How a first-language habit costs marks
Neither exam marks your accent. PLAB 2 marks whether the patient could follow you and felt heard; PACES marks whether you explained clearly, listened and kept the person comfortable. Both exam bodies name the habits that fail. The GMC's PLAB 2 feedback statements, listed on its page on understanding your results, include Language (the examiner felt "you used medical jargon, or spoke too quickly for the patient to take in what you were saying", including not checking understanding), Rapport (no sensitivity to the patient's feelings and concerns, "including use of stock phrases") and Listening ("you may have asked a series of questions but not listened to the answers and acted on them"). The PACES23 Station 1 communication marksheet names the same habits under skills C and F: "Unsystematic; uses jargon; appears unpractised; unprofessional", "Fails to involve patient/relative in developing management plan" and "Poor listening; lacks empathy".
This page takes the five first-language groups we expect most PLAB 2 and PACES readers to come from, in order: Hindi and Urdu; Malayalam, Telugu and Tamil; Arabic; Yoruba, Igbo and Hausa; Sinhala and Bengali. For each, it lists the habits that in our judgement most often turn into those statements: directness that reads as blunt, "sir" and "madam", jargon leaking into lay talk, missing or stock empathy, tag questions, and rhythm and stress. Each has a fix and a drill that takes about a minute.
- Every habit here is a tendency, not a rule. First-language transfer makes it more likely, not certain. Many doctors from every group below speak polished English and have none of them.
- Neither the GMC nor the Federation publishes results by first language, and we quote none. The habits are TalkDrill's judgement, based on published descriptions of these varieties of English.
- The only way to know which habits are yours: record one eight-minute station and listen back with the checklist at the end of this page. If a habit is not in your recording, skip it.
- Every example line is written by TalkDrill. Clinical detail in the examples is illustrative only; check any clinical point against current UK guidance.
The six habits at a glance
Two things sit underneath every section below, and neither is a language error. First, in our judgement, many of our readers learnt medicine in English and talk to patients in another language. Their English therefore has the textbook words and very few bedside words, because the bedside conversation often happened in Hindi, Malayalam, Arabic or Yoruba. Second, in our judgement, many of the health systems our readers trained in are more doctor-led than the shared decision-making the GMC and the Federation mark. The GMC's interpersonal skills domain asks about "involving the patient"; the PACES marksheet fails a candidate who "fails to involve patient/relative in developing management plan". Both show up as the same six habits.
| Habit | What the examiner hears | PLAB 2 feedback statement | PACES descriptor |
|---|---|---|---|
| Directness that reads as blunt | Orders where an option and a question were expected | Rapport; the interpersonal domain's "involving the patient" | C: "Fails to involve patient/relative in developing management plan" |
| "Sir", "madam", "aunty", "ma" | Distance or deference; the patient's name never used | Rapport | None directly; it colours C and F |
| Jargon leaking into lay talk | Textbook or home-hospital words a patient does not know | Language: "used medical jargon" | C: "uses jargon" |
| Missing or stock empathy | "Don't worry" before the worry is known; the same line in every station | Rapport: "use of stock phrases" | F: "lacks empathy" |
| Tag questions and "okay?" checks | "Isn't it?", "no?", "okay?" in place of a real check | Language: "not checking understanding"; Listening | F: "confirms patient's or relative's understanding" |
| Rhythm, stress and pace | Every syllable equal, so the key word is lost; speeding up under pressure | Language: "spoke too quickly" | C: "clear, structured" |
Hindi and Urdu speakers
Hindi and Urdu share their spoken grammar, so doctors from North India and Pakistan tend to carry the same habits into English. The biggest one is grammatical. In Hindi and Urdu, politeness lives inside the verb: "dawai le lijiye" is a courteous request because of its "-iye" ending, the form used with the respectful "aap". English has no such ending, so the same courteous sentence arrives in English as a bare order: "Take this medicine." To a British patient, and to the examiner, that is a doctor telling rather than asking. The second habit is a set of Indian and Pakistani hospital words that are normal at home and unclear in Manchester.
| Habit | How it can sound (TalkDrill examples) | Fix | One-minute drill |
|---|---|---|---|
| Directness | "You have to stop smoking." "Do one thing: get your sugar checked." "Your discharge is not possible today." | Offer, then ask. "Stopping smoking is the one change that would help most. How do you feel about that?" "Would it be all right if we checked your blood sugar?" | Take five orders you gave in your last real clinic. Rewrite each as an option plus a question and say it aloud in under ten seconds. |
| Sir, madam, aunty, ji | "Yes sir. Sir, I will explain, sir." "Aunty, don't worry." | Ask once: "What would you like me to call you?" Then use the name two or three times in the station, not in every sentence. | Open ten stations in a row with only your name, your role, their name and that question. Under twenty seconds each. |
| Jargon and home-hospital words | "Your reports are deranged." "Loose motions." "Your father expired." "The CT is suggestive of..." "Your pressure and sugar are high." | "Some of your blood test results are not normal." "Diarrhoea." "Your father died." "The scan shows..." "Your blood pressure and blood sugar are higher than they should be." | Write down twenty words from your last case notes. Say a plain version of each in five words or fewer. Any you hesitate on go on tomorrow's list. |
| Empathy | "Don't worry, we will manage everything", said before the patient has finished. "I can understand." | Name the feeling and stop: "That sounds frightening." Leave a short silence. Then: "What worries you most?" | Play back a recording and find the moment the patient voiced a worry. Did an acknowledgement and a pause come before any information? |
| Tag questions and question order | "You are worried about the operation, isn't it?" "You took the tablets, no?" "Since when you are having this pain?" | Drop the tag and ask openly: "How are you feeling about the operation?" Use English question order: "How long have you had the pain?" | Say fifteen history questions that start "How long have you...", "Have you noticed..." or "Did you...". Read them once, then say them from memory. |
| Rhythm, stress and sounds | Every syllable the same length, so the key word does not stand out; speeding up when nervous; v and w merged ("wein" for vein); retroflex t and d. | Stress the one word that carries the news: "The scan is NORMAL." Slow down for that sentence. Top teeth on the lower lip for v; rounded lips for w. | Read the v and w set aloud, then say "a vein in your wrist", "we will review it" and "very well" five times each. |
For the sounds in more depth, see the pronunciation guide for Hindi speakers and v and w. On "died": in a bad-news station, in our judgement, one clear use of the word is kinder than a softer word the relative may misread. The worked station scripts show it inside a full breaking-bad-news station.
If you fix one thing
Turn every order into an option and a question. It moves you on Rapport, on involving the patient, and on PACES skill C in one step.
Malayalam, Telugu and Tamil speakers
Doctors from Kerala, Andhra Pradesh, Telangana and Tamil Nadu are often the most formal speakers in the room; many Kannada speakers will recognise the habits below too. The risk is less bluntness than distance: long courteous openings, "kindly", "please cooperate", and Indian English expressions that a British listener hears as stiff or puzzling. The sound habit that matters most is rhythm. Malayalam, Telugu and Tamil give syllables more even weight than English does, so in a long explanation the one word that matters is not heard as louder or longer than the rest, and English weak vowels are often said in full.
| Habit | How it can sound (TalkDrill examples) | Fix | One-minute drill |
|---|---|---|---|
| Formal distance | "Kindly cooperate with the treatment." "You should not take sweets." "We will do the needful." | Warm, plain and shared: "It would really help if...", "Shall we work out together what you could cut down?", "I'll sort that out for you today." | Rewrite ten formal lines from your own notes as "we" sentences of under twelve words. Say them aloud. |
| Sir, madam, amma, aunty | "Amma, nothing to worry." "Madam, please be seated." | Use the name and title ("Mrs Green") until the patient invites otherwise. | The same ten-opening drill as in the Hindi and Urdu section. |
| Jargon and Indian English | "Today itself." "Take the same twice daily." "Your sugar is on the higher side." "It is common only." "The prognosis is guarded." | "Today." "Take it twice a day." "Your blood sugar is higher than we would like." "This is common." "I'm worried this may not get better, and I want to be honest with you." | Read one of your case summaries aloud, swapping each such phrase as you go. Record it and count what slipped through. |
| Empathy | "Nothing to worry." "It is common only, don't worry." Both can sound like the worry is being brushed aside. | Acknowledge first, then normalise only if it is true: "I can see this has really worried you. A lot of people feel that way when they first hear it." | Write three acknowledgement lines in your own words, so they do not sound like the stock phrases the GMC Rapport statement names. Say each until it sounds like you. |
| Tag questions | "You are taking the tablets, no?" "Right?" or "isn't it?" after every point. | Replace the tag with a real check: "Just so I know I've explained it well, can you tell me how you'll take them?" | In a recording, count every "no?", "right?" and "okay?". Next attempt, halve the count and add one check in the patient's own words. |
| Rhythm, stress and sounds | Even syllable rhythm; full vowels where English uses the weak "uh" sound; for some speakers a y before words that start with e ("yemergency"); for some Telugu and Kannada speakers a short vowel after a final consonant ("test-u"); noun and verb stressed alike. | Content words long and strong, small words short and weak: "We'll REPEAT the TEST in the MORNing." Learn the stress pairs: an INcrease and to inCREASE, a REcord and to reCORD, PROgress and to proGRESS. | Read the stress-shift set aloud, then the sentences in the schwa guide. |
More on the sounds: English pronunciation for South Indian speakers. For lists of formal phrases with their plain replacements, see the plain-English page.
If you fix one thing
In each sentence, stress the one word that carries the news and let the rest be lighter. A patient who hears "HIGHER" and "REPEAT" has understood the station.
Arabic speakers
Many Arabic-speaking doctors from Egypt, Sudan, Iraq, Jordan and the Gulf studied medicine in English and have only ever explained it to patients in Arabic, so bedside English was never built. Two grammar habits tend to travel with that, in our judgement: strong modal verbs ("must", "should") where English uses softer advice, and long explanations chained with "and", following the Arabic habit of joining clauses rather than starting new sentences. The sound habit that matters most in medicine is p and b, because "pills" and "bills", "pain" and "bain" are not the same word to a listener.
| Habit | How it can sound (TalkDrill examples) | Fix | One-minute drill |
|---|---|---|---|
| Directness and long chains | "You must take this medicine every day." "We did the test and it showed inflammation and we will give you tablets and then you will be better and..." | "I'd recommend taking it every day. How would that fit with your routine?" One idea per sentence, then a pause. | Explain any test in five sentences of under twelve words each. Count the "and"s; aim for one. |
| Sir, madam, my dear | "My dear, don't worry." "Sir, sir, please." | Use the name. "My dear" can sound over-familiar or patronising to a British patient. | The ten-opening drill. |
| Jargon | "Dyspnoea." "A lesion." "Investigations." "The culture is positive." "We will do an endoscopy." | "Breathlessness." "An area that looks different." "Tests." "The test found an infection." "A camera test to look inside your stomach." | Take the five words you most often say in Arabic at the bedside and find the plain English for each. Say all five in one sentence each. |
| Empathy and uncertainty | "Be strong." "Don't be afraid." "God willing, you will be fine" as the answer to "Will I get better?" | Acknowledge, then say what you know and what you do not: "I can see how worried you are. I can't promise that yet, but here is what we know so far." In our judgement, leave faith phrases out unless the patient brings faith in. | Write three honest-uncertainty sentences in your own words. Say each to your phone camera until it sounds natural. |
| Checks | "Okay?" or "Yes?" after every sentence, without waiting for an answer. | One real check per chunk: "What will you tell your husband about the test tonight?" | Count the "okay?"s in a recording. Replace two of them with a question the patient has to answer in words. |
| Sounds and stress | p and b merged ("bain", "bills" for pills); v said as f ("fein" for vein); a vowel added before or inside a cluster ("istroke", "sipecialist"); for many Egyptian speakers, th as t or s ("tree" for three, "sink" for think). | Hold a tissue in front of your lips: it moves for p, not for b. Top teeth on the lower lip with voice for v. Start the cluster straight away, with no vowel in front. | Read the p, f, b, v set, then say "pain in your back", "two pills a day", "a vein in your arm" and "a specialist will see you" five times each. |
For th, see the th sound guide; for clusters, the consonant cluster set.
If you fix one thing
One idea per sentence, then a check the patient answers in words. It fixes the long chain, the "okay?" and most of the jargon at once, because short sentences leave no room for textbook words.
Yoruba, Igbo and Hausa speakers
English is Nigeria's official language and the language of its medical schools, and many Nigerian doctors are native-level users of Nigerian English. So the issue is not English level. It is that Nigerian English has its own polite forms, idioms and rhythm, and some of them land differently with a British patient in an eight-minute station. Yoruba, Igbo and Hausa are tone languages, and Nigerian English tends to give syllables more even length and to place stress differently from British English, so the key word in a fast sentence can be missed.
| Habit | How it can sound (TalkDrill examples) | Fix | One-minute drill |
|---|---|---|---|
| Directness | "Madam, you must stop taking alcohol." "You have to do the test today." | Offer and ask: "Cutting down on alcohol would make a big difference here. What would make that possible for you?" | The five-orders rewrite from the Hindi and Urdu section. |
| Sir, ma, mummy, daddy | "Yes ma." "Mummy, sit down." | Use the name and title: "Mrs Jones". | The ten-opening drill. |
| Jargon and Nigerian English idioms | "I'm coming" (meaning I will be back shortly). "Drugs" for medicines. "The test is negative", with no word on whether that is good news. "Take heart." | "I'll be back in five minutes." "Medicines" or "tablets"; to some UK patients "drugs" suggests illegal drugs. "The test did not find any infection, which is good news." | Say five test results aloud as "what this means for you" sentences, never "positive" or "negative" on their own. |
| Empathy | "Take heart." "God will see you through." | Acknowledge the specific feeling: "It sounds like this has been a really hard week." Then ask what is worrying them most. | Three acknowledgement lines in your own words, recorded and played back. |
| Tag questions | "You have been taking them, not so?" "Isn't it?" | An open question or a check in the patient's words: "Tell me how you've been taking them." | Count the tags in one recording; replace each with an open question next time. |
| Sounds and stress | th as t or d ("tree" for three, "dis" for this); long and short vowels merged ("sleep" and "slip", "feel" and "fill"); for some Yoruba speakers, h dropped or added ("eart" for heart); for some Hausa speakers, p said as f; a fast, even rhythm. | Tongue lightly between the teeth for th. Hold long vowels longer. In a falls history, "Did you slip?" and "Did you sleep?" are different questions, so make the vowel do the work. | Read the voiceless th and short i and long ee sets, then say "sleep, slip", "feel, fill", "leave, live" and "heel, hill" five times each. |
For more pairs, see minimal pairs for confusing sounds and the voiced th set. The "negative" problem is not Nigerian only: every group on this page says "the test is negative" and leaves a frightened patient guessing.
If you fix one thing
Slow down for the sentence that carries the news and make its key word longer and stronger. Nigerian English is clear at conversational speed; it is the fast, even delivery under exam pressure that costs the Language statement.
Sinhala and Bengali speakers
Sinhala (Sri Lanka) and Bengali (Bangladesh and West Bengal) are unrelated languages, grouped here because their speakers share several habits in English: a "no?" or "na?" tag on statements, honorific politeness that does not survive translation (Bengali "apni", for example, is a respectful "you" that English cannot mark), formal hospital English, and a small set of sound swaps.
| Habit | How it can sound (TalkDrill examples) | Fix | One-minute drill |
|---|---|---|---|
| Directness | "Take the tablets after food." "Come back after one week." Courteous at home; orders in English. | Offer and ask: "It usually works best taken after food. Would that be easy for you?" | The five-orders rewrite. |
| Sir, madam, aunty, apa, dada, didi | "Aunty, you are taking the medicine?" "Yes madam." | Use the name and title. | The ten-opening drill. |
| Jargon and local hospital English | "Your pressure is high." "Tension" for stress. "Loose motion." "The report came." | "Your blood pressure is higher than it should be." "Stress." "Diarrhoea." "Your results are back." | The twenty-word swap from your own notes. |
| Empathy | "What to do, these things happen." A direct translation that can sound like a shrug. | "I'm sorry this has happened. Let's talk about what we can do next." | Three acknowledgement lines in your own words. |
| Tags and fillers | "You came yesterday, no?" "You are taking them, na?" A filler such as "aney" in Sri Lankan English. | Ask openly, then check in the patient's own words. | Count tags and fillers in a recording; halve them next time. |
| Sounds | Bengali: v as bh ("bhery" for very), s and sh merged ("shee" for see), z as j ("jero"). Sinhala: v and w merged; for some speakers f as p ("pever" for fever). | Top teeth on the lower lip for v and f, and keep the air flowing. Spread lips and tongue forward for s; rounded lips for sh. | Say "see, she", "sip, ship", "sore, shore" five times each; then the p, f, b, v set. |
"Come back after one week" is a good example of why this page asks for options rather than politeness words. Adding "please" does not fix it. "Shall we see you again in a week, to check how it's going?" does, because it asks.
If you fix one thing
Replace "no?" with a real question. "You are taking them, no?" invites a yes; "How have you been getting on with them?" invites the truth, which is what the Listening statement and PACES skill F reward.
One explanation, before and after
A task written by TalkDrill, not a recall of a real exam station: Mr Daniel Hughes, 58, was due to go home today. One of this morning's blood tests needs repeating before discharge. Explain this to him and address his concerns. The clinical detail is illustrative only. Version A packs in habits from several sections above. Nobody does all of them; your recording will show which, if any, are yours.
Version A: with the habits (TalkDrill example)
"Good morning, sir. Sir, your discharge is not possible today. Your renal function test is deranged, creatinine is on the higher side, so we will repeat the RFT tomorrow itself. Don't worry, it is common only. You have to stay one more day, okay? Kindly cooperate. Any doubts, no?"
| Phrase | Habit | What it risks |
|---|---|---|
| "Sir" twice | Address | Rapport: distance, no name |
| "Your discharge is not possible today" | Blunt news, no warning shot, no apology | Rapport; PACES G, "emotional discomfort" |
| "Renal function test is deranged", "creatinine", "RFT" | Jargon | Language; PACES C, "uses jargon" |
| "Tomorrow itself", "common only" | Indian English; minimising | Language; Rapport |
| "Don't worry" before he has said a word | Stock empathy | Rapport, "stock phrases"; PACES F |
| "You have to stay" | Order, not option | The interpersonal domain's "involving the patient"; PACES C |
| "Okay?", "no?" | Tags as checks | Language, "not checking understanding" |
Version B: fixed (TalkDrill example)
"Mr Hughes? I'm Dr Rao, one of the doctors on the ward. I know you were hoping to go home today. Is now a good time to talk about that?" [He asks what has happened.] "One of your blood tests from this morning, the one that shows how well your kidneys are working, came back a bit HIGHER than yesterday. We'd like to REPEAT it tomorrow morning before you go home, to be safe. I'm sorry. I know that's not what you wanted to hear." [Pause.] "How do you feel about staying one more night?" [He says his wife is on her own with the dog.] "That sounds like a real worry. Shall we think about who could help her tonight?" [They agree a plan.] "Before I go, could you tell me in your own words what's happening tomorrow, so I know I've explained it clearly?"
What changed: name and role; permission to talk; one idea per sentence; "how well your kidneys are working" in place of the test name; an apology; the worry asked about and then actually used; stress on HIGHER and REPEAT; and a check in his own words in place of "okay?". Nothing in Version B needs more advanced English than Version A. It needs different habits. The same shape, opening, worry, chunks, plan, check, fits a 10-minute PACES encounter, where the examiner notes expect "a summary plan of action" agreed before you close.
A 15-minute daily drill and a self-mark checklist
Do this every day for a week before you judge it. Habits change when you hear them, so the recording is the drill.
- Two minutes: record (a phone voice memo is fine). One 60 to 90-second explanation from the practice bank, or one AI role play with the patient played for you.
- Three minutes: listen once with the checklist below. Tally the habits; do not fix anything yet.
- Five minutes: one drill from your language section, for the habit with the highest tally.
- Five minutes: record the same explanation again and compare the two tallies.
| Check | Ask yourself | Where it is marked |
|---|---|---|
| Address | Did I use their name, and no "sir", "madam" or "aunty"? | PLAB 2 Rapport |
| Options | Did I offer and ask, or tell? How many "you have to" and "you must"? | PLAB 2 interpersonal domain; PACES C |
| Plain words | Any word a non-medical friend would not know? Any "positive" or "negative" left unexplained? | PLAB 2 Language; PACES C |
| Empathy | Did I acknowledge a feeling in my own words, and pause, before giving information? | PLAB 2 Rapport; PACES F |
| Checks | How many "okay?", "no?" or "isn't it?"? Did the patient explain the plan back in their own words at least once? | PLAB 2 Language and Listening; PACES F |
| Pace and stress | Could a stranger write down my key sentence after hearing it once? Did I slow down for it? | PLAB 2 Language |
| Time | Did the plan and summary start before the last two minutes? | PLAB 2 Time; PACES summary plan before closure |
Pair the drill with the eight-week roadmap, and use the plain-English page for the replacement phrases. For the sound drills, read-aloud practice scores each word, so you hear where stress or a merged sound hid the key word. The official sample material is free: the Federation's PACES sample scenarios page has communication encounter examples with the examiner notes, and the GMC's page on how you will be tested lists the interpersonal tasks PLAB 2 can set. Back to the PLAB 2 and PACES communication guide.