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Patient Satisfaction – Clear Speech for Effective Communication

Natacha Moreno, M.S., CCC-SLP


When it comes to patient satisfaction, the ability for patients to understand their physician is at the top of the list.  When doctors present with moderate-to-heavy accents, the clarity of the physician’s message to the patient, however, may be compromised and become a barrier to communication.  Oftentimes, patients are genuinely afraid to ask these doctors to repeat themselves more than once.  Others feel it is rude.  When patients do not seek clarification from their physician, they potentially walk away with gaps and/or misunderstanding of vital information, and the communication breakdown is often reflected in the patient satisfaction score.  


Foreign-born physicians who are wondering if their accented speech is a barrier to communication with patients and staff may find elucidation by asking:


  • Am I frequently asked to repeat words and sentences?

  • Do I often have to rephrase what I say?

  • Do others repeat what I have said to confirm understanding?

  • Do others misunderstand what I have said?

  • Do I  avoid speaking in certain settings or circumstances


Increased processing demands while listening to moderate-to-heavily accented speech can interfere with attention, language, and memory and ultimately the listener’s comprehension, or ability to interpret and understand the speaker’s intended message (Van Engen and Peelle, 2012).  Moreover, research by University of Chicago psychologists Shiri Lev-Ari and Boaz Keysar suggests that this reduction in  “cognitive fluency, “ or the ease with which the brain processes stimuli, causes people to doubt the accuracy of what is said (Lev-Ari and Keysar, 2010). The bottom line for physicians– the clearer the speech, the greater the comprehensibility and trust in the message, and ultimately the physician.    


For this reason, doctors with moderate- to- heavily accented speech may consider working toward improving their speech clarity, as well as utilizing strategies to boost their listeners’ comprehension.  Some suggestions include:  


  • Consider accent management with a speech-language pathologist certified in this area;  it will assist in reducing potential communication barriers, and increase quality, safety, and patient satisfaction

  • Provide explanations using a slower speaking rate, in small doses, to allow for adequate processing time

  • Use “everyday language,”  as there is a link between complexity of (accented) speech and decreased comprehensibility (Levi et al., 2007)

  • Confirm understanding – have the patient ‘teach back' key aspects of the communication

  • Use multi-media videos, visual models, and illustrations to supplement explanation of procedures.  Offer trusted internet resources.


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.  A doctor who uses clear speech engenders the patient’s trust, and forges a pathway to a positive patient experience and favorable health outcomes.   


Lev-Ari, Shiri, and Boaz Keysar. "Why the Brain Doubts a Foreign Accent." Scientific American Global RSS. Elsevier, 25 June 2010. Web. 05 July 2015.


Levi, Susannah V., Stephen J. Winters, and David B. Pisoni. “Speaker-Independent Factors Affecting the Perception of Foreign Accent in a Second Language.” The Journal of the Acoustical Society of America 121.4 (2007): 2327–2338. Print.


Van Engen, Kristin, and Jonathan Peelle. "Listening Effort and Accented Speech." Frontiers. Frontiers in Human Neuroscience, 05 Aug. 2014. Web. 19 Dec. 2014.






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