Britain's imported MDs scratch noggins over language

Those who do break through face formidable cultural and linguistic challenges. As Ahlert says, the human body is more or less the same the world over. But the vocabulary isn't.

In northern England, a group of Austrian family doctors have been left groping for responses by the infamous Yorkshire accent that challenges even Britons. Finally, after months of confusion over the meaning of "gut rot" (stomach ache) and "jiggered" (a lethargic feeling), the health authority produced a glossary for the bemused foreigners.

"They speak very good English, but they face a lot of terms that are from South Yorkshire in origin that they're not used to," says Ian Carpenter of the local health authority in Doncaster. "Patients will come in and say 'Ay up [hello], I'm feeling jiggered.' Or, 'There's something wrong with me lugholes [ears], noggin [head], sneck [nose], or trotters [feet].' All these terms you won't find in a dictionary, and you can't have the doctor go out and ask the receptionist what does he mean?"

A more serious problem is cost. Recruiting family doctors to come permanently is one thing. Filling in the gaps in the system with "freelance" doctors from Europe is another.

Ahlert travels twice a month to Britain from Heidelberg, Germany. He provides weekend cover, working perhaps 30 hours on the weekend. Typical pay is about $100 an hour. "I'm turning down work in Germany now," he says, "I don't really need it."

This highlights a major issue with the NHS: that the Labour government's extra billions may not always be spent efficiently. With more than a million staff, the service is referred to somewhat disparagingly as the world's third-largest employer, behind the Red Army and the Indian railways. The implication is that such a behemoth may not always allocate funds as deftly as it might.

Indeed, after a generation of decay, underinvestment, and bad press, it may be surprising that professionals from Europe are interested in working for the NHS.

Recruitment agents say, however, that the NHS brand remains strong. Ahlert says it is mercifully free of bureaucracy compared with Germany, and that he gets lots of phone calls from German doctors wanting to move to Britain. French doctors say that working in Britain is better from the point of view of flexible working hours, teamwork, and guaranteed pay.

"The good thing about working in [a British clinic] is, it's about teamwork - it's not about the more patients you see the more you get paid," says Yann Lefeuvre, a family doctor who has been working in southeast London for three years. "Everyone is fed up with the system in France because of the waste of resources," he adds. "The good thing in England is you have this sense of community."

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