When Thorsten Ahlert saw his first patients in England, his dictionary was almost as useful as his stethoscope. The German doctor, enticed to Britain by the prospect of lucrative work as a stand-in family physician, initially found accents more perplexing than ailments.
After all, when patients come in complaining of problems with their "lugholes" or "sneck," it takes a bit of local knowledge to understand what they're talking about.
"I had to get used to the slang," he says. "It was difficult in the beginning, but I had my dictionary there. One patient did look a little strange when I had to look up 'chicken pox.' "
The language barrier is only one of several hurdles facing a new contingent of foreign doctors recruited by Britain as part of an energetic drive to bring in hundreds of physicians from overseas, particularly from Europe and Asia. The Labour government urgently needs the manpower to live up to its electoral pledge to modernize the rundown National Health Service (NHS). The promise was to invest more than £100 billion ($180 billion) over 10 years in the NHS and attract 10,000 new doctors by 2005. Training such numbers would take years.
"The NHS is expanding a lot and we need more doctors - we always need increased capacity," says one health-department official, who requested anonymity. "We are training our own doctors, but in the short term you have to wait five or six years for a doctor to come through medical school. There are lots of doctors from overseas who want to come here."
The upshot has been a succession of recruitment fairs over the past two years - in Austria, Germany, Italy, and Spain - to bring in hundreds of family doctors, or general practitioners (GPs) as they are also known.
The influx has created teething problems, some amusing - like the language confusion - some more serious. Recruitment in south Asia has inadvertently lured a flood of thousands of interns, for whom there is not such need.
"People are coming and getting stuck," notes Shiv Pande, chairman of the Overseas Doctors Association, an independent representative body. Dr. Pande says as many as 8,000 interns from South Asia are stuck in limbo, sharing crowded accommodations and getting into financial difficulties. The average hopeful takes 11 months to find a job, he says. He says there are around 500 applicants for each vacancy.
"Some end up filling shelves at the local supermarket," he says. "I've seen doctors crying like a child because they are not able to meet their aspiration. It's a disgrace on the noble profession of medicine. It's a waste of medical manpower for India and Britain."
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."