How do I write a medical report? What is rehab? And why does the head of department never have time for me? Training for doctors from abroad aims to help make day-to-day communication easier.
© Oleg Prikhodko - iStockphoto.com"Where do you come from?" Physician Patricia* hears this question regularly when she visits patients. The undertone she registers is a little different: "A foreign doctor, oh dear, she'll have no idea what she's doing." Patricia laughs and shakes her head. It's late afternoon in Waldbreitbach in Rhineland Palatinate; wooded hills are visible through the large windows, an idyll, but inside serious problems are on the agenda. Anja from Hungary, Boris from Russia, Mahmud from Jordan and Patricia from Cameroon are sitting in a circle, fellow travellers for two days, fully qualified physicians who have come from their respective home countries to Germany to help counter the shortage of doctors here. People from very different backgrounds but with very similar experiences.
To ensure that they get by in Germany, they are attending a seminar held by Irena Angelovski, 51, a fully trained nurse, Diplom teacher and herself the daughter of a Macedonian doctor in Germany. She has been running her company "Kommedikus" for a little over two years and works as an intercultural trainer on overcoming problems in everyday hospital work. Irena Angelovski sits down opposite Patricia. "OK, let's switch roles, I'll be you, you pretend to be a patient and say your sentence - and I'll see how it sounds to me." Patricia leans back in her chair, her long, plaited hair falling over the backrest. "Hm, where do you come from?" Irena Angelovski says: "Oh, I hear interest in your voice."
Patricia says: "Yes, I would like to know." Irena Angelovski says: "I come from Cameroon and studied in Göttingen. If you like, I can tell you a bit more about it, I have a couple of minutes." Patricia nods. As a patient in this role play she is finding out what it's like to say something that might be misunderstood by the doctor. And she is learning how she as a doctor can handle such a situation the next time. The patient might say, "Oh, you're foreign" when she suddenly turns up at his bedside, but he may just mean that he's not feeling well and is worried that the doctor might not properly understand him. Because he's afraid to openly express this worry, he does it in a roundabout way.
Listening carefully and finding out what the other person really means when he or she says something is the aim of this lesson. And realising that everyone, the German patients as well as the foreign doctors, struggles with cultural baggage. The training consists of three parts: The opening seminar deals mainly with the language used in the hospital microcosm, for example there is an entire module on how to write medical reports; this is followed by online exercises in gathering a patient's medical history, indirect speech in medical reports, the specifics of the federal healthcare fund or topics such as Germany's law governing the guardianship of persons of full age. The closing session at the end, covering communication theory and conflict training, is the core part of the seminar. Irena Angelovski developed her training when she was working as a further education officer at a hospital after completing her teaching degree. She is passionate about the subject - and it has proved highly topical. This time the seminar is taking place in the medical academy attached to Marienhaus GmbH, whose Christian funding organisation has already hired Irena Angelovski for the fourth time.
The company owns 27 clinics, often in rural areas, where they provide primary medical care. Some of these clinics have trouble attracting new staff because many German doctors don't stay in rural areas when they gain further training. For this reason Marienhaus GmbH already employs 86 physicians from abroad, most of them from Eastern Europe. A Diplom thesis on the subject is currently being written in the company - which problems doctors from abroad face in German hospitals and how they can be solved is a current issue. Mahmud asks whether there might not be other fears on the patient's side than the worry of not being understood. Sure, that's possible, answers Irena Angelovski. Of course the patient may sometimes have misgivings about whether a doctor from abroad has received proper medical training.
Mahmud studied in Amman and in Cairo; he has been in Germany for 16 months to complete his specialist medical training - he wants to be a surgeon. Many of his colleagues from Jordan go to English-speaking countries for their further training, which causes no language problems because the degree is taught in English in their home country. He is 28 years old, and what he wanted most of all was to learn about all the possibilities of modern medicine and someday take this knowledge back home with him. Mahmud has completed an intensive language course here; high German is no problem at all for him, he says, and from the way he speaks it is immediately apparent that this is true. "But the Palatinate dialects", says Mahmud, "the way the patients speak in my clinic, that's really difficult." Boris comes from Moscow and was recruited for Germany by an agency. He works as a specialist in internal medicine. He too has hardly any problems with the language, and says it is mainly good to meet colleagues who are having similar experiences as newcomers to Germany.
The most urgent problem, in his opinion, is that many doctors have the feeling that their language skills are insufficient although they generally speak and understand German very well. The bureaucracy is a further difficulty. According to current figures from the German Hospital Institute (Deutsches Krankenhausinstitut), there are 5000 vacant jobs in hospitals, yet Mahmud and Boris must nonetheless apply for a verification of equivalency, that is, have their degrees recognised. That's arbitrary, he says, because in some federal states the test is a mere formality while in others it isn't. In Waldbreitbach the group has sat down together at a table, the heating is on. On the table are cards in various colours; the four participants are asked to think about which words come to mind in relation to "conflict". "Fight", says Boris; Mahmud writes down the word and next to it the word "misunderstanding". Often it is nothing more than different ways of holding a conversation that lead to escalation, explains Irena Angelovski. And usually it is problems with managers that weigh heavier than those with patients. For example in the case of a radiologist from Romania who didn't know how she should write the medical statements for her many patients. When she asked the head of her department for help, conflict ensued. "I've been in Germany for quite a while", the doctor told her boss, "the team is very nice, I get on well with the patients, I can explain to them where their problems lie..." Her boss responded with irritation, said he had no time for such banalities, they would talk some other time.
In some countries, employees and managers first have to make small talk to prepare the ground for what they actually want to discuss; in Germany on the other hand they get to the point very quickly, explained Irena Angelovski. The doctor from Romania rehearsed the conversation a second time, this time with a clear strategy: to immediately say what she wants. "Hello, I'm glad I've run into you, I have a request. Could we make an appointment to talk about the proper wording of the medical statements for my patients?" Irena Angelovski is considering offering training for German doctors too; after all, it always takes two sides to create an intercultural conflict. Both sides must realise that they have to adjust to the person they are talking to. Before a briefing for example, the Romanian doctor could make clear to herself that the meeting can't take forever, and her head of department could start with "Good morning, how are you?" before discussing the first item. Angelovski's intention is to most of all teach her seminar attendees self-confidence and that they have a lot to offer. "No", replies Mahmud to the question of whether he has ever had problems with patients: "Particularly the older ones are very nice." And he's already received an invitation for Christmas.
*The names of the doctors have been changed
1. November 2016
Graduate School of Economic & Social Sciences (GESS)
8. February 2017
PhD position: "A Systems Approach to Optimize Healthcare Delivery through Point-of-Care Diagnostic Testing in Primary Care"
University of Twente (UT)