The invitation to join the Workshop “Minimal English and Natural Semantic Metalanguage” in Canberra, inside the beautiful Australian National university, was the occasion to share and analyse a systematic reflection about the utilize – and the over-utilize – of English terms in the healthcare communication, between doctor and patient, between caregivers and managers inside the organizations.
In almost 6000 narrations collected in the last years by the Healthcare and Well-being area of ISTUD Foundation in the different context of care explored, the topic of communication recurs over and over talking about care relationships, starting from the language utilised. Some dialogues are remembered after years, after the healing, because of the wall that could have erect, because some words or inappropriate expressions could have injured, or compromised irreparably a relationship of care; otherwise, we remember the words of comfort, of understanding, affinity, little gestures of attention.
We wonder about how the utilise of “Anglicism” could influence the fluency of a communication inside a way of care, from the point of view of who discover of having a disease and have to start a therapeutic journey, and from the point of view of the professional that receive communications from his management and from his scientific community, and then have to translate the content to his patients. Abbreviation, technical jargon and English terms, the communicative wall is always more insurmountable. There are 8941 acronym utilised in the medical vocabulary, some of them are in Italian, others just in English [1].
We have examined three levels of healthcare communication, that correspond to three organizational levels where the narrations it’s applicable: the doctor-patient communication, the one between healthcare professionals and the one inside the healthcare system.
The doctor-patient relational level it’s the most circumscribed, contextualized inside the doctor’s room or in the clinic. In those rooms starts the care relation, the anamnesis are collected, the diagnosis are communicated, the therapies are illustrated and therapeutic project, also of long term, are established. Analysing the patient’s diaries and the doctor’s parallel charts, are many the recurring Anglicism, from both the sides: chek up, follow up, therapeutic output, transitional care, screening, device, all expressions that are normally utilised. There are also places and departments that by now are called directly in English: day hospital, day surgery, trauma center, breast unit, hospice. Inside the specific of some care setting, technical terms and English terms are melt together. For example, in the stories of preservation of the feminine fertility they talk of embryo transfer, criotransfer, pick up. In the stories of cardiology, they talk of push, bypass, stroller, puffer, stent, heart risk score.
The communication between healthcare professional it’s strongly influenced by terms that came from the scientific research, necessarily in English: paper, abstract, submission, impact factor, survival, biomarkers, range, survey, clinical trial, case study, proceeding, all expressions “imposed” by the international scientific community. The most valid and licit sources of upgrade and in-depth analysis are in English, so it’s to spread and promote an Italian clinical research it’s necessary being able to translate it in scientific English. It’s not a coincidence that the articles of scientific research submitted to international reviews by Italian professionals register a high degree of refuse, certainly not for a lack of quality in the contents, but only for the linguistic barrier, for the difficulties to uniform with the scientific English. But also in the clinical practice are usually utilised expressions like burn out, border line, compliance, target therapy, aging, burden of disease, and many others, utilised inside the “team”, another English word.
But it’s in the setting of the organization and management of the healthcare structures that we have the highest use of Anglicism, when the healthcare setting meets the managerial organizational one, importing the language that came from the business world: data manager, risk manager, management, decision maker, turnover, briefing, budget, fee, business plan, performance, spending review, vision, mission, timeline, clinical governance, standard, FAQ (Frequently Asked Questions), stakeholder, call center, feedback, customer satisfaction, privacy, ticket, patient journey, check list, flow chart, empowerment, e-health…and we can continue. For example, the 22nd September 2016 the Healthcare Minister promoted a national initiative of awareness about the theme of the preservation of fertility, literally the “fertility day”, but called in English. Or once again, often speaking of applicability of cares we utilize the term “dr shopping”, meaning the wandering of people searching answers of care through expertise centres and specialists; indeed, we don’t have an Italian word for that. We (alas!) talk of Medical Humanities, unsatisfied of the partial translations of our language.
What is the origin of all those English terms? Internet it’s one of the first sources, especially for the patients that consult internet to find out information about specific diseases and conditions. Scientific research instead it’s the primary source for the healthcare professionals, but not the only one. The healthcare structures where they work are managed from a long time like real companies, and the managements also adopted a “business” language, riche of English terms and expression.
What narrations are telling us is that English terms and technical terms, contrary to what we could think, are utilized not only by healthcare professionals but also from who is under care, patients and relatives. People under care, indeed, uses to adopt the language by their medical referent, even if very technical, in the moment when they recognise a familiarity with some terms. The difference consists in the fact that patients, before of adopting that language, have to turn into experts, to understand their health conditions, the therapeutic way and, above all, their reference caregiver. So there’s a first phase of approach to the disease and to the cares that could be lived with further difficulties due to a linguistic and cultural barrier that instead could be simplified by a smaller recourse and abuse of English and technical terms and by a return, where it’s possible and reasonable, to the Italian language.
Moreover, the recourse to English terms it’s connected to a language strictly focalized on the clinical and mechanical aspects of the disease, where the disease it’s interpreted like something that “broke” a part of the body; in English it’s called disease, in Italian the closer term probably it’s patologia. The growing use of this disease centred language, means going towards a technical approach to the disease and to who is under care, while it’s a long time that we recognize the need of expand the perspective integrating the personal experience with the disease, in English called illness, and that we can translate, again, utilizing an expression (with this lack in our vocabulary), “people that is living the disease”. From narrations emerge that the utilised English terms refers to the most clinical, technical and organizational aspect of cares, while to express emotions, the daily and relational living, it’s utilised the mother tongue language.
The possible role of Minimal English. In the actual context, therefore, the web universe inevitably introduces English terms and new expressions for the commune utilisation, the scientific world makes English the universal language of reference, the healthcare management is a “business model” also in the expression utilised; however, this same context highlights the need of simplify the language utilised in the healthcare communication. In the research of balance, Minimal English could be one of the keystones of this process. What is Minimal English? This concept was proposed for the first time by Anna Wierzbicka and Cliff Goddard in the 2014, two linguists and professors of the Canberra and Brisbane University, in Australia. It’s the result of a thirty-year work of research and analysis of almost all the languages of the world, with the purpose of find out a uniform version, “reduced” and simplified of English, that could be utilized by people that talks different languages, like a tool to simplify the intercultural understanding, where for different cultures we could mean different contexts. Not only, but to any Minimal English corresponds a Minimal Italian, a Minimal French, and so on for any languages. It’s a vocabulary of about 6000 terms considered “half-universal” for their simplicity and uniformity of meaning translated in the different possible languages. The purpose it’s also to limit the effects of the “English-centrism” that could impose in a global level English meanings and terms [2].
So, using terms included in the Minimal Italian into an healthcare communication, could means to find out a commune unequivocal language both for the physician and for who is under care, turning into one of the tools that help communication in the first phases of a way of care, that help to be familiar professionals and patients, to know the disease and the necessary therapy, to translate all the different cultural and context meanings in shared and commune expressions.
It was an honour and a pleasure meet Anna Wierzbicka, being her guests inside her study group at the Australian National University of Canberra, listening the possible practice translations and the real implications of the utilisation of this universal language in the healthcare communication. The Minimal English project it’s still in progress, but we hope that the practice application of this tool will help the spread and the development of the simplification process of the language utilised in the healthcare.
Like the narrations say, sometimes it’s necessary just one word, the right one, to make the difference, feeling cared o “real” caregiver and define the destiny of a way of care.
Download “English words and concepts used in healthcare in Italy”.
Notes
[1] Acronimi italiani e anglosassoni usati in medicina (a cura di Gilberto Lacchia, MD e Joseph Tein, MA) Acromed
[2] Cliff Goddard. Minimal English for a Global World: Improved Communication Using Fewer Words. 2017, in progress
