By Dr KK Aggarwal
With doctors at the receiving end of violence, their skills should also extend to knowing three languages so that there is no miscommunication about their diagnosis.
Recently, an altercation took place between activists of the Karnataka Rakshana Vedike and a postgraduate student at the Minto Ophthalmic Hospital in Bengaluru over language. The student did not respond in Kannada to their demand for compensation for patients blinded during a cataract camp simply because he did not speak Kannada. The matter has taken a political turn, with doctors going on strike and demanding enhanced security and action against the activists. The incident has sparked a national debate on the issue of language barriers in medical education in India.
Admission to medical colleges in India is based on common admission tests. The centre allocates seats to students in various colleges from an all-India quota. Unlike Ayurveda where the medium of education is Sanskrit, in allopathic medical colleges, it is in English. Even in the Supreme Court, the language is English. No one should expect students to learn the local language as soon as they enter a medical college. It could be a language they are completely unfamiliar with.
I did my under graduation and post-graduation from the Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, in Maharashtra where the local language was Marathi. I learnt Marathi during my college days but only as much as was needed for patient care. Ward boys and other staff would be our interpreters if we got stuck on any word.
However, some European countries such as Sweden have made it mandatory for doctors to learn Swedish if they want to practise there and many Indian doctors have done so by taking a course to demonstrate that they have reached C1- level Swedish. In 2010, the Eastern Mediterranean Health Journal touched upon the perspectives of students and staff on language barriers in medical education in Egypt and their attitude towards Arabization of the medical curriculum. In a survey of 400 medical students and 150 staff members, it was found that 56.3 percent of students did not consider learning medicine in English an obstacle, while 44.5 percent of the staff considered it an obstacle only during the first year of medical school. Some 44.8 percent of students translated English terms into Arabic to facilitate studying and 70.6 percent preferred to learn patient history-taking in Arabic. While Arabization in general was strongly declined, teaching in Arabic was suggested as appropriate in some specialties.
Thankfully, India does not have strict rules on language. Dr OP Gupta, my Professor of Medicine at MGIMS narrated what a colleague had told him. "I was examiner in one of the colleges of MP where I found that some students could not communicate well in English. But when I explained the questions in Hindi, they answered them with ease," he said. So should language be a barrier for treatment? No.
Gupta further said: "I had a similar experience when I used to go as an examiner for final-year students. Even when I have a bedside discussion about a patient with students, sometimes I have to explain in Hindi. With English as a medium of instruction in medical education, a perceptible gap in communication is noticed. If a learner cannot understand the language of instruction, it becomes difficult, if not impossible, to grasp the content."
In a sign of changing times, the National Eligibility Cum Entrance Test (NEET) 2018 examination was conducted in 11 languages. While 80 percent of the students wrote the exam in English, 11 percent did so in Hindi, 4.31 percent in Gujarati, 3 percent in Bengali and 1.86 percent in Tamil. About 20 percent of the 1.1 million students who appeared in NEET wrote in regional languages. NEET 2019 rules stated that the exam would be conducted in English, Hindi, Urdu and eight regional languages (Bengali, Assamese, Gujarati, Telugu, Marathi, Tamil, Oriya and Kannada). The regional language question papers would be bilingual.
However, it would be a good idea for all doctors to study one international language. As medical tourism is on the rise, that international language should be English. As it is also the medium in books and for teaching, they might as well learn it. To promote medical tourism, the government is also making it compulsory to have interpreter assistance at all levels. Recently, when I travelled to Japan as president of the Confederation of Medical Associations in Asia and Oceania, an interpreter was provided so that I could talk to my Japanese colleagues. For domestic medical tourism too interpreters should be made available in the hospital set-up in every state to facilitate communication between doctors and patients.
The second language for doctors to learn is the one most commonly spoken in the country. In India, it will be Hindi. The third language should be the local language where one is practising. The students themselves should learn it. That will be difficult unless the student devotes a full year to language learning or there are interpreters in hospitals.
These measures are necessary in order to stem disputes and arguments between patients/their families and the doctor. It is also needed to prevent deficiency in medical treatment due to wrong interpretation of symptoms. This may lead to wrong diagnosis and wrong treatment. The National Medical Commission should take these points into consideration and mandate local interpreters in the hospital setting.
Coming back to the violence against doctors, no one has the right to attack them for not knowing the local language. Doctors on duty are akin to pilots and flight attendants and any distraction from work can affect the pilot and jeopardise the lives of passengers. Similarly, any distraction in the treatment provided by doctors because of unlawful elements should be strictly prohibited and they should be arrested.