Miami, FL (October 26, 2016) Medimix International recently conducted an international survey among 1,032 oncologists in 21 non-English native countries (Europe, Asia, Americas, Africa Middle East) focusing on their self-rated knowledge of English and their language preferences when receiving communications.
The results were further broken down by country, practice setting (office/private) and hospital/public, and by years in practice.
Why the findings are important
The survey delivered some interesting insights that have relevance for the pharmaceutical industry and other bodies that design educational courses, recruit medical personnel, or even work with international agencies regulating European worker mobility and language certification requirements.
Pharmaceutical companies in particular are interested in learning how they can efficiently focus marketing campaigns and sales material to cost-effectively reach the largest number of oncologists.
It may be a truism that English has become the lingua franca in the world of higher education and research, particularly science, but the figures from the Medimix survey highlight the degree to which this is true in the world of specialized medical fields, like oncology.
The good news for Pharma: 96%
Of the entire sample interviewed, only 4% state that they “don’t know English at all”, which gives a rather astounding 96% overall of oncologists reporting that they have some level of English competency, and 62% stating they are fluent or bilingual in English (Figure 1).
In fact, in almost half of the countries, 100% of oncologists report that they are at least able to communicate in English, (whether bilingual/native, fluent, or basic knowledge): The Nordics of course (Denmark, Finland Norway, and Sweden), Israel and the Netherlands as well, but also more surprisingly in Austria, Belgium and Bulgaria.
Figure 1 – Oncologists self-declared English fluency
As one would expect, oncologists from South Africa, Israel and the Nordics (Sweden, Denmark) are the most fluent in English. Japan trails with only 21% fluency, but one can still communicate with oncologists in English, as only one respondent said he did not know any English.
Some results however are counter-intuitive: Spain seems to be more fluent than France, but in France 7% of the respondents identified as native or bilingual. Further analysis shows that these respondents have migrated to France as adults and performed their medical studies in English. France is also one of the countries with the higher proportion of oncologists who do not speak any English (at 9%, just behind Czech Republic (11%),Portugal (13%), and Hungary (16%)).
It is interesting to compare these results to the overall average fluency for the general population. As seen in figure 2, for a select group of 15 non-English native European countries, only 28% of the general population is native or has learned English, with low numbers for Spain (12%), Italy (14%) and eastern European countries (12-14%). As expected, Sweden and Denmark register a much higher score than the average, with more than 50% of their population speaking English. But altogether, oncologists fluency in English is much higher than the general population.
Figure 2 – Oncologists fluency in English versus general population
Public Sector/ Private Breakdown
A breakdown by practice setting brings another unexpected result: the greatest number of fluent English speakers are present in the hospital/public sector (60%), compared to 52% in the office or private setting. This result needs to be put in perspective with the higher proportion of physicians working in public/hospital practice in Nordics, where English is spoken more fluently, compared to countries like Germany or France, where a lot of oncologists have office practices and speak less English.
Figure 3: Oncologists Fluency by Practice Setting
Increasing English Fluency Rates
Additional encouraging inferences may be drawn from the increase in knowledge and fluency among the younger generation of oncologists.
Fluency levels rose almost by 20 percentage points from a low of 46% from those who had been in practice for more than 30 years to 63% for those who had less than 10 years in practice, and the level of those that have only a basic level of English dropped from 46% in the more than 30 years of practice, to 29% in those for the ones with less than 10 years.
Figure 4: Oncologists Fluency by Years of practice
What about countries with multiple languages?
Aside from fluency in English, we looked at the preferred language of communication in three countries with multiple official languages: Belgium, Canada and Switzerland.
In Belgium, Flemish dominates as the preferred language for 60% of oncologists, while French is preferred by 30%. A minority of oncologists said they prefer communicating in English in their exchanges.
In Switzerland, German dominates with 63% of the oncologists declaring that they prefer communicating in this language, while French is chosen by 31%. Italian spoken mostly in Ticino, is the language of choice for 6% of Swiss oncologists. Interestingly, no oncologists report that they prefer communicating in English.
In Canada, where overall the population are overwhelmingly native English speakers, 88% of the respondents declare that they prefer communicating in English, while the French-speaking portion of the population, largely located in the province of Quebec, shows preference for communications in French. It is however interesting to note that according to the 2011 Canadian Census, French is the mother tongue of 22% of the Canadian population, which would mean that even some French-Canadian oncologists prefer communicating in English for professional purposes.
“We observe the same trend in different countries,” comments Henry Gazay, CEO of Medimix International. “In the Middle-East for example, many physicians from Saudi Arabia or the Emirates shared with our team that they prefer to communicate with them in English, as this is the language in which they were educated in medical school, and they are not aware of some of the medical terms in Arabic.”
Figure 5: Oncologists preferred communication language in multilingual countries
The Push for English Fluency in the Healthcare Profession
These results are particularly meaningful in the light of many changes happening with the globalization of the healthcare profession. Even in English native-speaking countries like the United Kingdom, the fluency in English is not always a given.
Lately, an extensive press coverage has recorded the medical errors in Europe that were traced back to individuals considered “Limited English Proficient (LEP)” and to the government entities efforts to address these language barriers.
Although the medical professionals as a whole have been shown to have a higher level of exposure to English, we also live in an increasingly complex world of cross-country movements of large populations, which has caused a shift in the once homogenous makeup of many countries–particularly in Europe but also the United States.
This is at the root of the growing concern over the level of English proficiency among the medical profession. As EU countries try to fill gaps in their aging medical population by recruiting literally from around the world, they are increasingly facing important barriers to health literacy, as well communication challenges in the health care setting.
In the UK, for example, hospitals are asking whether those trained in Spain, Germany, Pakistan or India will be able to understand their patients as they describe their symptoms. Do they understand the local idioms? Can they clearly communicate their diagnosis, the probable prognosis for their condition, and most importantly the medical options available to the patient?
In a highly publicized case in 2008, David Gray, a 70 Year-Old patient from Cambridgeshire was prescribed 10 times the normal dose of his medication, resulting in his death. His doctor, a non-native English speaker, testified that the mistake was the result of confusion over differences between drugs used in Germany and those used in the UK
A Call for Standardized English Testing
Standard testing and competency systems exist, (i.e. Cambridge CELA – formerly ESOL) examinations and the Common European Framework of Reference for Languages are used and trusted throughout the EFL world. However, these exams have not proved to be sufficient to test competency in medical English. What is often lacking is the vocabulary and usage particular to the world of medicine.
Universities and government bodies are cognizant of the problem, and many require as a prerequisite that the applicant have English as a spoken language. In fact, several medical universities in Europe already offer medical degrees with courses in English (e.g., Bulgaria, Romania, Italy, and Spain) but many times not taught by native speakers.
As of early 2016, the General Medical Council (GMC), was granted new authority and requires doctors applying from the European Union to take language tests if there are concerns about their ability to communicate with their patients. Last year 69% of the candidates passed the knowledge portion of the test, and 68% passed the practical assessment, which includes many scenarios that accurately reflect real life consultations.
As John Nosta, Lead thinker at Nostalab and Google Health Advisory Board comments, “Since 2008, English certification is compulsory for both plane pilots and air traffic controllers. It is believed that prior to this standard, hundreds of lives were lost in crashes caused by communication problems. The medical community should come together with similar requirements for both physicians and nurses”.
What has changed in the EU is the creation of border-free labor. Current EU law makes it impossible to insist applicants demonstrate their English skills in a clinical setting. One of the fundamental freedoms that was established by the creation of the European Union was the recognition of a single market and the rights of EU citizens to move freely across borders and provide their services anywhere in the EU. Interestingly one of the by-product of Brexit might result in negotiating these restrictions and ensuring vigorous testing, which could result in better patient safety.
Based on the results of this survey, it is safe to say that English only communication reaches a large majority of European oncologists (and certainly other specialists). In non-native-English European countries, 62% of oncologists are either fluent or bilingual in English, and only 4% say they don’t know English at all.
English proficiency among European oncologists has improved notably over the last 30 years and is much higher than in the general population. However we are still far from a Lingua Franca for the entire profession. Medical university courses are still mostly taught in local languages, and more than 1/3 of the oncologists population knows no more than only basic English (even in the younger group).
As most of the medical research is published in English only, efforts still need to be made by governments and universities to facilitate English fluency and spread medical knowledge among practicing physicians, which will ultimately result in better patient care.
About Medimix International
Medimix provides “e-merging insights for tomorrow’s Global Healthcare™”. Medimix’s global online community provides direct access to almost one million physicians and healthcare professionals from around the world, making it one of the largest in the industry.
With a staff of 95 specialized in the healthcare sector, Medimix has offices across the globe, including New York City and Miami, FL (USA); London (UK); Paris (France), Basel, Switzerland, São Paolo (Brazil); Hong Kong, Beijing, Shanghai (China); and Bacolod (Philippines).
For more information about this press release please visit us as http://medimix.net or
Contact Kathryn McAdam, BD Director
About the survey
This survey was conducted online in the third quarter of 2016 among a representative sample of 1,032 oncologists and onco-hematologists in 21 countries.
Medimix asked each participants to self-assess their fluency in English by choosing from several possible levels, ranging from “I don’t know any English at all”, “I am able to communicate but am not fluent (basic level), “I am fluent” to “I am bilingual or native English speaker”. The question was translated and presented in each oncologist’s native language or the language of the country in which they were practicing.
All interviews were conducted in local language. The sample repartition was as follows:
For more information about this survey or our expertise in the field of oncology, please visit us as
Call Kathryn McAdam, BD Director
Links to Related Articles
Tandem Team, “A Universal Standard in Medical English” https://www.elanguest.com/content/Elanguest-school-Blog/a-universal-standard-in-medical-english.htm
Medical Universities in Europe with English Programs, http://www.medicaldoctor-studies.com/medical-school/medical-universities-in-europe-with-english-programs/
Press release from GMS: GMS Strengthens tests for overseas doctors, Mar 16, 2016 http://www.gmc-uk.org/news/28961.asp
Health Professional Mobility in a Changing Europe” – edited by James Buchanan, Mathias Wismar, Irene A Glinos, Jeni Brenner. WHO 2014 second volume of PROMETHEUS project, http://www.euro.who.int/__data/assets/pdf_file/0006/248343/Health-Professional-Mobility-in-a-Changing-Europe.pdf
Ahmar Mahbob-Leslie Barratt “ English in Multi-Lingual Contexts: Language Variation and Education, 2014th Edition Springer Dordrecht Heidelberg New York London.
“Twelve Facts: Europe’s Immigration Nations”, January 30, 2015, http://www.theglobalist.com/12-facts-europes-immigration%20nations
United Nations Global Migration Database (2015 revision), http://www.un.org/en/development/desa/population/migration/data/empirical2/index.shtml
Dr. Cheah, “English among Doctors- What Has Gone Wrong in Malaysia” Nov. 10, 2015, http://drcheah.com/blog/2015/11/10/english-among-doctors-what-has-gone-wrong-in-malaysia
Consumer Reports: “Can You Read this Drug Label?” 2011, http://www.consumerreports.org/cro/2011/06/can-you-read-this-drug-label/index.htm
“Should English Be the Only Official Language of the EU?”, Debating Europe, Sep 12, 2014 http://www.debatingeurope.eu/2014/12/09/should-english-be-the-only-official-language-of-the-eu/#.WA4f2_krLIU
Elisabeth Wilson, MD, MPH, Alice Hm Chen, MD, MPH, Kevin Grumbach, MD, Frances Wang, MS, and Alicia Fernandez, MD, “Effects of Limited English Proficiency and Physician Language on Health Care Comprehension”, July 19, 2015, http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2005.0174.x/
Inga T. Lennes, M.D., M.P.H.,1,2 Jennifer S. Temel, M.D.,1,2 Christen Hoedt, B.A., M.P.H.,4 Ashley Meilleur, B.S.,3 andElizabeth B. Lamont, M.D., M.S.1,2,3, “Predictors of Newly Diagnosed Cancer Patients’ Understanding of the Goals of Their Care at Initiation of Chemotherapy”,; PMC US National laboratory of Medicince National Insitute of Health, Cancer. 2013 Feb 1; 119(3): 691–699.
Sarah Knapton, Science Editor, “EU Doctors Three Times More Likely to Face Disciplinary Action”, The Telegraph- Science, Aug 17, 2016, http://www.telegraph.co.uk/science/2016/8/16/eu-doctors-three-times-more -likely-to-face-disciplinary-action-f/
“Communication in Oncology: now we Train- but how well? “, editorial Annals of Oncology Advance Access, Oct 26, 2016. http://annonc.oxfordjournals.org/content/early/2016/06/28/annonc.mdw229
Lucy Brown, “Language and Healthcare: Why Communication Matters”, Lucy Brown, Jan 24, 2014, citing multiple works. https://riverlinguistics.com/language-and-healthcare-why-communication-matters/
David Millward, “English to become compulsory for pilots” Mar 5, 2008, http://www.telegraph.co.uk/travel/761307/English-to-become-compulsory-for-pilots.html