Rapport, empathy and professional identity: some challenges for international medical graduates speaking English as a second or foreign language

This chapter focuses on the communicative challenges faced by international medical graduates (IMGs; doctors from non-English speaking backgrounds who have trained in different medical cultures) as they enact their professional roles in English within Australia. We concentrate on how differences in their interaction with patients may relate to their awareness and control of pragmatic features in English and to different expectations of patient-centred care in medical encounters across cultures. We draw on four data sets: interviews with international medical scholars; audio-recordings of authentic, surgical consultations and video-recordings of simulated doctor-patient interactions conducted for training purposes and mock exams. Using techniques from applied linguistics and discourse analysis we analyse linguistic and other communicative means used to establish rapport and empathy within an Australian context of patient-centred care. We show that sociopragmatic differences across cultures in doctor-patient roles, relationships and expectations as well as pragmalinguistic differences across languages and cultures can impact on how IMGs can successfully portray their professional identity and also how approachable and caring they appear to their patients before considering the implications for professional practice.