The element of language has proven itself essential to fulfilling the necessary skills of each field the presentations have covered. Be it communication between patient and doctor, engineer and building crew, computer and user, or hostage and hostage negotiator, language is the basis for each of these relations which if not for language would tumble to the ground in an almost biblical sense.
A common thread found in most of these fields is deciding on the tactics of parentalism, discourse communication, and informed. These strategies deal with the degree to which the first party, the expert in the field, and the second party, the layman have in both the discussion and decision making process in reaching a certain goal. However, which tactic is most appropriate and to what degree it is appropriate is determined by the importance of the subject matter and the requirements of the layman.
It is the importance that I find interesting when you consider the dealings of laymen in the decision process. In the accounting presentation a discourse communication technique is used because the full understanding of the laymen is necessary since the subject matter, money, is important in this instance, but when the subject of health is considered most of the time a parental tactic is taken, makes one wonder what mankind considers as important. The only reason that I could think of that makes money more important than one’s health is when money has an impact on the well being of those you provide or aid in providing for, such as children or a spouse. Yet even in the instance of children being the patients, parents will usually take a back seat, not wanting to get involved out of fear of incompetence. But, you should at least have an understanding of what’s going on with your child’s health.
It may be that the lack of discourse in the medical profession and the emphasis of discourse in accounting may be due to the ability to sue for any crime or malpractice since failure to do so is supposedly completely avoidable in accounting and could have a plethora of reasons for failure that are unavoidable in the medical field.
Monday, April 21, 2008
Tuesday, April 15, 2008
Medical Care
Imagine you are a doctor rushing to meet a new patient who all you know about is her name, Mrs. Haddad. Though the name sounds foreign, you are fluent in both Mandarin and Spanish, and your hospital has access to professional Cantonese, Korean, Toisanese, and Vietnamese interpreters, so you feel confident you will be able to communicate easily with her. Then you reach the examination room and are greeted by a silent woman dressed in a black hijab who only speaks Arabic. What do you do?
This is a rough description of how Alice Chen’s article Doctoring Across the Language Divide begins1. As Chen goes through the lengthy ordeal of treating Mrs. Haddad, she encounters many problems faced by doctors due to language barriers such as the reliability of Mrs. Haddad’s husband as an interpreter, the inability to ask personal questions, such as if Mrs. Haddad was being abused by someone, being unable to know what Mrs. Haddad’s expectations were for her medical treatment, and not being able to question Mrs. Haddad as to what aspects of her life might be causing these symptoms.
Frustrated by this ineffectiveness, Chew decides to find an interpreter through Mrs. Haddad’s Medicad plan. It is from this interpreter that Chen is able to open what she calls “suddenly, seamless communication,” with Mrs. Haddad, and learns that her patient’s age is around 39 instead of the officially documented 49, that because of this younger age Mrs. Haddad’s anemia is actually due to heavy, monthly periods instead the more likely reason for older women of colon cancer, and that the reason for Mrs. Haddad’s depression is because her son had recently been arrested for supposedly financing terrorism by owning a currency exchange business. During the arrest Mrs. Haddad was forced to the ground by a policeman who stood on her back with one foot, while she watched another officer point a gun at her son’s head. This incident was shortly described as “harassment” by Mrs. Haddad’s husband in earlier appointments, with no real account of the actions that took place.
After this interesting story Chew discusses the problems associated with obtaining interpreters which she so eloquently showed as being indispensible in the medical field1. She begins by reinforcing the need for interpreters by informing her readers that according to the 2000 census about a 50% increase of limited English speakers in the United States during the 1990’s. Chew then continues by describing the forming of a number of policies that are attempting to bridge this “language divide.” For example, the 2001 federal government’s national standards for Culturally and Linguistically Appropriate Services in health care has made many organizations refine or develop their interpreter services. However, it is Chen’s belief that these standards are considered more guide lines without any actual force of law and are thus forsaken by healthcare institutions.
Another problem addressed by Chew is the unreliability of the alternatives for skilled interpreters such as family members who may not possess the medical terminology to fully interpret one language into another or who may have reasons for altering a patient’s dialogue to suit their own means. Much like the experience Chew had with Mr. Haddad as interpreter1.
Another especially dangerous group to use as interpreters is children. This is because though they may have a full command of English their understanding of their parent’s native language is usually unreliable1. Also, in certain situations parents and elders may feel it necessary to withhold certain symptoms in order to protect the child. Furthermore if parents become dependent on children as interpreters the effects can be devastating on a child’s future. Chew gives an example of this by describing one of her patients who never finished high school because she was needed to interpret for her parents when her sister experienced chronic illness.
As for telephone interpreter services, Chew explains that this alternative is both extremely costly when dealing with long periods of time and obscure languages, and is inadequate when dealing with interpersonal issues1.
Seeing as how these alternatives fall short of their intended goal of open and unlabored communication, Chew end’s her report by proposing ways to fund medical interpreter services by reimbursing them through “direct, centralized payments” (similar to how our judiciary pays for qualified courtroom interpreters) or increasing payment to providers that care for patients with language barriers. Chew also proposes a national system of telephone interpreters much like the one established by the Australian government1.
In her story Chew showed a number of different problems faced with patients who have different languages than the medical staff who treats them, but what about interpreting medical information to a patient of the same language as the caregiver who only has little understanding of medical terminology. In Communication Techniques for Patients With Low Health Literacy: A Survey of Physicians, Nurses, and Pharmacists a study is conducted that shows the different techniques used by the three kinds of caregivers in order to communicate with their patients2. The study also attempts to show how each group favors certain techniques over others. These techniques include asking patients to repeat information, speaking slowly, presenting 2 or 3 concepts at a time and checking for understanding (termed the teach back technique), using simple language, and several others listed by the survey. From the study it was learned that each profession used only a few techniques far more often than others that were presented, and a tendency to use simpler techniques learned in the professional’s medical education was also found, while avoiding more complicated techniques such the (teach back) which was used by only 40% of the participants.
Education is not the only other language barrier that must be faced by health care professionals. In the article Communication Strategies for Nurses Interacting with Patients Who Are Deaf the importance of dealing with patients who are physically unable to hear is discussed3. For the most part learning how best to communicate with the deaf is no different than overcoming common language barriers. You first must assess the appropriate and viable method to use in communication, be it lip reading, written communication, technological instruments, such as teleprompters, or if standard American Sign Language (ASL) is usable. The most appropriate of these is chosen after considering the patient’s understanding of English and ASL, which is constituted by whether the patient was deafened before the acquisition of speech (pre-lingually deafened) or was deafened after the acquisition of speech ( post- lingually deafened), and of course the health literacy of the patient must also be considered.
If (ASL) is determined to be the best way of communicating with a patient then a professional interpreter is usually required, and even if an interpreter is available, healthcare professionals must use simple terminology in order for the interpreter to translate efficiently, seeing as how ASL is a language separate from English that has a unique syntax, structure, and cultural context of its own.
More important still are the words used to relate to patients who are either hard of hearing or completely deaf, which some in the Deaf (capital D) community consider to be a natural characteristic rather than a disability. Furthermore the cultural rules of polite and respectful behavior are different. For example, a doctor who does not look directly at the patient while talking, say while reading a chart, may be considered disrespectful.
As for the obtaining of interprets and the understanding of medical staff in how to access them, a large majority of professionals have been found to not to be aware of how to gain access to (ASL) interpreters, even though there have been laws passed that require their understanding of how to do so.
The ability to open communication with patients is a skill that seems to be neglected by most professionals in the medical field. If so, then perhaps an understanding of the repercussions of not opening communication with patients, and there by not gaining informed consent, should be covered. In Culture Communication in Ethically Appropriate Care by Fiona Meddings and Melanie Haith-Copper, the problems of using “western ethical principles” as a basis for how to treat patients of different ethnic and cultural backgrounds are described4. It is the view of Meddings and Haith-Cooper that the standard codes of ethics cannot be applied when treating patients from other cultural backgrounds. These codes must be flexible in order to respect cultural differences. However, the standard critique for insuring the ethically respectable care of patients, Gillion’s four principled model, calls for a culturally neutral stance. According to Meddings and Haith-Copper, this also means that providers must not use any of the previous feelings or awareness they have about patients in order to assess the best way to communicate with patients, this also means not taking the cultural values and beliefs of the patient into account. If this is so, a culturally neutral stance would seem to betray the other three principles of Gillion’s model, autonomy, beneficence and non-maleficience, and justice.
Autonomy is (in the medical context) the deliberate self-rule of patients which must be respected by informing patients thoroughly of proposed treatment and gaining their consent to being. It is the view of Meddings and Haith-Copper that assuming a culturally neutral stance can inhibit the ability of medical practitioners to communicate to patients. This is because a lack of “commonality (due to cultural disparity)” influences the type of information that a caregiver provides.
Meddings and Haith-Cooper also shows how autonomy has differing meanings in cultures other than the western ideal. The authors use the status of Egyptian, Muslim women as an example, where paternalism or the role of deciding to proceed or not with treatment and the decision of what treatment to pursue is given by the caregiver not the patient. Thus these women do not value their own ability to decide for themselves, thus making it impossible to gain informed consent. That is unless the caregiver understands this cultural disparity and can overcome it by engaging a client fully, understanding their hopes, fears, physical condition, and limits of intellectual understanding by employing a language in which the patients can interact.
As for the matter of Beneficence and non-malfeasance, the issue of being unable to open communication with patients of other language so as to know if a treatment is proving harmful or effective is presented. This means that in order to insure that treatment is beneficial and not determined to a patient’s health; the patient must be able to relate the symptoms he or she is facing. If this cannot be done; treatment could prove in effective or potentially harmful to patients.
The possibility of psychological harm also presents difficulties since a lack of communication may cause patients to feel vulnerable and inadequate when expressing their fears of their well being to non-responsive care-givers. It is also the belief of Meddings and Haith-Cooper that the misinterpretation of this quiet and defensive domineer may lead doctors to stereotype all non-English speaking patients as so.
Finally Meddings and Haith-Cooper discusses the lack of justice found in the dealings of patients with langage barriers. Specifically, the ability to access health services and the ability to communicate if unfair treatment has been placed upon a patient is covered. These two aspects have both proved unattainable to a large group of people since in order to be informed and use such services fully one must be able to understand and reply in English.
Though the language barriers found in patient/doctor relations are important, I believe that in order to analyze the language in the medical world one must also research the language barriers between medical colleagues and students as well. In the article It is not just work- It is also words by Murali Ramaswamy, the recent discovery of 15 Turkish physicists who have used plagiarized work on numerous occasions is discussed5. One of the physicists justified his actions with this statement “for those whose mother tongue is not English borrowing beautiful sentences from other studies on the same subject…is not unusual.” The physicists continues by saying the “the originality of scientific content should outweigh criticisms about language misappropriation, however the writer comments that it is important to remember that it is the responsibility of the scientist to meet the ethical standards established by the journals or societies in which they intend to be publish.
An even more disturbing occurrence of plagiarism is occurring in India where 20% of medical students feel plagiarism is an ethically sound practice, according to Gitanjali, in reference to copying during examinations. Such plagiarism suggests a lack of comprehension of the proposed material which could lead disaster in the workforce. This ethical view of plagiarism is due to the misperception of certain cultures as to the medical communities unfavoring one. Such communication in the Medical world could, be viewed as a sad reflection on how important Medical providers might view communication with their patients. After all, if medical professionals can’t break the language barrier with one another, how can one expect them to break it with an untrained, poorly health literate patient?
In closing, from these articles I have been led to believe that the accessibility to open and easy communication, without fear of incrimination or misrepresentation is a natural right of patients to receive their care givers. Modifying the current standards of insuring such accessibility to interpreters and the skills of medical providers to simplify communication, should be of great importance to those who believe in the very basis of why the medical world exists. To heal all of man kinds wounds no matter how you phrase it.
References
1. Chen A. Doctoring across the language divide. Health Affairs [Internet]. 2006 [cited 2008 Apr. 7] ; 25 (3) : 808-813. Available from Academic Search Premier: http://web.ebscohost.com.proxy. lib.utk.edu
2. Schwartzberg J.G, Cowett A, VanGeest J, Micheal SW. Communication techniques for patients with low health literacy: a survey of physicians, nurses, and pharmacists. American Journal of Health Behavior [Internet]. 2007 [cited 2008 Apr. 7]; 31 (1): 96-104. Available from Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu
3. Chong-Hee Lieu C, Sadler GR, Fullerton JT, Stohlmann PD. Communication strategies for nurses interacting with patients who are deaf. Dermatology Nursing. 2007 [cited 2008 Apr. 12]; 19 (6): 541-551. Available from American Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu
4. Meddings F, Haith-Cooper M. Culture and communication in ethically appropriate care. Nursing Ethics [Internet]. 2008 [cited 2008 Apr. 7]; 15 (1) : 52-61. Availiable from Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu
5. Ramaswamy Murali. It is not just the work- it is also the words. Indian Journal of Critical Care Medicine [Internet]. 2007 [cited 2008 Apr. 7]; 11 (4) : 169-172. Available from Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu
This is a rough description of how Alice Chen’s article Doctoring Across the Language Divide begins1. As Chen goes through the lengthy ordeal of treating Mrs. Haddad, she encounters many problems faced by doctors due to language barriers such as the reliability of Mrs. Haddad’s husband as an interpreter, the inability to ask personal questions, such as if Mrs. Haddad was being abused by someone, being unable to know what Mrs. Haddad’s expectations were for her medical treatment, and not being able to question Mrs. Haddad as to what aspects of her life might be causing these symptoms.
Frustrated by this ineffectiveness, Chew decides to find an interpreter through Mrs. Haddad’s Medicad plan. It is from this interpreter that Chen is able to open what she calls “suddenly, seamless communication,” with Mrs. Haddad, and learns that her patient’s age is around 39 instead of the officially documented 49, that because of this younger age Mrs. Haddad’s anemia is actually due to heavy, monthly periods instead the more likely reason for older women of colon cancer, and that the reason for Mrs. Haddad’s depression is because her son had recently been arrested for supposedly financing terrorism by owning a currency exchange business. During the arrest Mrs. Haddad was forced to the ground by a policeman who stood on her back with one foot, while she watched another officer point a gun at her son’s head. This incident was shortly described as “harassment” by Mrs. Haddad’s husband in earlier appointments, with no real account of the actions that took place.
After this interesting story Chew discusses the problems associated with obtaining interpreters which she so eloquently showed as being indispensible in the medical field1. She begins by reinforcing the need for interpreters by informing her readers that according to the 2000 census about a 50% increase of limited English speakers in the United States during the 1990’s. Chew then continues by describing the forming of a number of policies that are attempting to bridge this “language divide.” For example, the 2001 federal government’s national standards for Culturally and Linguistically Appropriate Services in health care has made many organizations refine or develop their interpreter services. However, it is Chen’s belief that these standards are considered more guide lines without any actual force of law and are thus forsaken by healthcare institutions.
Another problem addressed by Chew is the unreliability of the alternatives for skilled interpreters such as family members who may not possess the medical terminology to fully interpret one language into another or who may have reasons for altering a patient’s dialogue to suit their own means. Much like the experience Chew had with Mr. Haddad as interpreter1.
Another especially dangerous group to use as interpreters is children. This is because though they may have a full command of English their understanding of their parent’s native language is usually unreliable1. Also, in certain situations parents and elders may feel it necessary to withhold certain symptoms in order to protect the child. Furthermore if parents become dependent on children as interpreters the effects can be devastating on a child’s future. Chew gives an example of this by describing one of her patients who never finished high school because she was needed to interpret for her parents when her sister experienced chronic illness.
As for telephone interpreter services, Chew explains that this alternative is both extremely costly when dealing with long periods of time and obscure languages, and is inadequate when dealing with interpersonal issues1.
Seeing as how these alternatives fall short of their intended goal of open and unlabored communication, Chew end’s her report by proposing ways to fund medical interpreter services by reimbursing them through “direct, centralized payments” (similar to how our judiciary pays for qualified courtroom interpreters) or increasing payment to providers that care for patients with language barriers. Chew also proposes a national system of telephone interpreters much like the one established by the Australian government1.
In her story Chew showed a number of different problems faced with patients who have different languages than the medical staff who treats them, but what about interpreting medical information to a patient of the same language as the caregiver who only has little understanding of medical terminology. In Communication Techniques for Patients With Low Health Literacy: A Survey of Physicians, Nurses, and Pharmacists a study is conducted that shows the different techniques used by the three kinds of caregivers in order to communicate with their patients2. The study also attempts to show how each group favors certain techniques over others. These techniques include asking patients to repeat information, speaking slowly, presenting 2 or 3 concepts at a time and checking for understanding (termed the teach back technique), using simple language, and several others listed by the survey. From the study it was learned that each profession used only a few techniques far more often than others that were presented, and a tendency to use simpler techniques learned in the professional’s medical education was also found, while avoiding more complicated techniques such the (teach back) which was used by only 40% of the participants.
Education is not the only other language barrier that must be faced by health care professionals. In the article Communication Strategies for Nurses Interacting with Patients Who Are Deaf the importance of dealing with patients who are physically unable to hear is discussed3. For the most part learning how best to communicate with the deaf is no different than overcoming common language barriers. You first must assess the appropriate and viable method to use in communication, be it lip reading, written communication, technological instruments, such as teleprompters, or if standard American Sign Language (ASL) is usable. The most appropriate of these is chosen after considering the patient’s understanding of English and ASL, which is constituted by whether the patient was deafened before the acquisition of speech (pre-lingually deafened) or was deafened after the acquisition of speech ( post- lingually deafened), and of course the health literacy of the patient must also be considered.
If (ASL) is determined to be the best way of communicating with a patient then a professional interpreter is usually required, and even if an interpreter is available, healthcare professionals must use simple terminology in order for the interpreter to translate efficiently, seeing as how ASL is a language separate from English that has a unique syntax, structure, and cultural context of its own.
More important still are the words used to relate to patients who are either hard of hearing or completely deaf, which some in the Deaf (capital D) community consider to be a natural characteristic rather than a disability. Furthermore the cultural rules of polite and respectful behavior are different. For example, a doctor who does not look directly at the patient while talking, say while reading a chart, may be considered disrespectful.
As for the obtaining of interprets and the understanding of medical staff in how to access them, a large majority of professionals have been found to not to be aware of how to gain access to (ASL) interpreters, even though there have been laws passed that require their understanding of how to do so.
The ability to open communication with patients is a skill that seems to be neglected by most professionals in the medical field. If so, then perhaps an understanding of the repercussions of not opening communication with patients, and there by not gaining informed consent, should be covered. In Culture Communication in Ethically Appropriate Care by Fiona Meddings and Melanie Haith-Copper, the problems of using “western ethical principles” as a basis for how to treat patients of different ethnic and cultural backgrounds are described4. It is the view of Meddings and Haith-Cooper that the standard codes of ethics cannot be applied when treating patients from other cultural backgrounds. These codes must be flexible in order to respect cultural differences. However, the standard critique for insuring the ethically respectable care of patients, Gillion’s four principled model, calls for a culturally neutral stance. According to Meddings and Haith-Copper, this also means that providers must not use any of the previous feelings or awareness they have about patients in order to assess the best way to communicate with patients, this also means not taking the cultural values and beliefs of the patient into account. If this is so, a culturally neutral stance would seem to betray the other three principles of Gillion’s model, autonomy, beneficence and non-maleficience, and justice.
Autonomy is (in the medical context) the deliberate self-rule of patients which must be respected by informing patients thoroughly of proposed treatment and gaining their consent to being. It is the view of Meddings and Haith-Copper that assuming a culturally neutral stance can inhibit the ability of medical practitioners to communicate to patients. This is because a lack of “commonality (due to cultural disparity)” influences the type of information that a caregiver provides.
Meddings and Haith-Cooper also shows how autonomy has differing meanings in cultures other than the western ideal. The authors use the status of Egyptian, Muslim women as an example, where paternalism or the role of deciding to proceed or not with treatment and the decision of what treatment to pursue is given by the caregiver not the patient. Thus these women do not value their own ability to decide for themselves, thus making it impossible to gain informed consent. That is unless the caregiver understands this cultural disparity and can overcome it by engaging a client fully, understanding their hopes, fears, physical condition, and limits of intellectual understanding by employing a language in which the patients can interact.
As for the matter of Beneficence and non-malfeasance, the issue of being unable to open communication with patients of other language so as to know if a treatment is proving harmful or effective is presented. This means that in order to insure that treatment is beneficial and not determined to a patient’s health; the patient must be able to relate the symptoms he or she is facing. If this cannot be done; treatment could prove in effective or potentially harmful to patients.
The possibility of psychological harm also presents difficulties since a lack of communication may cause patients to feel vulnerable and inadequate when expressing their fears of their well being to non-responsive care-givers. It is also the belief of Meddings and Haith-Cooper that the misinterpretation of this quiet and defensive domineer may lead doctors to stereotype all non-English speaking patients as so.
Finally Meddings and Haith-Cooper discusses the lack of justice found in the dealings of patients with langage barriers. Specifically, the ability to access health services and the ability to communicate if unfair treatment has been placed upon a patient is covered. These two aspects have both proved unattainable to a large group of people since in order to be informed and use such services fully one must be able to understand and reply in English.
Though the language barriers found in patient/doctor relations are important, I believe that in order to analyze the language in the medical world one must also research the language barriers between medical colleagues and students as well. In the article It is not just work- It is also words by Murali Ramaswamy, the recent discovery of 15 Turkish physicists who have used plagiarized work on numerous occasions is discussed5. One of the physicists justified his actions with this statement “for those whose mother tongue is not English borrowing beautiful sentences from other studies on the same subject…is not unusual.” The physicists continues by saying the “the originality of scientific content should outweigh criticisms about language misappropriation, however the writer comments that it is important to remember that it is the responsibility of the scientist to meet the ethical standards established by the journals or societies in which they intend to be publish.
An even more disturbing occurrence of plagiarism is occurring in India where 20% of medical students feel plagiarism is an ethically sound practice, according to Gitanjali, in reference to copying during examinations. Such plagiarism suggests a lack of comprehension of the proposed material which could lead disaster in the workforce. This ethical view of plagiarism is due to the misperception of certain cultures as to the medical communities unfavoring one. Such communication in the Medical world could, be viewed as a sad reflection on how important Medical providers might view communication with their patients. After all, if medical professionals can’t break the language barrier with one another, how can one expect them to break it with an untrained, poorly health literate patient?
In closing, from these articles I have been led to believe that the accessibility to open and easy communication, without fear of incrimination or misrepresentation is a natural right of patients to receive their care givers. Modifying the current standards of insuring such accessibility to interpreters and the skills of medical providers to simplify communication, should be of great importance to those who believe in the very basis of why the medical world exists. To heal all of man kinds wounds no matter how you phrase it.
References
1. Chen A. Doctoring across the language divide. Health Affairs [Internet]. 2006 [cited 2008 Apr. 7] ; 25 (3) : 808-813. Available from Academic Search Premier: http://web.ebscohost.com.proxy. lib.utk.edu
2. Schwartzberg J.G, Cowett A, VanGeest J, Micheal SW. Communication techniques for patients with low health literacy: a survey of physicians, nurses, and pharmacists. American Journal of Health Behavior [Internet]. 2007 [cited 2008 Apr. 7]; 31 (1): 96-104. Available from Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu
3. Chong-Hee Lieu C, Sadler GR, Fullerton JT, Stohlmann PD. Communication strategies for nurses interacting with patients who are deaf. Dermatology Nursing. 2007 [cited 2008 Apr. 12]; 19 (6): 541-551. Available from American Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu
4. Meddings F, Haith-Cooper M. Culture and communication in ethically appropriate care. Nursing Ethics [Internet]. 2008 [cited 2008 Apr. 7]; 15 (1) : 52-61. Availiable from Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu
5. Ramaswamy Murali. It is not just the work- it is also the words. Indian Journal of Critical Care Medicine [Internet]. 2007 [cited 2008 Apr. 7]; 11 (4) : 169-172. Available from Academic Search Premier: http://web.ebscohost.com.proxy.lib.utk.edu
Friday, April 11, 2008
References
As I was reading the references I have selected for my paper and presentation, I was surprised by the problems faced by doctors when they try to relate the medical problems faced by patients and the treatments necessary for those problems. This is even the case with patients who speak the same first language as their doctor. Insuring that patients are fully informed has proved to be very important since without full knowledge of their diagnoses and treatment not only may the doctor be liable for any malpractice due to lack of understanding of a patient’s body chemistry but the risks to the patient can be dire. I have also found that psychological as well as physical damage may be impacted upon the patient. This could be from the lack of understanding, and thus respect, of a patient’s cultural and religious beliefs. Such circumstances could instill fear and distrust in a person for all medical professional.
So, how do professionals relate the medical conditions and treatment to their patients? In a study by Joanne G. Schwartzberg MD; Allison Cowett MD, MPH; Jonathan VanGeest, PhD; and Michael S. Wolf, PhD, MPH the different strategies that medical professional use to inform their patients with poor “health literacy” (understanding of medical terminology). The study found a great deal of variance in the techniques used by physicians, registered nurses, and pharmacists. These techniques includes speaking slowly, asking patients to repeat information, presenting 2 or 3 concepts at a time and checking to see if the patients understand, using simple language, etc. Of the techniques covered by the study, 11 of the 14 were used for one of the professions more than the others. It was later suggested in the paper that further study be done to see which techniques different medical personnel rely on more in order to see if any changes could be made to increase interpretation efficiency.
My final sources deals with the assimilation of medical information across languages by medical students and practioneers. It is important for new ideas and break-throughs in medicine that a discourse occurs with highly informed and well studied individuals. However, due the difficulties in language, non-English speaking medical students have been found to use plagiarism for a large portion of their work. This could well represent a lack of understanding not only in other languages but also in the material itself. Obviously such misunderstandings can lead to consequences when these individuals enter the workforce.
So, how do professionals relate the medical conditions and treatment to their patients? In a study by Joanne G. Schwartzberg MD; Allison Cowett MD, MPH; Jonathan VanGeest, PhD; and Michael S. Wolf, PhD, MPH the different strategies that medical professional use to inform their patients with poor “health literacy” (understanding of medical terminology). The study found a great deal of variance in the techniques used by physicians, registered nurses, and pharmacists. These techniques includes speaking slowly, asking patients to repeat information, presenting 2 or 3 concepts at a time and checking to see if the patients understand, using simple language, etc. Of the techniques covered by the study, 11 of the 14 were used for one of the professions more than the others. It was later suggested in the paper that further study be done to see which techniques different medical personnel rely on more in order to see if any changes could be made to increase interpretation efficiency.
My final sources deals with the assimilation of medical information across languages by medical students and practioneers. It is important for new ideas and break-throughs in medicine that a discourse occurs with highly informed and well studied individuals. However, due the difficulties in language, non-English speaking medical students have been found to use plagiarism for a large portion of their work. This could well represent a lack of understanding not only in other languages but also in the material itself. Obviously such misunderstandings can lead to consequences when these individuals enter the workforce.
Sunday, April 6, 2008
ABC's of High School Education
Wendy went to school one day to learn what life‘s about,
And in her excitement she talked and talked, her mouth just like a spout,
She wondered why the sky was blue and if brown cows ate beans,
As she continued on her way, scrutinizing many things.
But most of what her thoughts did wonder were quite a fear to count,
Would her teachers’ mouths be kind, or an evil fount?
And when she came across the door, she found her fear unfound,
For what she saw was far more strange, a crazy blend of sound.
There was a young teacher of clear cool form who looked for controlled speech,
And an old teach who used such words as Dilbert, dingbat, and cute as a Georgia peach,
Still another bold young man, who was quite new no doubt,
Set about to be a friend with words like “yo dog” and “man chill out.”
So Wendy sat and thought a new, of all she thus learned,
And now she wondered why on earth “ teachers are so weird.”
Teachers format their communication to fit their individual teaching style. However, certain differences in how teachers converse may be attributed to their age. This is what I observed from the communications of the teachers at my high school. I learned that the age of a teacher not only affects how that teacher communicates but also affects the ease of opening communication. Opening communication is derived from the ability of new teachers to relate to their students and how they find a balance between being a student’s friend and a disciplinarian.
To gain a first-hand perspective of this connection, I gave my old teachers a survey that is designed to display such views. Some of the questions presented in the survey include the following: How long have you been teaching; at what age did you start teaching; does your age affect your ability to or the way you communicate; and what kind, if any, slang terms do you use when teaching? It is from the assemblage of these expressed views that I will ascertain the stability of my thesis.
The communication style of the older teachers has many distinctive qualities different from the communication styles of other age groups. In high school I noticed that teachers in their late 40’s to early 60’s usually used little slang. If any slang was used, it usually originated from the language used by the educators from the present teachers’ adolescences. It is likely that this results from the current teachers, transposing the communication they experienced in high school into their current roles. These slang terms include the following: bonkers, ding bat, don’t sweat it, nifty, don‘t have a cow, don‘t flip your wig, bummer, screwed up, spazzed out, hunk, golly gee, stoned, swapping spit, lollygagging, cool threads, and thongs (apparently this means flip-flops). One of my teachers was Mrs. Gloria Diane Padgett, a 57-year-old teacher and my mother. A finer example of a teacher using this ancient slang I believe could never be found. I can remember walking down the hallway one day with a stack of copies which my dear teacher had so kindly asked me to “hurry up and get,” when I managed to trip and allowed the entire parcel to spew onto the floor. My dear teacher proceeded then by asking me, “Are you alright, ding bat?” After assuring her that I was quite unharmed, my ever-comforting educator said, “Well, gosh, are you just going to sit in the floor all day? Pick up the papers you silly goose and stop spazzing.” I replied ever so respectfully, “Well, you could help, nut job.”
As you can see, these examples of slang differ greatly from the slang we use today. This is why older teachers may strive to keep such language out of the education process. When I examined my surveys of the older teachers I found that most in fact did try to refrain from using slang when teaching, but they occasionally would use slang from the force of habit. This was the view of the foreign language teacher, Mrs. Carol Reid, who said in her survey, “At times, I use slang terms, but not as a general rule.”
With my examination of the older teachers complete it is now logical to continue with the observation of the teachers who fall into the middle-age group. These are teachers who fall into the late 30’s to mid 40’s in age. Though this age group is relatively young in terms of life span it is roughly the mid-point of a teacher’s occupation. These teachers use slang terms more freely. These are terms which only coexist within the teachers’ generation and the student population. Examples of this would be “cool,” “hey,” and “what’s up”. This slang vocabulary is more constricted in variety compared to the vocabulary of the older and younger teachers, yet proves a functional form of language. This is the view of one teacher who said, “Yes. Sometimes I do [use slang terms] purely for comic effect. I might intentionally make some clumsy effort to use current slang. It always elicits a laugh from my students, helps them relate to me, and lets them know that I value their experience and do not take myself too seriously. On the other hand, I routinely use words such as ‘cool’ that are common to my generation and to theirs.” The incorporation of these rules for deciding what slang terms are permissible and which ones are not might be viewed as a kind of pidgin language or “pidgin rules of language,” relating to the function of a different language or dialect to a current atmosphere. As these teachers grow older they might resist the urge to use such slang terms as the generation gap continues to grow, resorting to a more standardized style, as have their present older colleagues.
As for the younger generation of teachers, ages in the mid 20’s to early 30’s, I have observed that the use of slang words is either very common or it is very rare. The reason for this is that, as newer teachers with less experience, they are still searching for the balance between being a teacher and being a friend. “I tend to use words such as, bling bling, word up, and fine because, as an English teacher and one of the younger educators, I can relate to such language and incorporate it into my teaching.” This is a quote from the high school English teacher Ms. Karen Davis, who proved very fluent in the slang terms of my generation. Ms. Davis goes on to say, “As I grow older and gain more experience as a teacher, I will become better able to communicate with my students and assert my role as a teacher.” This idea of incorporating generational dialects into the classroom is not uniform for this age group, however. According to the High School Basketball Coach and Junior High English teacher Mr. Daniel Armstrong, he generally tries to avoid the usage of slang in his teaching. However, my observations have not proven this to be true. I can think of several occasions where Mr. Armstrong has referred to some of his students as dog or man, and has on occasion used the term “ya know”. Most of these instances are for exaggeration more than real assimilation into the teacher‘s conversations, but still the influence remains.
Some of the younger teachers may be unaware of their use of slang terms because they use them in their everyday conversation. A New York Times report by Jennifer Lee presents the idea that the usage of text language is used by students in papers because of the constant bombardment from their peers on instant messenger sites. “I was so used to reading what my friends wrote to me on Instant Messenger that I didn’t even realize that there was something wrong,” said student Montana Hodgen in Lee‘s article. It is probable that the communication style used by certain younger teachers to students is more likely to include current slang terms because many of these terms are still used by these teachers outside of the educational field. Perhaps at this level of experience and age, a more independent stance is necessary so that the ability to learn how to deal with students is gained.
In Deborah Tannen’s book The Argument Culture the idea that education has its basis as a kind of confrontational battle ultimately fighting to break the hold of ignorance on the unreformed is presented (256-290). Tannen suggests that this form of teaching would be better replaced by a more respectful form. Tannen uses the “rules of engagement” from The New Golden Rule by Amitai Etzioni as the guide to how teachers might try to communicate with their students (288). Of these rules, two seem to relate to the use of slang in education: “Don’t demonize those with whom you disagree,” and “Engage in a dialogue of convictions: Don’t be so reasonable and conciliatory that you lose touch with a core of belief you feel passionately about.” The usage of slang in the classroom might be the younger teachers’ way of “not demonizing” their students by trying to seem reasonable enough to communicate in the most comfortable way for them. This idea was very apparent in the High School Basketball Coach’s dialogue with students. It almost seemed as if because of his age the students expected him to have a completely different dialogue with them than would teachers of different age groups. This could be because he is closer in age and thus would have a more closely related slang vocabulary. This makes the use of slang necessary in order to not “demonize” the students. The whole point of teaching is to encourage students to grow not only in abilities but also in confidence as they pursue their ambitions in life. For the latter part of the curriculum to be efficiently achieved, it makes sense that younger teachers would slacken their speech for student, especially those in high school. It would be detrimental to the teaching process if a younger teacher, relatively close in age to the students one teaches, presents a front of highly polished and fine tuned speech in their conversation since this may cause students to feel incapable of reaching this professional level achieved so quickly by one so close in age. The slang used by younger teachers helps them to show students that at one time they were students in high school as well. In doing so, teachers become able to show students that reaching their goals is just as possible as it was for them at that age. However, these teachers have to distinguish if using these slang terms means betraying their “core beliefs” of teaching formalized Standard English. As these teachers grow older, learning more about their individual teaching styles will help them communicate with their students.
The reversal of this idea is true for older teachers. In order to not demonize students they must not use current slang terms, because it would show a lack of professionalism and strength for the students. The older teachers represent the end product, or what the students are supposed to aspire to at least in the professional since. In this way the two groups act as a fail-safe of each other. The younger teachers encourage the students and the older teachers insure that they know what is expected of them in the future.
But, these two objectives might be destructive to each other if it weren’t for the mid-range of teachers providing a “pathway” between the two disciplines. If it weren’t for the mid-range of teachers whose dialogue bridges the reserve of the older with the relativeness of the younger, the apparent differences between the two might pit them against each other, at least in the eyes of the students.
So far, I have covered the correlation between age and teachers communicating with their students, but what other circumstances could affect communication? From the survey, I found some interesting results. When asked the question, “Have you found that, when talking with other teachers, you have to adjust your language to better communicate with older or younger teachers?” Older teachers expressed the need to adjust their language to better the communication with the younger teachers. “I may not have to, but I’m sure I do--and I do this without any real thought. Being one of the oldest members of the faculty is part of it. Younger teachers often seek advice. I’m sure I relate differently to them than someone of my age group.” (Padgett)
The views of the younger educators, however, differed from the perspective of the elders. “No. Most of the teachers that I teach with are not very old. I do not feel that there is that big of a gap between us.”(Comuzie, Sarah) This view then proved to vary between teachers of the middle age group, with some affirming and others denying the influence of age on inter-faculty relations. This could be due to the inexperience of the younger teachers to communicate with people of this age as colleagues, and also due to the older teacher’s inexperience with the common dialect of the younger teachers.
Communication is the key element to any learning environment, whether it is a student trying to learn from a teacher, a teacher trying to learn how to teach a student, or learning how to communicate with colleagues. The further study into the relationships in the high school environment and how ideas are communicated might increase the efficiency of the education process. For now, teachers must continue the trial and error method of learning how to communicate.
References
Lee, Jennifer “I Think Therefore, IM.” New York Times on the Web 19 Sept. 2002. 16 Feb. 2007
Tannen, Deborah. The Argument Culture: Moving From Debate To Dialogue New York: Random House, 1998.
“Teacher Communication Survey” - Padgett, Tyler- quotes from Padgett, Gloria Diane. Reid, Carol. Kevin, Brewer. Davis, Karen A. Comuzie, Sarah. Armstrong, Daniel.
And in her excitement she talked and talked, her mouth just like a spout,
She wondered why the sky was blue and if brown cows ate beans,
As she continued on her way, scrutinizing many things.
But most of what her thoughts did wonder were quite a fear to count,
Would her teachers’ mouths be kind, or an evil fount?
And when she came across the door, she found her fear unfound,
For what she saw was far more strange, a crazy blend of sound.
There was a young teacher of clear cool form who looked for controlled speech,
And an old teach who used such words as Dilbert, dingbat, and cute as a Georgia peach,
Still another bold young man, who was quite new no doubt,
Set about to be a friend with words like “yo dog” and “man chill out.”
So Wendy sat and thought a new, of all she thus learned,
And now she wondered why on earth “ teachers are so weird.”
Teachers format their communication to fit their individual teaching style. However, certain differences in how teachers converse may be attributed to their age. This is what I observed from the communications of the teachers at my high school. I learned that the age of a teacher not only affects how that teacher communicates but also affects the ease of opening communication. Opening communication is derived from the ability of new teachers to relate to their students and how they find a balance between being a student’s friend and a disciplinarian.
To gain a first-hand perspective of this connection, I gave my old teachers a survey that is designed to display such views. Some of the questions presented in the survey include the following: How long have you been teaching; at what age did you start teaching; does your age affect your ability to or the way you communicate; and what kind, if any, slang terms do you use when teaching? It is from the assemblage of these expressed views that I will ascertain the stability of my thesis.
The communication style of the older teachers has many distinctive qualities different from the communication styles of other age groups. In high school I noticed that teachers in their late 40’s to early 60’s usually used little slang. If any slang was used, it usually originated from the language used by the educators from the present teachers’ adolescences. It is likely that this results from the current teachers, transposing the communication they experienced in high school into their current roles. These slang terms include the following: bonkers, ding bat, don’t sweat it, nifty, don‘t have a cow, don‘t flip your wig, bummer, screwed up, spazzed out, hunk, golly gee, stoned, swapping spit, lollygagging, cool threads, and thongs (apparently this means flip-flops). One of my teachers was Mrs. Gloria Diane Padgett, a 57-year-old teacher and my mother. A finer example of a teacher using this ancient slang I believe could never be found. I can remember walking down the hallway one day with a stack of copies which my dear teacher had so kindly asked me to “hurry up and get,” when I managed to trip and allowed the entire parcel to spew onto the floor. My dear teacher proceeded then by asking me, “Are you alright, ding bat?” After assuring her that I was quite unharmed, my ever-comforting educator said, “Well, gosh, are you just going to sit in the floor all day? Pick up the papers you silly goose and stop spazzing.” I replied ever so respectfully, “Well, you could help, nut job.”
As you can see, these examples of slang differ greatly from the slang we use today. This is why older teachers may strive to keep such language out of the education process. When I examined my surveys of the older teachers I found that most in fact did try to refrain from using slang when teaching, but they occasionally would use slang from the force of habit. This was the view of the foreign language teacher, Mrs. Carol Reid, who said in her survey, “At times, I use slang terms, but not as a general rule.”
With my examination of the older teachers complete it is now logical to continue with the observation of the teachers who fall into the middle-age group. These are teachers who fall into the late 30’s to mid 40’s in age. Though this age group is relatively young in terms of life span it is roughly the mid-point of a teacher’s occupation. These teachers use slang terms more freely. These are terms which only coexist within the teachers’ generation and the student population. Examples of this would be “cool,” “hey,” and “what’s up”. This slang vocabulary is more constricted in variety compared to the vocabulary of the older and younger teachers, yet proves a functional form of language. This is the view of one teacher who said, “Yes. Sometimes I do [use slang terms] purely for comic effect. I might intentionally make some clumsy effort to use current slang. It always elicits a laugh from my students, helps them relate to me, and lets them know that I value their experience and do not take myself too seriously. On the other hand, I routinely use words such as ‘cool’ that are common to my generation and to theirs.” The incorporation of these rules for deciding what slang terms are permissible and which ones are not might be viewed as a kind of pidgin language or “pidgin rules of language,” relating to the function of a different language or dialect to a current atmosphere. As these teachers grow older they might resist the urge to use such slang terms as the generation gap continues to grow, resorting to a more standardized style, as have their present older colleagues.
As for the younger generation of teachers, ages in the mid 20’s to early 30’s, I have observed that the use of slang words is either very common or it is very rare. The reason for this is that, as newer teachers with less experience, they are still searching for the balance between being a teacher and being a friend. “I tend to use words such as, bling bling, word up, and fine because, as an English teacher and one of the younger educators, I can relate to such language and incorporate it into my teaching.” This is a quote from the high school English teacher Ms. Karen Davis, who proved very fluent in the slang terms of my generation. Ms. Davis goes on to say, “As I grow older and gain more experience as a teacher, I will become better able to communicate with my students and assert my role as a teacher.” This idea of incorporating generational dialects into the classroom is not uniform for this age group, however. According to the High School Basketball Coach and Junior High English teacher Mr. Daniel Armstrong, he generally tries to avoid the usage of slang in his teaching. However, my observations have not proven this to be true. I can think of several occasions where Mr. Armstrong has referred to some of his students as dog or man, and has on occasion used the term “ya know”. Most of these instances are for exaggeration more than real assimilation into the teacher‘s conversations, but still the influence remains.
Some of the younger teachers may be unaware of their use of slang terms because they use them in their everyday conversation. A New York Times report by Jennifer Lee presents the idea that the usage of text language is used by students in papers because of the constant bombardment from their peers on instant messenger sites. “I was so used to reading what my friends wrote to me on Instant Messenger that I didn’t even realize that there was something wrong,” said student Montana Hodgen in Lee‘s article. It is probable that the communication style used by certain younger teachers to students is more likely to include current slang terms because many of these terms are still used by these teachers outside of the educational field. Perhaps at this level of experience and age, a more independent stance is necessary so that the ability to learn how to deal with students is gained.
In Deborah Tannen’s book The Argument Culture the idea that education has its basis as a kind of confrontational battle ultimately fighting to break the hold of ignorance on the unreformed is presented (256-290). Tannen suggests that this form of teaching would be better replaced by a more respectful form. Tannen uses the “rules of engagement” from The New Golden Rule by Amitai Etzioni as the guide to how teachers might try to communicate with their students (288). Of these rules, two seem to relate to the use of slang in education: “Don’t demonize those with whom you disagree,” and “Engage in a dialogue of convictions: Don’t be so reasonable and conciliatory that you lose touch with a core of belief you feel passionately about.” The usage of slang in the classroom might be the younger teachers’ way of “not demonizing” their students by trying to seem reasonable enough to communicate in the most comfortable way for them. This idea was very apparent in the High School Basketball Coach’s dialogue with students. It almost seemed as if because of his age the students expected him to have a completely different dialogue with them than would teachers of different age groups. This could be because he is closer in age and thus would have a more closely related slang vocabulary. This makes the use of slang necessary in order to not “demonize” the students. The whole point of teaching is to encourage students to grow not only in abilities but also in confidence as they pursue their ambitions in life. For the latter part of the curriculum to be efficiently achieved, it makes sense that younger teachers would slacken their speech for student, especially those in high school. It would be detrimental to the teaching process if a younger teacher, relatively close in age to the students one teaches, presents a front of highly polished and fine tuned speech in their conversation since this may cause students to feel incapable of reaching this professional level achieved so quickly by one so close in age. The slang used by younger teachers helps them to show students that at one time they were students in high school as well. In doing so, teachers become able to show students that reaching their goals is just as possible as it was for them at that age. However, these teachers have to distinguish if using these slang terms means betraying their “core beliefs” of teaching formalized Standard English. As these teachers grow older, learning more about their individual teaching styles will help them communicate with their students.
The reversal of this idea is true for older teachers. In order to not demonize students they must not use current slang terms, because it would show a lack of professionalism and strength for the students. The older teachers represent the end product, or what the students are supposed to aspire to at least in the professional since. In this way the two groups act as a fail-safe of each other. The younger teachers encourage the students and the older teachers insure that they know what is expected of them in the future.
But, these two objectives might be destructive to each other if it weren’t for the mid-range of teachers providing a “pathway” between the two disciplines. If it weren’t for the mid-range of teachers whose dialogue bridges the reserve of the older with the relativeness of the younger, the apparent differences between the two might pit them against each other, at least in the eyes of the students.
So far, I have covered the correlation between age and teachers communicating with their students, but what other circumstances could affect communication? From the survey, I found some interesting results. When asked the question, “Have you found that, when talking with other teachers, you have to adjust your language to better communicate with older or younger teachers?” Older teachers expressed the need to adjust their language to better the communication with the younger teachers. “I may not have to, but I’m sure I do--and I do this without any real thought. Being one of the oldest members of the faculty is part of it. Younger teachers often seek advice. I’m sure I relate differently to them than someone of my age group.” (Padgett)
The views of the younger educators, however, differed from the perspective of the elders. “No. Most of the teachers that I teach with are not very old. I do not feel that there is that big of a gap between us.”(Comuzie, Sarah) This view then proved to vary between teachers of the middle age group, with some affirming and others denying the influence of age on inter-faculty relations. This could be due to the inexperience of the younger teachers to communicate with people of this age as colleagues, and also due to the older teacher’s inexperience with the common dialect of the younger teachers.
Communication is the key element to any learning environment, whether it is a student trying to learn from a teacher, a teacher trying to learn how to teach a student, or learning how to communicate with colleagues. The further study into the relationships in the high school environment and how ideas are communicated might increase the efficiency of the education process. For now, teachers must continue the trial and error method of learning how to communicate.
References
Lee, Jennifer “I Think Therefore, IM.” New York Times on the Web 19 Sept. 2002. 16 Feb. 2007
Tannen, Deborah. The Argument Culture: Moving From Debate To Dialogue New York: Random House, 1998.
“Teacher Communication Survey” - Padgett, Tyler- quotes from Padgett, Gloria Diane. Reid, Carol. Kevin, Brewer. Davis, Karen A. Comuzie, Sarah. Armstrong, Daniel.
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