Intended for healthcare professionals


Language is the culprit

BMJ 2000; 320 doi: (Published 05 February 2000) Cite this as: BMJ 2000;320:0

How would you answer the question: “How does that make you feel?” You might, for example, respond by describing your personal feelings. But if the question was asked during an oral examination for membership of the Royal College of General Practitioners and the examiners were trying to elicit your approach to managing a type of patient then that would be the wrong response and you might fail.

The college wanted to find out why so many Asian doctors trained overseas were doing badly in its oral examination, and on p 370 Celia Roberts and colleagues describe the detailed sociolinguistic discourse analysis that they undertook on the examination. They found three areas of particular difficulty for doctors trained outside Britain and with English not as their first language. Much of the information examiners seek is couched in “institutional discourse”—abstract analytical talk that practitioners use to discuss what goes on in, say, a consultation, yet in exams this is muddled together with discourse about personal experience and about professional issues. Such hybrid discourse is combined with the interactional complexity of an oral examination (examiners and candidates responding to each other) and questions on slippery areas such as values and attitudes. In an accompanying commentary Aneez Esmail and Carl May argue that educational organisations had better get their oral examinations right, or abandon them altogether.

Another place where language gets in the way is highlighted by Iona Heath and colleagues in their editorial (p 326). They endorse the definition of general practice proposed by Frede Olesen and others (p 354), with its emphasis on frontline care and integration of psychological, sociological, and biomedical perspectives, but they worry that in English “generalist” is the opposite of “specialist.” This contrast, they argue disadvantages general practitioners in the political machinery of training standards in the European Union. To enhance their training and status general practitioners are thinking of claiming specialist status.

Meanwhile Phil Alderson and Ian Roberts lament the liking of English language editors for dramatic findings (p 376). Systematic reviews that show no evidence to guide practice tend not to get published in prominent journals, yet the fact that there is no good evidence for an intervention is important and can make it easier to perform subsequent trials—as, for example, with the current MRC trial of corticosteroids in head injury. Moreover, reviews are more likely to have dramatic findings if their methods are weak. “Uncertainty is the lifeblood of clinical research,” say the authors, and they urge editors—and readers—to embrace it.


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