The Language of Exclusion

Who want’s a doctor who doesn’t use received pronunciation?

It’s an interesting question and one that, if anything, brings up more loose ends and tangents than it does narrow the field of potential answers.

Before we tackle it however, we shall first take a detour into the world of linguistics, to define what exactly Received Pronunciation is. Received Pronunciation, or RP for short, is what you might know as ‘Queen’s English’, or “that bloody posh accent”. It’s the kind of drawn out, drawling tones used by BBC presenters of old,  and their modern counterparts (Sir David Attenborough is a perfect -and much loved- example.)

However, when one considers the role of doctors, RP becomes, rather ironically, a bit of a sore point.

RP has always been necessary to demarcate doctors as academically trained and intelligent, due to it’s rooting in the standardisation of English and it’s association with the Oxbridge universities. The strong linkage between RP and these elite academic institutes creates a rather large issue however; historically, one could only attend Oxford or Cambridge if one had rather a lot of money. And one only really spoke RP if one attended Oxbridge or similarly prestigious establishments, that also required their pupils to have rather a lot of money. As such, there is a rather obvious correlation between wealth, privilege, academia and RP that not only inhibits non RP speakers, but also alienates them from the “occupational discourse communities” of the medical profession- simply put, RP has become a language of exclusivity.

Think of it like this; the way we speak has been a catalyst for classism since at least the 16th century. The linguist Wareing explains it pretty perfectly in his theory of educational gatekeeping; children struggle to succeed in  academic environments if they do not use Received Pronunciation or it’s written counterpart, Standard English, due to the gatekeeper function of academic language. This, in turn, then dissuades  or physically inhibits non RP speakers (who are most likely from less privileged backgrounds) from pursuing high profile jobs, and therefore furthers the cycle of classism within education and employment.

This might have been considered “fair enough” pre 1870, as rich white boys were the only people to receive formal schooling before education became compulsory, and these were the only people that were even remotely allowed to pursue high profile jobs.  Although inherently classist, sexist and racist, this was the status quo of it’s time; consider now however that although everyone in the UK receives at least some level of standardised education throughout their young adult life, only 3% of speakers use RP, according to the findings of linguist Trudgill. So why is it necessary for the role of doctor?

One could suggest that RP is necessary in high profile jobs (doctors, politicians, judges) as it is easy to understand, with no muddying-of-the-waters through a thick regional accent, slang or a regional dialect.  This argument does have some value; imagine footballer Steven Gerard (who has also theoretically nabbed an imaginary 10 year doctor’s degree and GP qualification) prescribing your meds in his soft scouse tones, accompanied with his perpetual um-ing and ah-ing (known as hedging in linguistic terms). You might come away feeling a tad confused, or a tad doubtful of his reliability as a trained professional; and that’s simply based on his accent diverging from the prescribed bench mark of RP. Although this may seem rather innocuous, it can quickly devolve into downright prejudice. Take, for example, a thickly accented non-native english speaker prepping little-old-right-wing-Doris-down-the-road for her hip replacement. It’s a sad fact, but the leap from unsurety regarding a medical complaint to outright xenophobia is easily made by a large portion of the populace: illness breeds uncertainty, uncertainty breeds fear, and the potential for prejudice floods in.

Now I’m by no means suggesting that clarity should be sacrificed in order to be more inclusive; Standard English should undoubtedly be required for ease of understanding, particularly when concerning the health of a patient. However, (and here’s the kicker) RP and Standard English are used in completely different formats (spoke and written) and therefore cannot be directly compared. Theoretically, spoken English should be understandable for all fluent English speakers (regardless of background) in a doctor-patient setting, through avoidance of “exclusive lexis” (e.g. obscure accent traits, jargon, slang and dialect specific to only one small group or discourse community). So, owe’ve ascertained that doctor’s need to be understandable; but in what possible way does that suggest a need for doctors to solely use RP?

As has already been acknowledged, RP is not necessarily easily understandable or relatable for 97% of the population. This is widely regarded as a classist issue, but can alsooften be due to the use of very specific, specialist language within an occupational discourse community, which can easily exclude those with little to no knowledge of the topic in question. (Linguists Swales and Hymes describe a discourse/speech community as a group with the same occupation specific language, and an assumed understanding of the specific rules regarding that language.) An easy example would be the staff of a hospital- the specialist language they use is understood by all staff members present apart from (most likely) the patient, who awaits a more understandable, less jargon-filled explanation in a state of mild terror.

Realistically, there’s no way of editing down the lexis involved in medical science to make it more understandable for the average Joe, and nor should there be; medical language is specific because it has to be, in order to cover the myriad of things that can go wrong in the body and also to prevent mistakes.  What can be changed is the classist undertones attached to language, specifically that attached to accent.

It’s important to note here that the decline in RP has been accompanied by a decline in accents and dialects, due to dialect levelling; on a base level this can be described as the loss of regional/ethnic group/social class specific language due to the spread of Estuary English. (David Rosewarne first coined the phrase Estuary English in a 1984 linguistic study, in order to describe the “modified RP/regional speech” falling somewhere between RP and cockney that was growing in popularity within the UK.)

What’s interesting about Estuary English however is that it has predominantly spread as the links between social groups have increased;  a time of social mobility also means a time of linguistic mobility, creating a far more patchwork-like use of language for your average patient, doctor or person for that matter. Despite the potential to lose language, the overwhelming benefit of estuary english is that it is classless, and understandable; and perhaps a happy medium for doctors and patients everywhere?



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