Language Barriers: Bridging the Gap

Sondra Thiederman

How many languages do you think are being spoken in the United States today? Take a minute to think about it. Survey your friends, neighbors, colleagues, and patients and count how many different languages they speak. If you live in states like New York, New Jersey, or California, you probably fairly quickly reached a figure of thirty or more. If you dug a bit deeper, you might even approximate the actual figure of 400 distinct languages being spoken in the United States today. If we add to this the fact that languages other than English are spoken in at least 14% of all homes, we begin to see the impact that language diversity has on our lives.

The purpose of this article is to help you overcome some of this confusion and communicate effectively despite this proliferation of accent and language differences. You will be surprised how much more easily you will be able to get along once you learn to practice some of the simple techniques presented here.

Making Yourself Understood

Let's begin by looking at some tips that will help you communicate to patients, families, and colleagues whose English language facility is not fully developed.

1. Do not shout.
There is, unfortunately, a natural tendency to shout when we are not understood. Obviously this makes no sense when the problem is not deafness, but language differences. In fact, the very act of shouting interferes with effective communication because it can intimidate the listener who is probably already feeling inadequate because of the language confusion.

2. Speak slowly and distinctly.
Americans generally talk fast, a trait considered a sign of brightness and enthusiasm in the business world. We also tend to run words together and pronounce words incompletely. To ask, for example, "Whatdjasay?" is all very well, but it will not elicit much information from someone who does not have a great deal of proficiency in English. Similarly, "Didjaeetyet?" will be meaningless to even the hungriest nonnative speaker. Try to be aware of your speech and to enunciate carefully even the most commonplace words.

3. Allow pauses in the conversation.
Just as mainstream American culture encourages rapid speech; it discourages pauses in the conversation. We think of silence as threatening and a sign of failure or lack of communication. But many other cultures regard silence as a demonstration of strength, as a way of communicating respect for what the speaker has just said, and as an opportunity to formulate well-thought-out comments and questions. The Japanese proverb, "He who speaks does not know; he who knows does not speak" exemplifies the perspective found in many Far Eastern countries. The practical use of a silence is to provide the non-English speaker with time in which to digest what you have said and in which to formulate a response.

4. Decide what you are going to say and say it.
Elaborate asides, personal anecdotes, and amplification may make for interesting conversation, but will often confuse the immigrant who is struggling to keep up with the point of your message.

5. Stop and check for understanding frequently.
Do not let too much material go by before assessing if you have been understood. This is particularly important when giving an important instruction because, if one part of the material is lost, the rest is apt to make no sense.

6. Use cognates whenever possible.
A cognate is a word that shares the same roots in two different languages. Approximately 70% of all English and Spanish vocabulary, for example, share the same roots. Some examples of Spanish words that are similar in English are banco, client, doctor, hospital, hotel, distancia, diferente, complicado, and cancelar.

7. Be precise in your choice of words and avoid vague terminology.
Questions like "How did things go today?" or instructions such as, "Be sure to change several beds before too long," involve both vagueness and idiomatic expressions that can be easily misinterpreted. State concretely what you want. Vague terms such as "often," "several," "soon," and "many" have subtle culturally-specific meanings and can lead to serious misunderstandings in the multicultural workplace.

8. Keep your message simple and short.
This does not mean to speak Pidgin English, but it does mean to avoid complex sentences such as this. "What matters in a situation such as this is that you never again fail to complete the patient's chart at the end of your shift. This effort will be greatly appreciated by myself and by my superiors and will most certainly be reflected in our feeling better about your work than we have in the past. It will also look extremely good on your record and in the eyes of your colleagues and may eventually result in a promotion or at least a better position." Of course this example is an extreme, but it does reflect how easy it is to fall into the trap of constructing overly-complex sentences.

9. Avoid idioms, slang, and jargon.
We are often unconscious of the idiom, slang, and jargon that we use. When, for example, was the last time you greeted someone with the phrase, "What's up?" or said goodbye by saying, "Catch you later"? Upon not-very-close examination, these phrases are found to be nonsense at best. A future column will deal with the complexities and vagaries of the English language, but here it is important to note that idioms, slang, and jargon are serious blocks to our ability to communicate across language barriers.

10. Use positive phrasing.
Sentences like, "Do not give medication to the woman in Room 201 before 10:00 AM" could easily be misunderstood if, in the heat of the moment, the "not" were missed. It is far safer, and efficient, to phrase the request, "Give medication to the woman in Room 201 after 10:00 AM."

It may seem like a monumental chore to keep all these rules in mind as you go about your already difficult task of communicating across accent and language barriers. Be assured, however, that if taken one step at a time, the task of good communication, like any other, can be easily accomplished.

Assessing If Your Message Has Been Understood

George Bernard Shaw once said, "The greatest problem with communication is the illusion that it has been accomplished." Never before has this been so true as in our multicultural society where misunderstandings are common and where it is not unusual for people to pretend to understand when, in fact, they have little idea of what has been said.

The practice of feigning understanding is, of course, not confined to foreign-language speakers. Occasionally we have all pretended to know what was going on when we were actually utterly confused. We usually do this for three reasons:

1. We do not want to appear foolish or ignorant.

2. We do not want to insult the speaker by implying that the material has not been explained well.

3. We are concerned that even if we ask for the material to be repeated, we will not understand it the second time.

None of these motives involve malicious deceit, nor do they reflect a desire to make the speaker appear foolish. As professionals, however, it is impossible to function effectively unless we can establish, beyond a doubt, whether we are being understood. The following suggestion will help you assess how much information has actually gotten across:

1. Watch for non-verbal signs.
Although non-verbal signals can be helpful in assessing how much has been understood, body language is by no means universal throughout the world. A blank expression may be a sign of poor understanding for most people but in the Far East, is more likely to reflect the Asian desire to avoid an overt display of emotion. Similarly, the avoidance of eye contact can indicate that the person is not following you but can also be an indication of respect.

I am not saying that body language is of no use in assessing understanding. It is still fairly safe to assume that when a listener narrows his or her eyes, stays focused on the speaker, and nods and smiles in appropriate spots, that he or she is generally grasping what you are saying. Beware, however, of perpetual nodding and smiling that does not relate directly to what you are saying. This behavior might reflect a desire to please and often indicates very little real comprehension.

2. Notice a lack of interruptions.
Although some people misinterpret this as an indication of attentiveness, a complete lack of interruptions often means that the material is not being understood.

3. Note the complete absence of questions.
Paradoxically, this often means that the listener is not grasping what you are saying. Perhaps he or she is not understanding enough to allow for the formulation of questions.

4. Notice inappropriate laughter.
A self-conscious giggle can indicate poor comprehension. Do not interpret laughter as a sign of disrespect for what you are saying. It more likely is a way of covering up embarrassment.

5. Invite questions in private and in writing.
By providing the opportunity to ask questions in private or in writing, you spare the listener the humiliation of having to admit a lack of understanding in front of colleagues or friends. This suggestion is especially valuable during meetings or training sessions when the number of people present can make it particularly difficult for the individual to admit his or her confusion.

6. Allow enough time for questions to be formulated.
Remember that non-native speakers need more time in which to construct questions. A person who is rushed may miss the opportunity to clear up an important point.

7. Beware of the "yes" that means "Yes, I hear your question," not "Yes, I understand."
In Asia, it is appropriate to answer any question with an initial "yes." This positive response is often merely an acknowledgment that the question has been heard and understood; it is not an actual answer to a specific inquiry.

8. Beware of a positive response to a negative question.
In English, when asked, "You don't understand, do you?" the appropriate response, if the listener does not understand, is to say, "No [I do not understand]." In many Asian languages, on the other hand, the way of communicating a negative response would be to say "Yes [I agree with you that I do not understand]." Remember to phrase all questions in the positive that is, "Do you understand?," rather than, "You don't understand, do you?"

9. Beware of a qualified yes in response to the question, "Do you understand?"
Tentative answers such as "Yes, I think so" and "I suppose so" may be efforts to cushion the abruptness of a negative response and amount to a gentle way of saying "No, I do not understand [but I am not comfortable coming right out and saying so]."

10. Have the listener repeat back what you have said.
This is a simple way of assessing understanding. There are, however, a couple of pitfalls to this approach. First, if at all possible, it must be done in private to avoid loss of face in front of others. Second, you should be skeptical if you get back a word-for-word recitation of what you have just said. Rote repetition may indicate merely the ability to mouth the words, not a real understanding of the material.

When checking for understanding it is important to avoid putting the immigrant in an uncomfortable or conspicuous position. By using the techniques provided here, it is possible to assess how much has been understood while preserving the dignity and pride of all concerned.

Taking It To The Workplace

Language diversity has come to be one of the greatest challenges, and opportunities, facing health care professionals today. Although bridging language barriers can be frustrating and confusing, we need to remember that having access to health care workers who speak more than one language is a significant asset in caring for our increasingly diverse patient populations. The information in this column will help you minimize the frustrations of language and accent barriers and maximize the potential of delivering optimal care to all patient populations.

Sondra Thiederman is a speaker and author on diversity, bias-reduction, and cross-cultural issues. She is the author of Making Diversity Work: Seven Steps for Defeating Bias in the Workplace (Chicago: Dearborn Press, 2003) which is available at her web site or at www.Amazon.com. She can be contacted at:

Sondra Thiederman, Ph.D.
Cross-Cultural Communications
4585 48th Street
San Diego, CA 92115
Phones: 619-583-4478 / 800-858-4478
Fax: 619-583-0304
www.Thiederman.com / STPhD@Thiederman.com

The material in this article is based on that found in Sondra Thiederman's Bridging Cultural Barriers for Corporate Success: How to Manage the Multicultural Work Force (New York: Lexington Books, 1990) and in Profiting in America's Multicultural Marketplace: How to Do Business Across Cultural Lines (New York: Lexington Books, 1991).

Career Channels