get this right, and your rapport with your patient will be a powerful factor in building a successful therapeutic partnership. Get this wrong, and your relationship may never recover.

Giving Advice Sensitively

There are some occasions, when healthcare professionals have to give advice in a sensitive manner. Think of some of the times, when you have had to do this. What sorts of things were you discussing?

Perhaps:

misuse of illegal drugs
misuse of legal drugs, e.g. using someone else’s medication, increasing the dose of your own medication
excessive alcohol consumption or lack of knowledge about safe levels of alcohol use
weight issues, e.g. obesity/overweight, underweight, eating disorders
body image issues, e.g. dysmorphia
depression or bereavement
avoiding STIs, e.g. use of safe sex

Now, think about the language you might use in these situations. It is useful to have a ‘scale’ of language in mind, when you are giving advice sensitively. In order to be effective, you will be using several communication skills. Here are 3 very useful skills:

a) Using non-judgemental language (both verbal and non-verbal)

At times, you may be talking about subjects which you find uncomfortable, so it is important to pay attention to your own body language. Are you using gestures (e.g. crossing your arms in front of your chest) or negative body positions (e.g. leaning back or away from the other person)? Are you using judgemental phrases, e.g.

You’re going to have to make more of an effort. You need to pull yourself together now?

b) Acknowledging the patient’s situation

In order to be non-judgemental, it is often a good idea to acknowledge the difficulty the patient may have with their particular health issue, e.g.

I can see you are finding losing weight very challenging.
It looks like you are having a difficult time coming to terms with your mother’s death.

c) Empathising with the patient

It is also a good idea to empathise with the patient, before giving any advice, e.g.

I imagine that it must seem almost impossible to tackle your drug issues.
I guess it must be overwhelming to deal with your weight problem.

Giving Advice

Now, onto the giving of advice in a sensitive manner. You may find you are using phrases such as:

It would be a good idea to..
It would be helpful, if you could…
It would be useful to think about…..
Would you be willing to try….?

As you can see, these phrases are similar to the phrases used to make suggestions. In contrast, when giving advice, you might say:

You should….(reduce your fat intake, exercise more etc)
You need to…(keep an eye on your weekly alcohol intake)

In the case of sensitive advice, these phrases may appear too harsh at first. Of course, in situations where immediate lifestyle changes need to be made, strong advice may need to be given, e.g. evidence of dangerous drug habits or unsafe exposure to infections. In these cases, you may use phrases such as :

You must…
It is essential that you…
It is vital that you….

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GMC English Language Requirements for European Doctors

June 9, 2016

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The GMC uses the following evidence to demonstrate that a European doctor qualifying from one of the member states of the European Economic Area (with the exception of the UK) has sufficient English language skills to practice safely and effectively in the UK.

Evidence Type 1: Academic IELTS 7.5

Doctors should have an overall score of 7.5 in the academic version of the International English Language Testing System (IELTS) from the last 2 years. As part of this, a doctor must score a minimum of 7.0 in each of the four papers: reading, writing, listening and speaking. These scores must be achieved in one sitting of the test.

This, in practice, is how most overseas doctors demonstrate their knowledge of English. The GMC may accept IELTS test scores that are more than 2 years old if a doctor can show that their English language skills have not deteriorated in that time. They may have worked in a country where English is the first language for example, or they may have taken a postgraduate course of study which has been taught and examined in English.

While IELTS is currently the only test recognised by the GMC, the organisation is open to alternatives in the future which can be shown to be reliable and appropriate tests of a doctor’s English language skills.

Evidence Type 2: A primary medical qualification (PMQ) that has been taught and examined in English.

The GMC requires the PMQ to have been taught and examined in English and to be from the last 2 years. As part of this, at least 75% of the doctor’s clinical interaction, including personal contact with patients, relatives and other healthcare professionals, must have been conducted in English

Where the PMQ is not so recent, then the GMC requires clear evidence that the doctor has extensive experience practising in English over the previous 2 years in a country where English is the first language, to include employer references.

Practice may be clinical, teaching, management or research-based. The GMC will take into account whether this is continuous or periodic, and ensure that the practice uses the knowledge, skills, attitudes and competences gained in a medicine degree and any further study.

Evidence Type 3: an alternative language test for registration with a medical regulatory authority in a country where the first and native language is English

The GMC will explore which test was used and what requirements were met. If the test pass is over 2 years old, then the GMC may ask for evidence that demonstrates the doctor’s experience of practising for the preceding two years, as outlined above in evidence type 2.

Evidence Type 4: An offer of employment from a UK healthcare organisation

The GMC requires written confirmation from the UK healthcare organisation that an offer of employment has been made, and that the healthcare organisation must be a designated body. The GMC may also ask for evidence of a doctor’s English language skills along the lines outlined above in Evidence Types 1, 2 and 3.

As part of this process, the GMC requires the appointing clinician to complete an English language reference form detailing the applicant’s skills in reading, writing, listening and speaking, and how these were assessed during the recruitment process. The appointing clinician must then get confirmation from the Responsible Officer for the employing organisation that they endorse the recruitment processes the employer has in place to ensure that the applicant has the necessary knowledge of English to practise safely in the UK.