Living the Language

A doctors’ guide to English usage

in British life and work
Everyday I need to participate
in such meetings. Initial days of
coming to this country I used
to find difficult to understand
accent of some people. But
with time it has been easier and
now I am very comfortable to
speak on the public platform.
Binny
Introduction
Notes for readers
I’m pleased to bring you Living the Language
– a new resource designed to help overseas The term ‘patient’ is used to refer to any person
doctors working in the UK healthcare system receiving care in a UK healthcare setting, be that a
develop their English communication skills. care home resident, hospital inpatient, outpatient,
individual seeking therapy or any other healthcare
Living the Language has been created to help service user. While much of the content refers to
with the communication challenges overseas a hospital context, the material is also relevant to
doctors experience when they start working in workers in other UK healthcare settings.
the NHS. It includes practical advice on coping
with local accents, working with teams, written
documentation and speaking on the phone,
plus lots more guidance to help new hires
adapt and integrate into their workplace and Share your feedback
wider British society.

The publication of Living the Language has This is the first ever edition of Living the Language for
been supported by Doc2UK, Health Education Doctors and we’d love to know what you think of it. Your
England and NHS Employers and includes input feedback will help us ensure the content provides the best
from overseas doctors now working in the NHS possible support for future doctors coming to the UK. Which
who have shared their own experiences in order sections did you find the most helpful? Is there anything
to help others. OET is committed to supporting missing that you think we should include? Let us know!
overseas doctors beyond the English test as
a helpful partner on the candidate’s journey Tell us what you think
to their dream job as a registered doctor in an
international healthcare setting.

Mickey Bonin
OET, UK.

Naveen’s top tips for new

doctors practising in the UK
1. Put your PATIENT AT THE HEART OF
DECISIONS you make. Do not hesitate to
seek help from your seniors or ask a patient
to repeat what they have just said if you
didn’t understand. That could be the most
important part of the diagnosis.

2. Familiarise yourself with the NHS

Trust or NICE guidelines in patient
management. This will help a lot of
decisions become easier.

3 | Living the Language | A guide for doctors

Contents
05 Introduction to the NHS 21 Active listening

06 How the NHS works 22 Plain English and paraphrasing

07 UK-specific health issues Asking for consent

23
09 1. Workplace communication 25 The language of bad news

10 Working as part of a team

27 Avoiding discriminatory language
11 Understanding medical terms and abbreviations
28 3. Social Communication
12 Using SBAR to improve clinical communication
29 Slang and idioms
14 Participating in meetings
29 Local accents and dialects
15 Documentation
30 Manners and etiquette
16 Revalidation and CPD

31 Topics and conversational behaviours

17 2. Patient Communication

18 Person-centred care 32 Humour

19 Establishing rapport 33 Indirect speech and understatement

20 Hello, my name is 34 Bibliography

Introduction to the NHS

The UK’s National Health Service The role of the NHS

or NHS was established by the
Minister of Health, Aneurin Bevan Taking care of its citizens from ‘cradle to grave’ (Aneurin
Bevan, 1948), the NHS occupies a very special place in
in 1948. Today, not only is the NHS UK society. A survey by the Kings Fund in 2017 found
one of the biggest employers in the that 77% of the population believed that ‘the NHS is
crucial to British society…’.
world, it is the largest employer in
the UK, employing around 1.3 million We think of the NHS as a ‘national treasure’ and regularly
celebrate its achievements and its employees, including
staff, roughly a third of whom were on postage stamps and even during the opening
trained overseas. ceremony of the 2012 London Olympics.

Support for the NHS during the COVID-19 crisis in 2020

was overwhelming. In homes across the country people
sewed scrubs for hospital staff while neighbours came
together once a week to applaud the work of our
NHS staff.

During this time, the nation was also inspired by 99-year-

old ‘Captain Tom’. The World War II veteran who raised
nearly £33 million for NHS Charities by walking around
his garden following a hip operation later received a
knighthood from the Queen, becoming Captain Sir Tom
Moore (1920–2021).

References
The King’s Fund. (2017, October 6). How does the NHS in England
work? Retrieved from:
https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-
england-work
INTRODUCTION TO THE NHS

How the NHS works Emergency & urgent care

999 is the number to call for emergency care. However,
It’s important to understand how your patients access there are various services providing urgent, but non-
their healthcare, especially as it may be quite different emergency care. These include NHS Walk-in centres
from healthcare provision in your home country. open 365 days/year without an appointment, out-of-
hours surgeries, open all day, as well as weekends and
Healthcare in the UK is provided by the government
holidays, and minor injuries units.
and paid for by taxes. The NHS delivers GP services,
Accident and Emergency care (A&E), hospital services UK patients tend to rely heavily on their GP and are less
and social care for free. likely to visit a specialist, including a pharmacist. Often
GP surgeries dispense medications or, on occasion,
Accessing the NHS refer a patient to a pharmacy to collect a medication.
In recent years however, public health campaigns have
To access NHS healthcare and treatment, everyone is encouraged people to visit their local pharmacy for minor
required to register with a General Practitioner (GP) at a ailments or contact NHS 111, a free 24-hour telephone
GP practice, usually the one nearest to their home. The service, for healthcare support and advice.
GP practice, or surgery, is where one or more GPs as
well as other community healthcare professionals, e.g.
nurses, midwives, dieticians deliver their services. Once
Paid services
they have registered, patients receive an NHS number While most services are free, there are some private
which entitles them to NHS services for life. services, charged at NHS rates. Most patients pay for
their dental and eye care treatment and prescriptions,
Primary v. secondary care for example. However, certain groups are exempt from
paying for these services, including anyone over 60,
The first point of contact for all non-urgent healthcare children under 16 and the unemployed.
is the patient’s primary care provider, e.g. GP or dentist.
If necessary, the GP or dentist will refer the patient to a The cost of medications in NHS England is universal.
secondary care provider or specialist, e.g. cardiologist, Irrespective of the cost of the medicine (£1000 for
dental surgeon, etc. via a medical referral letter. Once a cancer drug or 50p for paracetamol), a universal
the specialist has provided the necessary treatment and prescription cost applies to most patients (unless in
care within the hospital setting, the patient will then be the exemption group described above).
discharged back to their primary care provider.

What is an NHS Trust?

You will hear people refer to a local hospital as an
NHS Trust. An NHS Trust is a legal entity set up under
the NHS Act 2006 to provide goods and services for
the purposes of the health service. NHS Trusts act as
Healthcare Providers and provide hospital services,
community services and other aspects of patient
care, They may also act as commissioners when sub-
contracting patient care services to other providers of
health care.

References
NHS Data Model and Dictionary. Retrieved from
https://datadictionary.nhs.uk/nhs_business_definitions/nhs_trust.html

The King’s Fund. (2017, October 6). How does the NHS in England
work? Retrieved from:
https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-
england-work
6 | Living the Language | A guide for doctors
UK-specific health issues

Common causes of death

Considering the health risk factors and the leading causes of death in the UK, will give you a better understanding
of your patients. Disorders related to the heart brought about by high blood pressure are the most common causes
of death in the UK, with cancer predominantly caused by smoking coming in second.

Leading causes of death in perspective

war
pregnancy & birth
medical complications
heart & circulatory murder
disorders undetermined event
cancer mental health disorders
transport accidents
respiratory suicide
disorders
musculoskeletal disorders
nervous system diabetes
disorders
non-transport accidents
infections
kidney disorders Source
digestive disorders NHS Atlas of Risk (2017)

Risks leading to death in perspective

high blood war

pressure pregnancy & birth
smoking medical complications
murder

high cholesterol illict drug use

transport accidents

obesity non-transport accidents

infections
alcahol
Source
physical inactivity
low fruit and vegetables NHS Atlas of Risk (2017)
UK-SPECIFIC HEALTH ISSUES

Ageing population Obesity

By 2050, it is projected that one in four people in the UK Obesity is now a major public health issue in the UK,
will be aged 65 years and over. Co-morbidities of older with 36% of the adult population in 2019 classed as
patients in the UK tend to be diabetes, cardiovascular overweight and 28% as obese. Likewise, childhood
diseases (hypertension, angina) and chronic respiratory obesity is one of the biggest problems currently being
diseases (asthma, chronic obstructive pulmonary disease faced. In England nearly 25% of all five-year-olds are
(COPD)). Dementia is also quite prevalent, with one in six obese or overweight, rising to one third by the age of 11.
people over 80 living with Alzheimer’s disease (62%) or The government Childhood Obesity: Plan for Action aims
vascular dementia. to ‘halve childhood obesity […] by 2030.’

Care for the elderly is carried out either informally by

family members or formally in residential homes, known Alcohol use
as care homes. These are run privately and depending
The UK’s relationship with alcohol might also be very
on the financial situation of the person concerned can
different from your own country. In 2016 Drinkaware
be free. Specialist care homes exist, caring for those
noted that adults in the UK drink on average 11.4 litres
with dementia, for example. Recognising the difference
of alcohol a year, the equivalent of 22 units a week
between a residential home (with wardens), a care
compared with 6.4 litres across the rest of the world.
home (with carers) and a nursing home (with nurses)
Drinking large quantities of alcohol over a short time
is important as it helps with offering specific services
period – usually Friday and Saturday evenings – is part
for discharged patients e.g. a nursing home can offer
of the culture for many, regardless of age, gender or
procedures such as injections, whilst care homes and
social background. Sadly, this has quite a significant
residential homes cannot.
effect on hospital admissions both directly and indirectly.
Understanding the discharge destination of patients is
crucial as it forms an important part of decision making.
It is important to ask the right questions early enough to
determine and plan the best final discharge destination 358,000 admissions to hospital
for the patient. in 2018/19 where the main
Bed blocking is a big problem in the NHS as it reason was due to drinking
restricts other patients admission and costs the NHS
a lot of money.
alcohol. 6% higher than 2017/18
and 19% higher than 2008/9.

38% of men and 19% of women

aged 55 to 64 usually drank over
14 units in a week
Source

References Statistics on Alcohol in England (2020)

Age UK. (2019, May). Later Life in the UK. Retrieved from:
https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/later_life_uk_factsheet.pdf

Department of Health and Social Care. (2018, June 15). Childhood Obesity: a plan for action, Chapter 2. Retrieved from:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/718903/childhood-
obesity-a-plan-for-action-chapter-2.pdf

Drinkaware. (2016, April 9). UK comparisons with other countries. Retrieved from:
https://www.drinkaware.co.uk/research/research-and-evaluation-reports/comparisons

NHS Digital. (2020, Feb 4). Statistics on Alcohol, England 2020. Retrieved from:
https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-alcohol/2020

Nuffield Trust. (2021, January 27). Obesity. Retrieved from:

https://www.nuffieldtrust.org.uk/resource/obesity

Office of National Statistics. (2021, January 14). An overview of the UK population. Retrieved from:
https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/
overviewoftheukpopulation/january2021

8 | Living the Language | A guide for doctors

1.

Workplace Communication

In this section we highlight the of communication that overseas

different ways of working that you doctors are often challenged by,
may encounter in English-speaking e.g. participating in meetings and
healthcare systems. We address the handovers, written documentation and
concept of a ‘collegial’ style of working record-keeping and we offer guidance
and the challenge this may pose to on understanding the special language
overseas doctors unfamiliar with this of your setting – the abbreviations and
feature of hospital life. We provide medical terms you’ll need to know.
advice on some practical aspects
1. WORKPLACE COMMUNICATION

Working as part of a team Here are some points to bear in mind

as you work in your team:
Don’t be afraid to ask for help or advice from your
team members – junior doctors, nurses, other allied
healthcare professionals as well as your seniors
Naveen says...
Don’t assume you know the roles and responsibilities
“Sometimes it does come as a surprise
of your team
when a doctor/nurse challenges a decision
made by an overseas doctor. It took time to
get acquainted with this approach which I Respect the opinions and expertise of the others
now feel is the correct way of doing things. in your team
Challenging a decision doesn’t imply
offending...” If necessary, explain to patients you are interested in
getting a second opinion; patients prefer honesty and
appreciate there is a multi-disciplinary team approach
to healthcare
Binny says...
Question your team member’s decision if you feel it is
“Few occasions my decisions have
misplaced, even if you are wrong
been challenged by nurses and therapists
which was something very different
compared to my home country. I feel Be assertive if you feel you are being taken advantage
it is important to express their opinion of or pressured
for the best patient care.”
Remember you are all working towards a common goal

Doctors from your country may have similar experiences How can you learn more about
to Naveen and Binny. However, you’ll notice that in the your team?
UK doctors, nurses and other practitioners function as
one team, adopting what is known as a multi-disciplinary,
person-centred approach. Ask team members about
their expectations

Attend multi-disciplinary meetings to

understand who’s involved and their different
What differences might you notice roles and responsibilities
about your new working environment? Research the roles within your setting so you
understand where you fit in
Being part of a multi-disciplinary clinical and
social care team – nurses, physiotherapists, Observe colleagues as they interact and
nutritionists, pharmacists, occupational identify and copy appropriate behaviours
therapists and social workers, among others

Realising nurses are expected to make

decisions independently of doctors’
instructions

A higher level of teamwork between

doctors and nurses

A flatter, more flexible hierarchy

10 | Living the Language | A guide for doctors

1. WORKPLACE COMMUNICATION

Understanding medical terms Phone/Tablet Apps

and abbreviations Medical Dictionary by Farlex

Many overseas doctors are faced with difficulties Oxford Handbook of Clinical Medicine – Ian Wilkinson
understanding medical terms and abbreviations used
in the NHS on arrival in the UK. There are a number of
sources to help you find meanings for words, acronyms
and phrases you are unfamiliar with. It is worth asking Reference Books
your employer for locally created crib sheets or lists of
commonly used local words and phrases. Oxford Concise Colour
Medical Dictionary

Medical Terminology:
NHS Lists The Best and Most Effective
Abbreviations commonly found in medical records Way to Memorize,
Pronounce and Understand
Acronym Buster Medical Terms:
Second Edition

Trust-created Lists Other ways you can help yourself

Your Trust may produce their own like this one from
Southern Health NHS Foundation Trust Asking colleagues to define terms

List of Abbreviations produced by Clinical Staff for

use within Health Records
Using Google to clarify terms

Taking a course

Engaging in self-study

11 | Living the Language | A guide for doctors

1. WORKPLACE COMMUNICATION

Using SBAR to improve Why is SBAR used?

clinical communication Provide structure to the information giving process
SBAR is a tool that was originally designed for the US Facilitate the passing of all essential information
Navy. It has since been adapted for the healthcare in the right amount of detail
setting to improve both spoken (face-to-face and by
phone) and written communication. Allow staff to communicate their message clearly,
succinctly and assertively
When is SBAR used?
Avoid the need for repetition and delay
Here are some of the ways the NHS encourages the use
of SBAR during the patient journey: Help staff anticipate the information they are going
to hear
GP referral letter
Make sure roles and responsibilities are clearly
Consultant to consultant referrals understood

Movement of patient between areas of diagnosis, Save time

treatment and care
Ensure patient safety
Handovers

Discharge back to the patient’s GP or community care setting

12 | Living the Language | A guide for doctors

1. WORKPLACE COMMUNICATION

How does SBAR work?

SBAR stands for Situation, Background, Assessment, Recommendation. These questions will help you provide the right
information for each stage of the process:

S – What is happening at the present time?

B – What are the circumstances leading up to this situation?

A – What do I think the problem is?

R – What should we do to correct the problem?

And here are examples of language that can be used

to communicate the information required:

SBAR COMMUNICATION TOOL

I'm (name), I'm the SHO on the ward this evening.

S
SITUATION
I am calling about one of your patients, (patient X).
I am calling about ... (patient X's test results).
I'm ringing to see if we can ... (arrange for transfer of patient X, discuss ...).
The situation is ...

The background (to the situation) is ...

B
BACKGROUND
Patient (X) was admitted on (XX date) with ... (e.g. MI / chest infection).
He's had (X operation/procedure/investigation).
Patient (X)’s condition has changed in the last (XX mins).
His obs were within normal limits / His post op bloods are ...

A
My assessment is that ...
I think the problem is ...
I'm worried / concerned about the possibility of ...
ASSESSMENT And I have... (e.g. given O2 / analgesia, stopped the infusion).
OR I am not sure what the problem is, but patient (X) is deteriorating.

I'm considering ...

R
I need you to ...
Could you come and see the patient in the next (XX mins)?

RECOMMENDATION AND Is there anything I need to do in the meantime?

(e.g. start IV antibiotics / ask the nurses to repeat the obs)

The SBAR tool orginated from the US Navy and was adapted for use in healthcare by Dr M Leonard and
colleagues from Kaiser Permanente, Colarado, USA

13 | Living the Language | A guide for doctors

1. WORKPLACE COMMUNICATION

Participating in meetings Leading meetings

When it comes to taking the lead during a meeting
Some overseas doctors struggle with stating their point or handover, it’s important to be able to manage that
of view succinctly and effectively in English. This may situation effectively. Make sure you:
especially be the case in a larger group during multi-
disciplinary meetings.
Make introductions (i.e. to the patient) if necessary

Avoid dominating the meeting

Listen carefully and respectfully to others

Binny says... Avoid and discourage interruption

“Everyday I need to participate in such
Encourage input from your team
meetings. Initial days of coming to this
country I used to find difficult to understand
accent of some people. But with time it has If the patient is present, take care to involve them
been easier and now I am very comfortable where possible
to speak on the public platform.”
Obtain patient consent for further continuation, when
necessary

Provide a good role model to medical students and staff

members training

Summarise the key points and highlight the plan of action

and/or goals for the day

How to communicate more effectively in meetings and handovers

Indicate a new topic Now, let’s look at (patient name)’s

Finish a point That’s all for the (past medical history).

Return to the main point As I was saying …

Explain something more

What I mean is …
clearly

Make a suggestion Can I make a suggestion …

Encourage input from team (Nurse’s name) did you have any input from the nursing side?

Inviting questions Does anyone have any questions?

Involve the patient Is there anything you would like to add, (patient’s name)?

Check there no other

Any other comments before we finish?
comments
Signal the end of the
I think we’re coming to the end now
handover

So, to summarise … / Just to recap …

Summarise
Let’s go over what we’ve agreed …

14 | Living the Language | A guide for doctors

1. WORKPLACE COMMUNICATION

Documentation What are the challenges?

Writing quickly
Good record keeping is vital for effective
communication and integral to promoting Being clear – can it be read by another doctor, nurse
continuity of care and safety for patients. or medical specialist
In the worst-case scenario written documentation also
Knowing what to write and what not to write
provides evidence should there ever be a complaint
from a patient about their treatment.
Knowing how much to write
Examples of written documentation might include:
Getting the tone right
Handover notes

Care plans
How to overcome them
Admissions paperwork Familiarise yourself with templates used in your setting

Read good examples from other doctors

Medication and observations charts to understand what is expected

Referral letters/emails Adopt the writing style of colleagues

Memorise and employ standardised

Discharge summaries/emails sentences and phrases

Overseas doctors sometimes struggle with written Practice using best practice templates
forms of communication. This may be due to differences e.g. OET Referral Letter
between the new workplace format and that with which
the doctor was previously used to. Find a favourite pen brand that is clear, dark,
legible and comfortable

Refer to superiors or your mentor

Naveen says... Speed up your typing with a free typing tool like
“Documentation is much more detailed in www.typingclub.com or rapidtyping.com
the NHS compared to the one in India. The
challenge is that an average patient speaks
for 5 mins conveying at least 20 salient
points. We have to document all these 20
points irrespective of their pertinence to the Know your responsibilities
diagnosis or management of the patient.
This is hard to document whilst we have for record keeping by checking
hardly 20 mins to spare on a patient..”
> R
 CP: Generic medical record keeping
standards
Parmvir says...
“I have to clerk in patients and do clinic
> GMC: Good Medical Practice (page 9)
letters. Challenge I faced was that letter
has to detailed and it quite difficult to get > M
 edical Protection: An Essential
detailed letter always right.”
Guide to Medical Records

15 | Living the Language | A guide for doctors

1. WORKPLACE COMMUNICATION

Revalidation & CPD Reflective writing

If you chose to reflect on an encounter with a patient,
you should do this in writing (reflective writing) and
What is revalidation? submit it to your supervisor during your annual appraisal.
As a doctor working in the NHS, you will be asked to For some overseas doctors reflective writing might
revalidate your GMC licence every five years to ensure sound a daunting task, but it doesn’t have to be. Samples
you are still fit to practice. Your annual appraisal with of reflective writing can be fairly short – 150–200 words
your supervisor or Responsible Officer is part of the – and the GMC proposes this series of simple questions
revalidation process. During the appraisal, you will be which you can use as a guide:
asked to provide examples of your work and will also
have the chance to discuss areas for development over
the coming year. This process ensures you’re keeping
yourself up-to-date with current practice and offering What’s the issue you reflected on?
safe, most recent and best management and care of
What made you stop and think?
your patients.
There are many ways to reflect – how did you do it?
What is Continued Professional
What did you do?
Development (CPD)?
Continuing Professional Development (CPD) is the Tell us what you took away or learned from this
development of the skills you need to carry out your role experience?
effectively. During your annual appraisal you will need
to demonstrate you have completed around 50 credits/ How did it change your thinking or practice?
hours of CPD.
Has it improved your practice and outcomes?

What areas and activities should

I choose for my CPD? CPD Reflective Narratives provides some examples
of reflective practice written by NHS doctors from
The skills you choose to develop depend on you different specialisations. For more on Reflective
and your needs and/or the needs of your team. CPD Practice visit the GMC website. https://www.gmc-uk.org/
activities can be a mix of formal learning e.g. attending education/standards-guidance-and-curricula/guidance/
courses such as Advanced Life Support, speaking at reflective-practice
an international conference, attending a workshop
on leadership skills, or informal learning, e.g. reading
and online research, reflecting on an encounter with
a patient.

References
General Medical Council. (2019, December). Guidance for doctors:
requirements for revalidation and maintaining your licence.
Retrieved from: https://www.gmc-uk.org/-/media/documents/
revalidation-guidance-for-doctors_pdf-54232703.pdf

General Medical Council. (2012, June) Continuing professional

development. Guidance for all doctors. Retrieved from: https://www.
gmc-uk.org/-/media/documents/cpd-guidance-for-all-doctors-0316_
pdf-56438625.pdf

General Medical Council. (2015, February 15). Reflecting on an

experience: breaking bad news. Retrieved from: https://www.
gmc-uk.org/education/standards-guidance-and-curricula/guidance/
reflective-practice/breaking-bad-news

The CPD Certification Industry. CPD in the Healthcare & Medical

Industry. Retrieved from:
https://cpduk.co.uk/industries/healthcare-medical

16 | Living the Language | A guide for doctors

2.

Patient Communication

Doctors tell us that tasks related to

communicating with patients and their
families present one of the greatest
challenges when starting work in a new
English-speaking setting. Difficulties
can arise from the ‘person-centred
care’ model, an approach to healthcare
which may be new to incoming doctors
and different to the accepted model
of care in their home country.
2. PATIENT COMMUNICATION

Person-centred care It requires that:

We think about the effect of what we’re doing
What is person-centred care? on the person as a whole

How is it different to the model of care in other We act on what people want when we plan
countries where you trained/worked? and deliver their treatment and care

What communication challenges may this pose We always have the person’s safety, dignity,
for you as an overseas-trained doctor? comfort and well-being uppermost in our mind

Person-centred care is the predominant model of care We communicate well across multidisciplinary
within the NHS. Some of its features may be familiar to teams to meet the person’s needs
you, others will be strange and even clash with your
previous ways of working.

Communication challenges presented

by person-centred care
Gautham says… Working across teams
“Care is more holistic here when compared
to India when we mostly focus on Need to build rapport
medical aspects.”
Requesting consent from the patient for all aspects
of their treatment and care

Parmvir says... Providing information in a format that is acceptable

“Over here in UK we not just look after to them and helps them make decisions
a patient’s medical condition we sort out any
social issues, family problems etc. In India, Explaining complex information in plain English
all that is patient’s problem.”

References
Person-centred care General Medical Council. Duties of a Doctor. Retrieved from:
means that: www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/
good-medical-practice/duties-of-a-doctor
Care focuses on the individual’s particular
healthcare needs

The person is an equal partner and

active participant in the planning of care

Their opinions are important

and respected

They are involved in decisions at every step

of their treatment and care

Workplace procedures are patient focused,

rather than task focused

18 | Living the Language | A guide for doctors

2. PATIENT COMMUNICATION

Establishing Tips on building rapport

for overseas doctors
rapport
Use a clear introductory routine involving a concise
opening statement (see #Hellomynameis section on
What is rapport? page 20)

O’Toole defines rapport as the development Make use of small talk to help engage with the patient
of a therapeutic relationship based on mutual
understanding (respect, empathy and trust) (O’Toole,
Use body language to show empathy e.g. maintaining
2016). Establishing rapport is a central concept in the
steady eye contact, using open posture (not folded arms)
model of person-centred care.
and positive facial expression

Listen actively to the patient (see page 21)

Why is it important
to establish rapport? Employ the cone technique (open followed by closed
To gain a patient’s trust questions) to encourage the patient to tell their story

To make them more receptive to the care Explain procedures and conditions with confidence and
you will be giving in a language the patient can comprehend (avoiding
medical jargon or terminology)
As preparation for gaining consent for
care or medical intervention Deliver information in small chunks using signposting
(linking words) to ensure the message is clear
To reassure a patient and make them feel
acknowledged and valued Ask for clarification and check for understanding where
necessary

Rehearse important conversations (e.g. breaking bad

news) before speaking to patients
Some obstacles to gaining rapport
Concerns about miscommunication through accent or
misunderstanding local expressions

Being task focused rather than patient focused

References
Time constraints through pressure of work
Adapting to British Culture, Ramesh Mehta and Raj Kathane,
BMJ Careers (2004)
Misunderstanding subtleties of the patient’s language or
non-verbal cues

Being unaware of differences in patient expectations

of their healthcare

19 | Living the Language | A guide for doctors

2. PATIENT COMMUNICATION

#hellomynameis Why use

The #hellomynameis initiative was launched in 2013 #hellomynameis

by Dr Kate Granger MBE, who was a doctor, but also a
terminally ill cancer patient. While she was in the hospital Repeatable phrase that is easy to remember
as a patient, she noticed that so many of the doctors and
nurses and other healthcare professionals who looked Use to quickly establish rapport
after her didn’t introduce themselves. She wanted to and build trust
remind healthcare workers about the importance of
introductions, not just as a courtesy but as a way to A confident introduction brings patient comfort and
establish a human connection between one who is reassurance (I am in safe hands)
suffering and another who wants to help.
Good for use with all types of patients

https://www.hellomynameis.org.uk/

20 | Living the Language | A guide for doctors

2. PATIENT COMMUNICATION

Active listening
Skills of active listening
What is active listening?
Use the cone technique (open followed by closed
questions)
Why is it important?

Tips on active listening for overseas nurses Ask open directive questions: for example: “How have
you been since I saw you last?”

Active listening is possibly one of the most important

Look and listen for cues
skills in the doctor’s toolkit and is the basis of the
person-centred approach. A doctor who listens actively
takes responsibility to understand what the patient is Reflect back to show you have heard what was said and
saying and how they are saying it and then acts on what to expand the conversation
they’ve heard.
Use positive body language – maintain open posture
and good eye contact, use gestures

Benefits of active listening

for the doctor Phrases to help you become
a good active listener
Demonstrate you are listening to the patient and are
interested in them and their story
Encouraging the patient’s perspective: “I’ve got an
Listen to the ‘whole’ person (their illness and how it is idea why you’ve come into A&E today, but I’d like to
affecting them) hear the story from your side, if that’s OK.”

Observe the patient more closely, picking up on verbal Exploring cues: “You said you’re ‘not with it’. Can you
and non-verbal cues tell me more about that?”

Gauge the patient’s emotion and respond appropriately Screening: “Is there something else on your mind?”

Avoid making assumptions and premature hypothesises Clarifying: “You said you’re ‘not with it’. From what
you say, it sounds like it’s hard to concentrate?

Reflecting back (echoing):

Benefits of active listening Patient: I thought I’d bounce back after the surgery,
but that hasn’t happened.
for the patient Doctor: Bounce back? (pick up on the cue and
pause for the patient to say more)

Allows the patient to feel respected and treated

with dignity

Gives the patient the time necessary to express

themselves adequately
Oindrilla says...
Personalises the experience for the patient
“Sometimes patient will not tell you the
history and be ‘rude’ and say it’s in my
Enables the patient to participate more fully in the file. This is where it is best to explain that
consultation yes they might have to repeat their history
again, but you want to listen with fresh ears
Encourages the patient to take greater as to not miss something important or they
responsibility for their healthcare might remember something important.
You’ll definitely see their notes but a fresh
perspective is always good.”
References
Skills for Communicating with Patients, Silverman, Kurtz and Draper
(2005) Radcliffe
21 | Living the Language | A guide for doctors
2. PATIENT COMMUNICATION

Plain English ‘What this means is …’

and paraphrasing ‘In other words, …’

An important part of person-centred Check the patient’s understanding using

communication is learning how to talk expressions like:
about medical issues using words that
‘Does that make sense?’
a patient without a medical background
can understand. Equally important is
‘Do you have any questions at this point?’
understanding exactly what the patient is
saying. Paraphrasing as well as summarising, When you paraphrase the patient’s words, start by
clarifying and checking are effective tools for saying ‘If I’ve understood (you) correctly, …’ Then to make
doing this. sure you have understood completely, ask:

‘Is that right?’ or

Why is it necessary?
For having effective conversations with a doctor, ‘Is that an accurate summary?’
patient and family. In this role doctors are often called
on to summarise, paraphrase or translate into plain Do not move forward if you don’t understand or would
English sometimes complex medical scenarios like others present to help with understanding.

For gaining consent. Patients and their families must

be able to understand the care or treatment they are
consenting to

For checking your own understanding of what a

colleague or patient has just told you

For ensuring an accurate diagnosis

Tips for overseas doctors

Organise and reflect on information before paraphrasing

Build up a bank of plain English words to complement

your existing medical vocabulary e.g. bruise for
haematoma, needle for cannula, ‘to lie on one’s back’ for
‘to lie supine’.

Use common analogies to help the patient understand

medical, e.g. ‘the heart is like a pump’, ‘the kidney is a bit
like a filter’.

If you have to use a medical term, explain it immediately

in plain English.

Practice using phrases such as

‘Let me explain it in a different way.’

22 | Living the Language | A guide for doctors

2. PATIENT COMMUNICATION

Asking for consent Phrases you can use to ask

for verbal consent
If you give your consent to something, you
I just want to ask you a few more questions if that’s
give someone permission to do it. In the alright/OK (with you)?
healthcare setting, consent is a key aspect
of the person-centred approach; it’s about Does that sound OK/alright? / Is that OK/alright
demonstrating respect for the patient and (with you)?
ensuring they are part of the decision-
making process. It’s also a legal and ethical Are you OK for me to just … / Do you / Would you mind
if I just…? If you don’t mind, I just want to … listen to
requirement and must be documented. your chest?

Are you happy for me to continue? / proceed?

Prisha says...
Phrases you can use to ask
Although care of the patient is at the heart
of every doctor, person-centred care is
for verbal consent
significantly different in both systems.
I just want to ask you a few more questions if that’s
Emphasis is given to patient consent is one
of the important aspects. Patients’ approval
alright/OK (with you)?
in decision making is quite important in the
NHS whilst it is not so much in the Indian Does that sound OK/alright? / Is that OK/alright
sub consitnent. Generally, it is assumed (with you)?
that doctor would prescribe medicine and
a nurse would give it to him/her.”
Are you OK for me to just … / Do you / Would you mind
if I just…? If you don’t mind, I just want to … listen to
your chest?

Are you happy for me to continue? / proceed?

Verbal consent
Situations when it is necessary to ask patients for their Written consent
verbal consent can be as varied as:
For the patient to give consent to treatment, it’s important
• setting the agenda for the consultation you inform them fully about:
• taking the patient’s temperature
The procedure (investigation, operation, treatment) being
• carrying out a pelvic examination proposed

• discussing a treatment option

Why it is necessary
• agreeing the presence of a chaperone during a
patient examination How it will be performed

• moving on the discussion after having delivered

Benefits, risks and possible side effects of the procedure
some bad news

In fact, doctors should be asking for consent several Alternative treatments available
times over during any consultation.
Likely success of the procedure

* Asking for consent from children (under 16) and in

emergency situations, see the references below

23 | Living the Language | A guide for doctors

2. PATIENT COMMUNICATION

Phrases you can ask to obtain Do you have any questions at this point?
written consent
So, (just to summarise) we’ve talked about ….
Before we go any further, I just want to explain the
procedure we’re proposing, if that’s OK. Are there questions (you’d like to ask me) about anything
we’ve talked about today?
Let me just explain what happens during the procedure.
/ What we do during the procedure is … Could you tell me what you understood from our
conversation?
We recommend this procedure because …
Are you comfortable knowing … / Are you OK with …
The benefits of the procedure are that you’ll … / we can … the risks that we talked about?

There are some more serious complications with this

procedure.

You may/might … / It’s possible that you’ll …. References

experience develop …
British Medical Association. (2019). Consent and refusal by adults
with decision-making capacity. A toolkit for doctors. Retrieved from:
The most common side effects are … / There is a chance https://www.nhs.uk/conditions/consent-to-treatment/
that …. but this is very rare.
GMC. (2020). Decision Making and Consent. Retrieved from:
https://www.gmc-uk.org/-/media/documents/gmc-guidance-for-
There are some alternatives with this procedure, and I doctors---decision-making-and-consent-english_pdf-84191055-pdf?
can explain the risks and benefits of those if you wish. la=en&hash=BE327A1C584627D12BC51F66E790443F0E0651DA

NHS. (2019) Overview: Consent to treatment Retrieved from: https://

The decision to go with another procedure is yours. www.nhs.uk/conditions/consent-to-treatment/

24 | Living the Language | A guide for doctors

2. PATIENT COMMUNICATION

The language Frameworks for

delivering bad news
of bad news
Bad news can mean different things to different people,
Doctors often report that communicating bad the death of a child following an RTA, breaking an arm
ahead of a school tennis tournament. But whatever the
news to patients and patient families is the situation, using a framework can help you deliver the bad
most difficult communication task they face in news in a structured way using the right language.
their work.
Using a template or framework for the delivery of bad
You might not know a particular patient (e.g. in A&E) or news can help make sure you handle it in the right way.
had chance to build a rapport with their relative. The
person may already be prepared for bad news but > SPIKES: was originally designed for oncologists to
equally it could be totally unexpected and sudden. In deliver bad news to their patients, but is now used widely
addition, you may have to deliver the news by phone across all specialities including in emergency medicine.
or online (e.g. during the COVID-19 crisis) which can be
even more challenging. Setting up the interview – making sure there is privacy
and that you won’t be interrupted
Tips to develop your skills
Assessing the patient’s Perception of their situation –
Seek opportunities to see good skills modelled by what does he/she already know?
another doctor
Obtaining the patient’s Invitation to deliver the bad news
Find a mentor to guide you in best practice
Giving Knowledge and information to the patient.
Remember the role of body language when delivering
bad news Addressing the patient’s Emotions with Empathetic
response.
Memorise or rehearse key phrases – particularly useful in
an emergency situation Having a Strategy or plan going forward and
Summarising.
Make sure your tone of voice is appropriate when you
deliver bad news.

Other useful advice

Give a ‘warning shot’ to help prepare the patient/relative
for the news (see page 26).

Deliver the information in small chunks using signposting

(linking words) to ensure the message is clear.

Check the patient’s understanding and pause regularly

to give the patient time and ‘space’ to grasp the news.

Gauge the amount and level of detail the patient would

prefer to hear (it may be more than patients in your own
country)

Keep checking the patient’s emotional reactions and

respond with empathy

Be honest about what you know; honesty is linked to

trustworthiness and helps build rapport

25 | Living the Language | A guide for doctors

2. PATIENT COMMUNICATION

Useful phrases and words 4. Respond empathetically: Avoid using sympathy

(e.g. ‘I’m sorry for your loss.’ ‘Don’t worry’) as this can
for communicating bad news sound dismissive or patronising. Instead, empathise
Having some well-tested, standard phrases that you can with the patient and their situation. Expressing
practice saying will help you feel more confident in these empathy helps to connect with the recipient and
situations. The following is adapted from the book ‘How validate their feelings and shows that you have given
to Break Bad News’ (Buckman, 1992). some consideration to them.
“I wish the news were better”
1. Preparing someone that bad news is coming.
This ‘warning’ gives the individual a few seconds “I can appreciate this is difficult news to hear”
longer to psychologically prepare. This preparation is
sometimes called ‘a shot across the bows’, or ‘to fire 5. Handing difficult questions may include, “Am I
a warning shot’. going to get better?” “Am I going to die?” “How long
do I have?” A sample answer may be:
“The results are not as good as we expected....”
“That’s a difficult question, there are no
“Yes, it could be serious ….” simple answers.”
“We are concerned by the test results ….”
“We can hope to control your illness, but can’t
“I’m afraid I have bad news ….” hope to cure it.”
“I’m very sorry I have some bad news to tell you...” Do not be afraid to say, “I don’t know.”
“The news is not good…”
“You may have a number of months,” or “You may
2. Giving information honestly but sensitively in have months rather than years.”
plain English. Use language that is appropriate to
your patient’s ability to understand, with minimal
medical and technical jargon.
“She has had a heart attack.” Rather than
‘myocardial infarct’ References

“He has died,” rather than “he has gone/ Buckman R. (1992) How to Break Bad News, a guide for
passed away.” health care professionals. University of Toronto Press,
Toronto.
“You have cancer,” rather than “You have a tumour.”
Buckman R. (2007) SPIKES Makes Bad News Easier,
3. Acknowledging emotions Conversations in Care.

“Hearing the result of the bone scan is clearly a

major shock to you.”
“Obviously this piece of news is very upsetting
for you.”
“I can see this is very distressing.”
“That’s not the news you wanted to hear, I know.”

26 | Living the Language | A guide for doctors

2. PATIENT COMMUNICATION

Avoiding discriminatory How can overseas doctors avoid using

language discriminatory language?
Use gender-neutral language, e.g. ‘partner’, instead of
Words can have a powerful effect on the person who ‘husband’/’wife’, doctor, not ‘female doctor ‘, ‘nurse’, not
hears them. Language, intentionally or unintentionally ‘male nurse’ and ‘Ms’, not ‘Miss’ or ‘Mrs’
can patronise, discriminate or promote stereotypes. It
can upset and offend and ultimately cause a breakdown Listen to how patients describe themselves (e.g. British
in communication. But the right words can help to Muslim, Black British) and only refer to a patient’s race if it
break down barriers, celebrate differences, and most is directly relevant to the point you’re making
importantly treat the other person with dignity and as an
equal in our very diverse society. Don’t make assumptions about a patient’s sexual
orientation and use the correct terms (e.g. straight,
What is discriminatory language? bisexual, gay, lesbian)

Discriminatory language includes words and Avoid asking: ‘Are you married?’ Ask: ‘What is your
phrases that: relationship status?’
• reinforce stereotypes
Employ expressions that emphasise the person not the
• reinforce derogatory labels disability, e.g. ‘Steven is a child with autism’, not ‘Steven is
an autistic child’
• exclude certain groups of people through
assumptions, eg assuming the male or white Don’t refer to ‘the blind’, talk about ‘people who
population is the norm are visually impaired’, and ‘accessible toilets’ not
• patronise or trivialise certain people or groups, or ‘disabled toilets’
their experiences
Remember that language is always changing. Terms
• cause discomfort or offence disappear and are replaced. So, try to always to keep in
touch with what is current.

Who can be affected by discriminatory

language?
The nine ‘protected characteristics’ in the 2010 Equality
Act are: References
• age A guide to effective communication: Inclusive language in
the workplace, BMA (2016)
• disability

• gender

• gender reassignment

• race (this includes ethnic or national origins, colour

and nationality)

• religion or belief

• sexual orientation

• marriage and civil partnership

• pregnancy and maternity

27 | Living the Language | A guide for doctors

3.

Social Communication

As a new recruit you will be mixing in with people

from many different areas of British society in both
your professional and personal life. Some overseas
doctors say that they find it harder to communicate
on a social rather than a professional level. This is
because they may be less familiar with general or
cultural topics than workplace ones. In addition, the
way people speak English and the words they use
vary hugely across the regions of the UK and across
social groups.
3. SOCIAL COMMUNICATION

Best practice
Slang and idioms When taking patient histories, patients will speak in
their own dialect and use slang and colloquialisms. It
is important to make sure you have fully understood
meaning as this could affect care plans.
“It’s raining cats and dogs
Ask your employer for a list of local dialect terms that you
out. I think I’m going to need will hear in your setting
my brolly.” If you can’t understand a word, ask the speaker to repeat
themselves or speak more slowly

English idioms, proverbs, and expressions are a key It’s OK to ask for clarification, for example “What did you
feature of everyday English. Because idioms don’t mean when you said you had ‘been in the wars?”
always make sense literally, it’s a good idea to familiarise
yourself with the meaning of the most popular ones and Re-phrase parts that you haven’t understood in your own
how they are used. Including idioms in your speech will words, for example “So you mean that you’ve got injuries
make your English sound more natural. to many different parts of your body?”

Why not practice with this: Listen closely and try to remember and repeat commonly
used terms and phrases
> list of everyday English phrases.
Use Google to clarify meanings of slang terms if you
don’t feel comfortable asking
How well do you know your English idioms?

> Try this free 2-minute online test

Reference
Wikipedia contributors. (2020, June 5). List of dialects of English.
Retrieved from https://en.wikipedia.org/w/index.php?title=List_of_
Local accents dialects_of_English&oldid=960901530

and dialects
You will probably be most familiar with the English accent
known as ‘Received Pronunciation’ or ‘Queen’s English’.
This is the accent described as typically British. However
the UK is made up of more than 50 different accents and
dialects! (2020, Wikipedia contributors).

Accents (the way words are pronounced) and dialects

(the local use of specific non-standard words) vary
depending on where in the country a person is from,
as well as socially.

> Here’s a guide to just a few of these British dialects

29 | Living the Language | A guide for doctors

3. SOCIAL COMMUNICATION

Manners and etiquette General rules

You can never say thank you too many times
Please and Thank You Always say please if you ask for something
New arrivals in the UK, even from other English-speaking Say sorry when you bump into someone,
countries, are often surprised and amused by the even if it’s their fault
number of times people say ‘please’ and ‘thank you’ in
everyday conversation. It’s not unusual to hear people Remember! Most British people will consider you rude,
repeat ‘please’ and ‘thank you’ many times in the course or even aggressive, if you don’t regularly use these
of a very simple transaction as in this example: terms when interacting with them

In a restaurant, you will have to say thank you when

you get the menu, thank you when you place the order,
thank you when get your dishes, thank you when the
References
waiter takes away the plates and even thank you when
you pay! You’ll have to say excuse me if you want to Geddes, L. (2016, February 24). Why do the British say ‘Sorry’ so
pass someone and I’m sorry if you accidentally touch much? Retrieved from www.bbc.com
someone. British people even say sorry if you stand on
Harzing, A.-W. (2018, August 15). British Culture. Retrieved from
their toes! (Harzing, 2018) Harzing.com Research in International Management https://harzing.
com/resources/living-and-working-abroad/british-culture
> How to say THANK YOU: British English Etiquette
English, A. (2017, June 5). How to say thank you: British English
etiquette. [Video file]
Sorry https://www.youtube.com/watch?v=hSV6RV-bON4

According to a survey by the BBC of more than 1,000

Brits, the average person says ‘sorry’ around eight times
per day – and one in eight people apologise up to 20
times a day! (Geddes, 2016)

Some nationalities almost never apologise but in English-

speaking societies, you will be expected to apologise
for something, even if it is not your fault! For example, in
Britain, it is quite common for people to say something
like “I’m sorry about the rain.”

https://www.youtube.com/watch?v=hSV6RV-bON4

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3. SOCIAL COMMUNICATION

Topics and conversational behaviours

What to talk about

When meeting people casually, whether it’s at the school gate, in the supermarket queue or passing a neighbour
in the street, it’s worth having a few topics ready with opening lines that will help you to confidently start a
conversation and ‘break the ice’.

Conversation starters
Choose these topics to avoid awkward silences, seem friendlier, easily get to know someone new, and build
foundations for deeper friendship.

“This weather is crazy! It was freezing yesterday but today I’m in a

THE WEATHER
T-shirt. I hope it stays warm, don’t you?”

SPORTING EVENTS “Did you catch the football at the weekend?”

HOLIDAYS “This time last year I was in Tenerife for my holidays. I’ll miss that this
year. What plans have you got for the summer?”

WORK “My job is so busy at the moment, the days are really full. Is it the same for you?”

FOOD / COOKING / “We got a takeaway from Pizza Express yesterday. Have you been using
RESTAURANTS any good takeout places?”

ARTS AND “Did you watch anything good on TV last night?”

ENTERTAINMENT

THE DAY/ “The day is almost over! Do you have any interesting plans for the evening?”
THE WEEKEND

OBSERVATIONS “I love your shoes today, they really pull your outfit together.”

Topics to avoid
Avoid these topics as you don’t want to cause an argument or make people uncomfortable or want to leave
the conversation:
Politics Personal Gossip
Religion Offensive jokes
Personal Finances Anything so specific that very few people can relate
Age and Appearance Topics that are sexual in nature

31 | Living the Language | A guide for doctors

3. SOCIAL COMMUNICATION

Humour
A vital element in all aspects of British life is the British sense of humour. The British poke fun at almost everything
themselves, each other, politicians, class, society and you. It is often self-deprecating (putting oneself down), teasing,
sarcastic and can be full of puns and innuendo (remarks that suggests something sexual or unpleasant but do not refer
to it directly).

Uses of humour

To build rapport and informality

To downplay achievement, appear modest

To relax a room

To introduce risky ideas

To present criticism in an acceptable way

Have you heard of any of these popular

comedians? Take a look at some of their
videos to understand more about the British
sense of humour.
Peter Kay

Michael McIntyre

Sarah Millican

Ricky Gervais

Jimmy Carr

VeryBritishProblems Reference
Follow VeryBritishProblems on Twitter (@SoVeryBritish) Harzing, A.-W. (2018, August 15). British Culture. Retrieved
for more hilarious insights into the strange behaviours from Harzing.com Research in International Management:
and peculiar worries of the British. https://harzing.com/resources/living-and-workingabroad/
british-culture

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3. SOCIAL COMMUNICATION

Indirect speech and understatement

“Perhaps you might like to come round for speaking in this way, all parties are protected from
dinner sometime, maybe, only if you’re free of possible confrontation and standards of politeness
are upheld. This can be frustrating if you come from
course, no compulsion” a country where people are transparent about what
Would this statement leave you wondering if you’d been they think and feel. You’ll find yourself having to ‘read
invited for dinner or not? Possibly! A phrase like this is between the lines’ to understand what they really mean
typical of indirect speech and understatement – a style which can feel like a big waste of time.
of communication which characterises the British. By

Common examples of understatement and indirect speech (Harzing, 2018)

WHAT FOREIGNERS
WHAT THE BRITISH SAY WHAT THE BRITISH MEAN
UNDERSTAND

I disagree and do not want

I hear what you say He accepts my point
to discuss further

With the greatest respect You are an idiot He is listening to me

That’s not bad That’s good That’s poor

That’s a very brave proposal You are insane He thinks I have courage

Quite good A bit disappointing Quite good

Do it or be prepared to Think about the idea, but do what you

I would suggest
justify yourslef like

The primary purpose of our

Oh, incidentally/by the way That is not very important
discussion is

I was a bit disappointed that I am annoyed that It doesn’t really matter

Very Interesting That is clearly nonsense They are impressed

I’ll bear it in mind I’ve forgotten it already They will probably do it

I am sure it’s my fault It’s your fault Why do they think it was their fault?

You must come for dinner It’s not an invitation, I am just being polite I will get an invitation soon

I almost agree I don’t agree at all He is not far from agreement

I only have a few minor

Please rewrite completely He has found a few typos
comments

Could we consider some

I don’t like your idea They have not yet decided
other options

33 | Living the Language | A guide for doctors

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Wellings, D. (2017, September 16). What does the public think about the NHS? The King’s Fund. Retrieved from:
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Patient communication
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Retrieved from: https://www.nhs.uk/conditions/consent-to-treatment/

British Medical Association. (2016). A guide to effective communication: Inclusive language in the workplace. Retrieved
from: https://www.northstaffslmc.co.uk/website/LMC001/files/BMA-guide-to-effective-communication-2016.pdf

Buckman R. (1992). How to Break Bad News, a guide for health care professionals. University of Toronto Press, Toronto.

Buckman R. (2007). SPIKES Makes Bad News Easier, Conversations in Care.

GMC. (2020). Decision Making and Consent. Retrieved from: https://www.gmc-uk.org/-/media/

documents/gmc-guidance-for-doctors---decision-making-and-consent-english_pdf-84191055.
pdf?la=en&hash=BE327A1C584627D12BC51F66E790443F0E0651DA

GMC. Duties of a Doctor. Retrieved from: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-

medical-practice/duties-of-a-doctor

Kathane, R and Mehta, R. (2004) Adapting to British Culture. BMJ 2004; 328:s273

NHS. (2019) Overview: Consent to treatment Retrieved from: https://www.nhs.uk/conditions/consent-to-treatment/

Silverman, J., Kurtz, S., Draper, J. (2016). Skills for Communicating with Patients. CRC Press.

34 | Living the Language | A guide for doctors

Bibliography
Workplace Communication
General Medical Council. (2019, December). Guidance for doctors: requirements for revalidation and maintaining
your licence. Retrieved from: https://www.gmc-uk.org/-/media/documents/revalidation-guidance-for-doctors_pdf-
54232703 pdf

General Medical Council. (2012, June) Continuing professional development. Guidance for all doctors. Retrieved from:
https://www.gmc-uk.org/-/media/documents/cpd-guidance-for-all-doctors-0316_pdf-56438625.pdf

General Medical Council (2015, February 15). Reflecting on an experience: breaking bad news. Retrieved from: https://
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The CPD Certification Industry. CPD in the Healthcare & Medical Industry.

Retrieved from: https://cpduk.co.uk/industries/healthcare-medical

Social communication
British Medical Association, (2016). A guide to effective communication: Inclusive language in the workplace. Retrieved
from: https://www.northstaffslmc.co.uk/website/LMC001/files/BMA-guide-to-effective-communication-2016.pdf

35 | Living the Language | A guide for doctors

Living the Language
A doctor’s guide to English
usage in British life and work
Postal address
The OET Centre
PO Box 16136
Collins St West VIC 8007
Australia

Telephone
AUS +61 3 8658 3963
UK +44 1202 037333
USA +1 855 585 0125

Website
www.occupationalenglishtest.org