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Clear Speech – A Pathway to Patient Understanding

Natacha Moreno, M.S., CCC-SLP


With interpersonal communication skills at a premium in healthcare today, foreign-born physicians can make great strides in improving patient satisfaction by ensuring their speech is easily understood.  The Joint Commission defines effective communication as that which is in part “timely, accurate, complete, unambiguous, and understood by the recipient.”  Physicians are charged with explaining things in a way the patient can understand, and for non-native, English speaking doctors, the important first step is using clear speech.


In the medical setting, clear speech is one of the keys to a physician’s intelligibility and comprehensibility, and is essential for accurately articulating sound-alike drugs, medication doses, treatment orders, reports, and dictation. In cases where physicians present with moderate-to- heavy accents, the clarity of the physician’s message to the patient may be compromised and become a barrier to communication.   The patient may be unable to decipher utterances accurately, leaving gaps in the critical understanding of their diagnosis, treatment plan, and next steps. 


When it comes to patients, a physician’s unfamiliar accent can present as a processing challenge.  Recent research employing fMRI demonstrates that “foreign-accented speech perception places greater demand on the neural systems underlying speech perception.” (Yi, Han-Gyol, and Rajka Smiljanic, 2014).    Speech signals that match listeners' perceptual expectations are processed relatively automatically, but when acoustic match is reduced (for example, due to noise or unfamiliar accents), additional executive resources are needed to compensate.   The increased processing demands while listening to heavily accented speech can interfere with attention, language, and memory and ultimately the patient’s comprehension, or ability to interpret and understand the doctor’s intended message.  The implication of this processing challenge, particularly in cases of heavily accented speech, is effortful listening and frustration on the part of the patient.  


Research has suggested possible ways to not only enhance the clarity of speech of non-native speakers of American English, but to also positively influence the perception of accented speech on the part of the listener.  Some strategies include:


  • Engage in accent reduction training , including pronunciation(speech sound)  and prosody training (pauses, word stress, and intonation patterns used when speaking)   

  • Use “everyday” language and avoid uncommon or complex words

  • Hold conversations in a quiet environment

  • Speak at a reasonable volume – accented speech can be particularly challenging to the listener when coupled with a quiet voice

  • Decrease rate of speech to allow the listener additional processing time to facilitate comprehension


Effective communication is critical to every aspect of life, and most remarkably in healthcare, where the stakes are high and patients are looking to their doctors to help in understanding their illness and treatment options.   Clear speech is an essential first step, and one that will engender trust in the physician, facilitate understanding in the patient, and create a solid foundation for communication between the patient and physician. 


The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010.


Yi, Han-Gyol, and Rajka Smiljanic. "The Neural Processing of Foreign-accented Speech and Its Relationship to Listener Bias." Frontiers. Frontiers in Human Neuroscience, 08 Oct. 2014. Web. 19 Dec. 2014.


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