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It was with a slight feeling of trepidation that I boarded a plane from Heathrow to Belgrade to attend this year’s English for Healthcare conference. I knew that numbers were going to be smaller than usual. Post-Covid (can we say that yet?) participation at other conferences has been down across the board, and I had heard of confirmed participants dropping out at the last minute thanks to cancelled flights or universities refusing funding. A couple of old friends weren’t going to be there for different reasons.


However, I needn’t have worried. Numbers were small at around 50 participants, but this allowed for an intimate, convivial atmosphere to develop where one could speak easily with many of the participants – at the talks, over coffee, the excellent lunches, and then the OET wine reception and conference dinner. There were plenty of familiar faces from past events and some really interesting new ones too. A strong university representation as ever, but also others from language schools and OET.

The conference started with an excellent, thought-provoking plenary from Kevin Harvey on the stigmatising portrayal of dementia in much contemporary discourse – the reductive language, the images, the ‘life is over’ narratives – and how debilitating that is. Kevin showed the multi-faceted, complex nature of the condition and suggested ways that allow us to see it differently, emphasising the individuality and ‘personhood’ of someone living with dementia.

The programme that followed was varied and interesting, including presentations on research projects, classroom practice and assessment. In particular, I enjoyed Alan Simpson’s session on the medical ethics course he designed for his students in Japan, Danka Sinadinović’s research in to the impact of online teaching during Covid on her classes of 150 students (150!) she had previously taught face-to-face, and Csilla Keresztes’ presentation on the pressures faced by researchers to publish in English and the challenges they face.

Finding out more on how English for Healthcare courses in so many settings are designed and taught, and the constraints in which so many lecturers work – from large class sizes to groups of widely mixed English levels to squeezing as much out of the very limited time available – was also reflected in the talk I gave on the research SLC conducted earlier in 2022, analysing the provision of Nursing English courses to undergraduates across healthcare polytechnics in Indonesia.

Clearly there is still much to be done to improve English for Healthcare programmes in so many places in order to give students and professionals the English skills they need to study, work and engage in the rapidly internationalising world of global healthcare.

Finally, I also got to spend some time exploring the fascinating city of Belgrade – so much history! – with Bethan, Virginia and Alexia, my colleagues from SLC, who joined me in for the conference. They also agreed that the conference was a real success, reflecting the hard work of the EALTHY team and the local organisers – Danka and Irena in particular – in Belgrade. I’m already very much looking forward to the next English for Healthcare conference.

EALTHY is delighted to offer the next in our series of free professional development webinars on all things Medical English. This session, coming on Friday 22nd July at 10.00 UK time, is aimed at teachers who are preparing or aiming to prepare students for OET, the Occupational English Test.

OET has grown significantly in popularity as it has become recognised by healthcare regulators and governments around the world, including the US, UK, Australia, Canada and Ireland. Here organisations use OET to assess the ability of overseas-trained healthcare professionals to give safe and effective care in English.

However, even though the numbers studying for OET have grown quickly, there is still a lack of materials and knowhow around the test, both for teachers and their students. While this is changing as Cambridge University Press, as well as specialist publishers such as Express Publishing and SLC, have recently published courses. There is still nothing like the material available for IELTS, for example.

In this webinar, OET teacher and author Tom Fassnidge looks at how to deal with a number of common issues facing OET teachers. These include initial level testing, developing courses which take students to the level they need to achieve, and how to best use learners’ clinical skills and experience to support their classroom learning.

Throughout the session, Tom will share classroom tips and techniques to help teachers get the best out of their students. It’s a must-attend session for any academic manager or teacher getting to grips with preparing healthcare professionals for OET.

Tom is the perfect presenter for this webinar. He wrote OET Reading & Listening Skills Builder, published by Express in 2020 and endorsed by OET. He is also a highly experienced OET teacher, having taught thousands of hours of OET preparation courses to groups of nurses and doctors, including for the National Health Service in the UK, SLC, and international refugee organisations such as RefuAid.



If you are not able to attend the webinar, it will be recorded and stored in the Members Area of EALTHY along with the other webinar recordings from this series. This series is already becoming an essential resource for English for Healthcare teachers.

If you’re not already a member, joining EALTHY costs only €55 a year and gives you unlimited access to lesson plans, articles, research summaries and videos specifically for English for Healthcare and OET Preparation teachers.


After a 3-year break from face-to-face events, the entire EALTHY team together with our Serbian partners ate hugely looking forward to welcoming you at the 5th English for Healthcare Conference hosted by the Faculty of Medicine and School of Dental Medicine, University of Belgrade, Serbia. The conference takes place on 16th and 17th September. We´re publishing five excellent reasons for joining us. Here´s our 4th reason for coming.

REASON 4:  Face to face is back!

We´ve done the virtual thing and it was fun. And successful. However, there´s nothing like a face-to-face conference to stimulate the brain, engage our social nature, and make a joke or two over dinner.

Many English for Healthcare teachers, writers and researchers work in small teams – or even alone. This conference is a fabulous opportunity to come together as a community of practice, exchange ideas and experience, and discover new ways to approach what you do when back at work.

There will be plenty of time to meet others and network – whether it will be in the workshops, over coffee during the break, or at the conference dinner. Attendees have a lot in common and there is always much to share.

You only have to read a few of the reviews from the last English for Healthcare Conference, back in 2019, to get a strong sense of what this means for so many:



Read more reviews and join us:

After a 3-year break from face-to-face events, the entire EALTHY team together with our Serbian partners are hugely looking forward to welcoming you at the 5th English for Healthcare Conference hosted by the Faculty of Medicine and School of Dental Medine, University of Belgrade, Serbia. The conference takes place on 16th and 17th September. We´re publishing five excellent reasons for joining us. Here´s our 5th and final reason for coming.

REASON 5: Discover Belgrade!

Belgrade is ancient, full of history and culture, and has a great buzz. The ´white city´ is one of the oldest continuously inhabited cities in Europe and the world. There is much to see, from the imposing Belgrade Fortress to the magnificent Temple of St. Sava, the Nikola Tesla Museum, and the many bohemian shopping streets, cafes, bars and restaurants, many of them moored in the boats and barges on the rivers.

Kafe CegerOne of the must-haves of every conference is a social dinner. On Saturday evening, the local conference team invites you to Ceger Kafe (´Ceger Cafe´), a cosy restaurant in the vicinity of the conference venue overlooking the Temple of St. Sava. Temple. The menu offers a typical Serbian mixed grill called Ćevapčići (or evapii) along with vegetarian/vegan and pescatarian options. You can look forward to a welcome drink, including a local spirit called Rakija which you may have never tried before.

Would you like to taste more? The locals recommend walking down the pedestrian street called  Beton Hala (´Concrete Hall´) and enjoying the confluence of the Sava and Danube rivers while having your first sip of coffee in the morning. In the afternoon, the sunset will keep you company as you savour your meal in one of the posh restaurants offering traditional Serbian cuisine, but also a variety of international dishes. And just when you think nothing could top this, wait till the evening, so you can taste Belgrade´s vibrant nightlife in clubs and bars.

One of the real pleasures of attending a conference is the chance to explore new cities and try local food and drink with fellow attendees. So, what are you waiting for?

Register and join us to enjoy the feel of the city:


In her webinar, Virginia described a shift in the market for teaching materials over the past decade, showed examples of texts used in the workplace and how to use them to approve a learner´s communication skills, outlined new trends in writing materials, and answered interesting questions asked by the participants.

At the beginning of the webinar, Virginia provided a brief overview of her experience. From 2008 to 2010, Virginia´s goal was to fill a hole in the ESP market with coursebooks for nurses aimed at developing their communication skills in clinical settings. Since 2014, she has both been helping nursing candidates to prepare for OET, and writing a series of online Medical English courses fo SLC.

She listed examples of workplace-based language associated with each communication skill. For instance, doctor-patient interactions to practice speaking, hospital documentation to enhance reading comprehension, informal sessions about new equipment or drugs to develop listening skills, and making notes in a patient file to improve writing. She also mentioned materials that deserve more attention due to technological developments in the workplace such as emails, phone and video consultations. She considers them challenging both for a writer/teacher and learners.

In the second part, Virginia presented a list of things she considers before writing and a list of characteristics that materials should have. She highlighted the integration of communication skills, using up-to-date sources of information, the optimum length of texts, how to customize materials for the specific needs of a teacher and their students, and the healthcare environment in a particular culture, and many others.


Watch the webinar to find out more about Virginia´s approach:

  • What does Virginia want to achieve with her materials?
  • What does Virginia want to help with?
  • What do learners want to achieve?
  • What does Virginia take into consideration before writing course materials?
  • What characteristics should modern materials have?


You will also get the answers to specific questions asked by the participants on the following:

  • Tools used to find out learners´ needs
  • How to approach writing materials for both pre-service and in-service healthcare professionals
  • Digital vs. hard copy coursebooks
  • Minimum requirements of student’s communication skills and knowledge of medical English
  • How to approach teaching groups with different levels of language skills
  • The latest and future trends in material writing
  • Types of texts which are currently in demand by healthcare professionals in the workplace


Virginia´s webinar is in the EALTHY Member Area, along with other webinars in the current series given by Ros Wright and Bethan Edwards among others. Log in to watch it.

Not a member but want to access this webinar along with lesson plans, articles and a tone of useful resources? Join today:

After a 3-year break from face-to-face events, the entire EALTHY team together with our Serbian partners ate hugely looking forward to welcoming you at the 5th English for Healthcare Conference hosted by the Faculty of Medicine and School of Dental Medicine, University of Belgrade, Serbia. The conference takes place on 16th and 17th September. We´re publishing five excellent reasons for joining us. Here is reason number 3.

REASON 3: Two very different but equally compelling plenaries


Friday sees the conference kick-off a fascinating plenary from Kevin Harvey, Associate Professor in Sociolinguistics at the University of Nottingham in the UK. Kevin´s work includes research into interdisciplinary approaches to professional communication, with a special emphasis on health communication.

His talk, Depicting Dementia: A Critical Examination of Discourses of Ageing and Cognitive Decline in the Popular Media, examines how dementia is presented in mass media and the consequences that has for those affected.

“I present a critical analysis of the discourse of ageing and cognitive decline in the mass media, exposing some of the often taken for granted beliefs and assumptions at work in popular depictions of ageing. I argue that much media reporting, particularly that of the press, often depicts older people in objectifying and de-humanizing terms, trading on emotive metaphors and reductive language and imagery. One consequence of such reductive portrayals is that any notion of the whole person is excluded, along with any sense living well with dementia.”

Given the rapidly rising numbers of cases of dementia worldwide, his talk is of tremendous significance and highlights the challenges facing those working with dementia patients, their families and the wider communities where they live.


Saturday follows with a very different focus from SLC co-founder and managing director, Chris Moore. His talk, Research: Improving the National Provision of Nursing English in Indonesia, presents the results of a 2022 research project on Nursing English across Indonesia.

Indonesia is an ambitious and rapidly growing industrialising country looking to create an internationally recognised healthcare system. As a part of this, the Indonesia Ministry of Health and the British Embassy in Jakarta commissioned SLC to analyse the provision of Nursing English – from objectives to curriculum design, material provision, teaching, and professional development.

The plenary describes the methodology, the challenges faced, the results, and the recommendations made in order to achieve the ambitions of the Ministry.

“The results give insight into the challenges of designing and implementing an ambitious nationwide Nursing English programme and inherent tensions between what happens at Ministry level on one hand and in practice across very differentiated contexts on the other”

What the research uncovered is undoubtedly not unique to Indonesia. During this presentation, the audience will be able to reflect on how these apply to the contexts they work in.


Read more:

After a 3-year break from face-to-face events, the entire EALTHY team together with Serbian partners are hugely looking forward to welcoming you at the 5th English for Healthcare Conference hosted by the Faculty of Medicine and School of Dental Medicine, University of Belgrade, Serbia. The conference takes place on 16th and 17th September. We´re publishing five excellent reasons for joining us. Here is the second one.

REASON 2: A wide-ranging programme offering a great value to anyone involved in the teaching of English for Healthcare

The English for Healthcare has always had an excellent selection of talks, workshops and poster presentations given by practitioners from around the world, and this year´s line-up is no exception. Just look at the following:


Reasearch-based talks

Sessions include research on the use of role play when teaching clinical language, the challenges of transcultural nursing, publication of research by non-native English academics, and the comparison of online and classroom-based teaching of English for Medical Academic Purposes.

Practice-oriented talks

A wide range of sessions including those on assessing communicative competence in nursing, providing English language training for lecturers working on EMI programmes, incorporating technology and film in the classroom, and the use of consecutive interpreting classes to teach language. There is a number of presentations on course design, from an academic writing course to a medical ethics and reasoning training course, an interdisciplinary course for 1st-year students, a communicative CALL programme for medical students, and an international project to develop a communication workshop, Radiography English Across Borders.


Workshops are longer, hands-on sessions. Those on the programme include how to help healthcare students read and listen more effectively in English, use an immersive approach in the classroom, develop nurses´ clinical communication skills, help students in OET Writing, promote peer-to-peer learning, and develop the art of listening.

Poster Presentations

The conference sees an excellent variety of researchers presenting on a range of topics, including medical terminology, translating medical texts for social media, metaphors used when describing Covid-19 and more widely across medicine, attitudes to online assessment, ageism in communication, language markers in research articles, an using medical interview when teaching.


Phew! What a selection! The 5th English for Healthcare has something for everyone. So, what are you waiting for?

Check the programme:

After a 3-year break from face-to-face events, the entire EALTHY team together with Serbian partners are hugely looking forward to welcoming you at the 5th English for Healthcare Conference hosted by the Faculty of Medicine and School of Dental Medicine, University of Belgrade, Serbia. The conference takes place on 16th and 17th September. We´re publishing five excellent reasons for joining us. Here is the first one.

REASON 1: This is the only international conference dedicated to the teaching of English for Healthcare!

While other language conferences cover a wide range of topics – something for everyone – this conference is dedicated to the teaching and learning of English for Healthcare. The importance of English for Healthcare has grown exponentially over the last few years as medicine has globalised and healthcare professionals need to improve their English to keep up with research, join international teams, attend conferences and work in different countries.

As demand mand for English for Healthcare has grown, so has the need for teachers and lecturers to develop their expertise in this challenging area. Teachers around the world work with a wide range of disciplines in healthcare, from medicine and nursing to pharmacy, radiography, and veterinary science. The subject matter is highly technical at times, and there are often few resources to draw on. Many teachers need to create their own curricula, make their own materials, and design courses that address a quite specific language and communication needs.

The English for Healthcare Conference is a unique opportunity for teachers and lecturers, as well as academic managers, researchers and translators, to meet colleagues from different countries, attend workshops and presentations, and gain insights into their work and how to improve what they do. They get ideas, practical tips and techniques, and forge connections with the wider world of English for Healthcare that they would not find elsewhere – not only through the formal programme, but also through meeting and chatting with colleagues over a cup of coffee, a glass of wine or an evening dinner.

So, what are you waiting for?

Find out what´s happening on the conference website and register for this unique event!

We’re delighted to welcome pre-eminent Medical English writer and speaker, Ros Wright, to the EALTHY webinar series. Ros will be presenting on the place of grammar in the teaching of English for Healthcare, ‘Creating Fuzziness: Filling the Accuracy Gap in English for Healthcare’.

Ros is well known for her many publications used by medical universities, nursing colleges, OET preparation providers and teachers around the world. Her books include Good Practice (CUP), English for Nursing 1 & 2 (Pearson Longman) and OET Speaking & Writing Skills Builder (Express).

Ros recently wrote two Grammar for Healthcare courses for SLC, one at a lower level (A2-B1) and another at a higher level (B2-C1). The courses focus on how grammar is used in a healthcare context. They use authentic video, a wide range of inputs and activities, with downloadable resources throughout. In both courses, students learn a comprehensive set of grammatical structures and functions and practice using them in dialogues and written communication.

In this webinar, Ros looks at how grammar often takes second place to communicative fluency, even though this may mean a compromise on the accuracy of that communication. However, speaking and writing correctly is also essential to effective communication. Using the correct tense, modal verb or question form really matters, especially in high stakes situations such as explaining a diagnosis, taking a history, or dealing with upset patients.

Ros will then look at creative ways to ensure grammar takes a more prominent role in a way that is motivating and engaging for learner and trainer alike. The webinar promises to be both insightful and impactful. It takes place on Friday 27th May at 10.00am UK time. Register your attendance now.



After the webinar, the recording will be kept in the EALTHY members resource section. Here you will find the other webinar recordings, as well as a growing number of lesson plans, articles, research, conference videos, access to journals and discounts for publications and courses. All this is available for EALTHY members for only €55 a year.


We’re delighted to have Alexia Sporidis give our next webinar this Friday. 

Alexia is a Medical English and OET preparation specialist with many years’ experience teaching professional and student nurses from around the world. Alexia is senior teacher at SLC, the UK’s leading provider of Nursing English services to the global healthcare sector.  

This webinar focuses on developing speaking materials, to help students communicate better with their patients and their colleagues.  

The webinar has three main sections: 

  1. Exploiting a patient information leaflet for vocabulary, collocation and role play 
  2. Giving a handover using the SBAR communication framework 
  3. Developing speaking scenarios from scratch for OET speaking role plays 

The webinar will be hands-on, providing teachers with lots of practical ideas that they can use with their students. While the focus is on nursing students, the tasks and activities will also be applicable to other healthcare students, such as medicine and pharmacy.  

The webinar is free to attend and takes place on Friday 22nd April at 10.00 UK time. 

Developing Speaking Materials for Nursing English


The recording will then be available in the EALTHY members’ section, where you will find other webinar and conference recordings, along with lesson plans and many articles. 

 If you’re not a member yet, then sign up here.  


We’re delighted to have offered the first in a monthly series of webinars specifically developed for English for Healthcare teachers.

This webinar focuses on OET, the Occupational English Test. OET has rapidly become the test used by healthcare regulators around the world to assess whether a healthcare professional has the right levels of English to work in English. Countries now recognising OET include the US, UK, Canada, Australia, Ireland and New Zealand.

OET is designed specifically for healthcare. The Reading and Listening papers cover a wide range of academic and practical healthcare English, while the Writing and Speaking papers focus on the profession-specific language used by 12 different professions, including medicine, nursing, pharmacy and dentistry.

The number of candidates taking OET has accelerated rapidly over the last few years. As a result, many English teachers now have to learn about the test and how to best prepare candidates to achieve the grades they need.

We’re delighted to welcome Bethan Edwards, Academic Director at SLC (Specialist Language Courses), to share her experience and ideas with us. Bethan has prepared hundreds of students for OET, written OET preparation courses and trained teachers around the world on how to prepare their students for the test. SLC is an OET-accredited Premium Preparation Provider and works extensively with the UK’s National Health Service, as well as with healthcare educators, employers and individuals around the world.

This webinar focuses on the Speaking and Writing papers. It will cover a range of ways of helping students develop the skills they need to be successful in both areas. The session will have a strong practical focus, drawing on the strategies and classroom activities Bethan and her teachers have developed over the last five years she has been working on OET courses.


Tips for Teaching OET

Watch the Recording Here

And watch out for details of more webinars soon!


We’d love to receive your proposal for this year’s English for Healthcare Conference in Belgrade.

Not sure where to start?  Here’s a short guide to writing a successful proposal.

This blog summarises a conversation hosted on Twitter by Cochrane UK, inviting views on the use and misuse of language when talking about long-term conditions. 

Following on from Anne Cooper and Bob Swindell’s blog The impact of language on people living with long-term conditions: having the rug pulled out from underneath you Cochrane UK hosted a tweetchat to discuss the language used to talk about long-term conditions, its impact, and alternatives to language that people find problematic. There are so many different aspects to this that we couldn’t hope to do more than scrape the surface of a few of them, but here are some of the points that were raised. Do feel free to add your own via the comments facility below the blog. 

Plain language is important 

Using plain language is an important part of ensuring that information is communicated in ways that are easy to understand. The use of terminology can be confusing, especially when it is used differently by different people. Be prepared, if you’re a health professional, to speak plainly, even if that is to deliver bad news, but also mirror the language people use if possible. 

Respect and reflect people’s choice of language about themselves  

Someone described how health professionals sometimes reject the language she uses to talk about her mental health problems, often attempting to make it sound less serious. She said this makes her feel disbelieved, and that this behaviour, a refusal to use certain names and words, contributes to mental health stigma. 

When a health professional (or anyone else) uses the language a person uses themselves about their health, this shows that they have listened, and it shows respect. Pertinent to this is the What Matters To You? initiative. 

Avoid judgmental language 

 ‘Non-compliant’ or ‘non-adherent’ were mentioned as judgemental and as revealing a perspective that is all about the practitioner rather than the patient. ‘Sufferer’ and ‘survivor’ were others. It would be interesting to hear more views on these last two, as I have also seen them used by people about themselves, but sense that the shift away from their use may be gathering momentum. 

Language can apportion blame, such as asking someone with Diabetes “How well controlled are you?” or “have you been eating correctly?” @emmajdoble notes “I much prefer ‘how are you coping’ or ‘managing’. Or ‘that I am finding my diabetes challenging or difficult’. I feel this puts the blame on diabetes rather than me!” For Olivia @just_TUX, “I often get ‘what did you do to set off an asthma attack?’ but would prefer ‘do you know what triggered your asthma?’” 

Some alternatives for language used in the context of personality disorder were suggested recently and what a different feel the alternatives have! ‘Survival strategies’ instead of ‘acting out’ and ‘attention needing’ rather than ‘attention seeking’, among others. 

This reframing is important and it’s one of the key principles of the @NHSEngland ‘Language Matters’ guide: “Avoid language which attributes responsibility (or blame) to a person for the development of their diabetes or its consequences”. This could easily be adapted for other conditions, of course. 

@Anniecoops noted that “When we developed #LanguageMatters we discovered the importance of neutral and factual labelling, choice, and positive motivating language. but for me always #PersonFirst too.” 

It’s not just about alternative terms. “Specific language alternatives don’t interest me. A reduction in direct or inferred blame, telling off patients and scare tactics are important to me.” @DiabeticDadUK 

Use sensitive language 

This was mentioned in the context of talking about suicide and is so very important. The Samaritans have this guidance on how to talk about suicide safely online. 

Words can traumatise… 

This is also about sensitivity and thinking about the possible impact of your words. @Claire_F1att shared this: “I actually had a nurse ring me when I was diagnosed and she left a voicemail message saying she was a palliative care nurse… I wasn’t palliative and found the use of that word traumatising. I didn’t seek support from her… as a nurse & as a rational person I am/was aware palliative doesn’t mean dying but as a patient I found the word quite distressing.” 

The language of war 

Dislike of the language of war and battles was raised here and this aspect of language use on its own could fill a tweetchat and much more. Indeed, a great deal has been said elsewhere about these military metaphors that have been used for centuries and that we still see so often, especially in relation to cancer (‘beating cancer’, ‘lost their brave fight against cancer’ etc), with all that implies about efforts by the person with the illness to ‘win the battle’ – or not… 

“I’m not fighting cancer and I’m not a “warrior” either, I’m just “dealing with cancer” each day at a time. I’m not at war with my own body. Yes, a few bits don’t work as they should but it’s still pretty amazing so I’ll work with it, not against it.” @FionaMartin123 

“I know I haven’t ‘beaten’ cancer, I haven’t ‘fought’ it either. But I have lived as effectively, thoroughly and wholly, as I can.” @therapy2optimum 

“There is a lot of war language used with chronic illness, which isn’t always helpful- brave, fighting, beating illness- and then losing the fight… it can add to a sense of blame- didn’t fight hard enough etc.” @sarah16107480 

The blog Battling, brave or victim: why the language of cancer matters reminds us that people’s preferences vary, a recurring theme in this chat. 

The naming of health conditions – time for a rethink? 

 It’s time to rephrase Heart Failure, suggested one person, when this a normal process as we age, unless brought on prematurely. They also told us about a call to rethink how doctors talk to some people with reduced kidney health, replacing the term ‘Chronic Kidney Disease’ with different bands of kidney age. 

I am aware that the territory of language around deafness (Deaf, deaf, hard of hearing, hearing loss, and more) can be difficult to navigate. People have different preferences – and often strong feelings about it. 

Labelling and lumping together 

Being labelled by a health condition can be unwelcome. @Anniecoops says she hated being called a Diabetic (or one of ‘The Diabetics in the waiting area’) and prefers ‘Anne who has Diabetes’. A label might mean that they look at the diagnosis before the person. But it should be driven by choice. As the Language Matters: Language and Diabetes document says: “it is up to the person concerned as to how they would like to be addressed, supported and understood but as healthcare professionals, we need to be aware of the need to give them that choice, not make it for them.” 

The language (and images) used by the media 

Influencing the media in how they portray and speak about people with Diabetes was one of the aims of the Language Matters publication. Of course, public perceptions, attitudes and language are influenced by the language used by the media, and the images used too. Poor choices of words and images can give a negative impression of a health condition and the people who have it and contribute to stigma and stereotyping. 

Advice and guidance 

There is much that is common to the use of language across different health conditions, but some helpful condition-specific resources were mentioned during the conversation. Also, speaking to patients about how they think of their condition, what words they use, can be really helpful. 

References (pdf) 

Read the rest of the blogs in our ‘Living with Long-Term Conditions’ series. 

Join in the conversation on Twitter with @CochraneUK or leave a comment on the blog. 

Please note, we cannot give medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.

Sarah Chapman has nothing to disclose. 


5th English for Healthcare Conference  

 Hosted at the University of Belgrade, 16-17 September 2022  

 KEYNOTE SPEAKER:  Kevin Harvey, University of Nottingham 

The English for Healthcare Conference aims to encourage an exchange of ideas to stimulate discussion and to provide a platform for the presentation of new approaches to the teaching and learning of language and communication in medicine.  Due to popular demand we are extending the deadline for proposals until March 1st.

We particularly welcome proposals that relate to classroom practice  and the teaching of English for medical purposes. We also welcome proposals that are research-based which help to develop our understanding of how language is used in the practice of medicine and healthcare. The event attracts language teachers and communication skills trainers working with health professionals, both in training and in the workplace, and practitioners from the medical translation and interpreting field.  

Areas/Themes include but are not limited to: 

  • Content-Based and CLIL  in EMP
  • English Medium Instruction  in EMP
  • Medical Academic English  
  • Teaching language skills for EMP (Reading, Speaking, etc.)  
  • Assessment (e.g., Occupational English Test) for EMP
  • Task-based and problem-based learning in EMP
  • Role plays / Simulation in English for medical purposes  
  • Corpus linguistics in EMP 
  • Professional practice and discourse  in EMP
  • Communication skills training for healthcare  
  • Interpreting /translation for healthcare  
  • Medical Humanities in language classes



Workshop: a practical, interactive, how-to session with plenty of audience involvement– 45 minutes  (or 90 minutes depending on the proposal) 

Practice-oriented presentation: focused on classroom practice – 15 minutes (+ 5 minutes questions) 

Research based presentation: focused on completed research – 15 minutes (+ 5 minutes questions.) 

Poster presentation: A1 or A0 format academic posters. Particularly suitable for uncompleted research.

  • Word doc, 300 words maximum (no references)  
  • Do not use any special fonts, such as bold print or caps (italics fine)  
  • Do not add tables, photos, or diagrams to your abstract  
  • Do not indent your paragraphs, leave one space between paragraphs instead  
  • Your abstract should clearly summarise the content of your session/poster  
  • Please indicate what type of session your submission is for. 



Please email your abstract to:  

*Please note that all presenters should be paid-up members of EALTHY when they confirm their participation at the conference. 

Professor John Skelton’s keynote at the Languages in Medical Education online conference at Voronezh N.N. Burdenko State Medical University, December 2020.

Watch more presentations from the conference here

Virginia Allum, EALTHY’s clinical nursing advisor and Head of Medical English for Specialist Language Courses, is a busy woman. As well as writing courses, training teachers and providing expertise and support for EALTHY and SLC, she is an item writer for the Occupational English test (OET). Remarkably, she also works part time as a Registered Nurse, bringing her unique blend of experience, humour, and knowledge to patients across the Western Isles off the coast of Scotland. Yesterday she received the first dose of the Pfizer vaccine. This is her story. 

I feel very privileged to have received a Covid-19 vaccination today at NHS Western Isles where I work. The procedure had all the hallmarks of a pandemic response. We arrived with our masks on, sat in chairs spaced the correct distance apart and received information about the vaccine (the Covid-19 mRNA Vaccine BNT162b2 or ‘Pfizer’ vaccine). Important questions were asked to ensure all precautions were taken and then it was on to the ‘vaccination room’. Consent given, I had my injection, or ‘jag’, as it is known here on the Isle of Lewis (I haven’t been able to find out why it isn’t ‘jab’…in any case, I was used to the term ‘shot’ in Australia).

I returned to my chair in the waiting room where I was observed for 10 minutes and then sent home to rest. I hope to receive the second dose in 12 weeks.

It started me thinking about all the vaccinations I have received in the past, vaccinations which protected me from some very nasty diseases. Some of you will know that I was born in Australia and so started my vaccination history there.

Triple Antigen and Polio

In 1953, the Diphtheria-tetanus-whole-cell pertussis vaccine (DTPw) was introduced. This was a 3-dose infant-based schedule which I was to receive 5 years later. In Australia, mass production of the inactivated polio vaccine began in July, 1956, two years before my birth, so I was amongst the early youngsters vaccinated against poliomyelitis. The oral Sabin vaccine (live attenuated oral polio vaccine) was not registered until 1964 after trials in Tasmania. Australia and the Western Pacific Region was to be declared polio-free in 2000.

Travel overseas: The International Certificate of Vaccination (the ‘Yellow Card’)

This record was developed by the WHO and one which my parents had to have completed before we travelled from Australia to the UK (by boat, via South Africa) so my father could work there. I was vaccinated against smallpox (and still have the scar on my upper arm), cholera and yellow fever. My first vaccinations were given to me by my grandfather (a GP) who refused to give me the boosters as he didn’t want to be remembered as ‘Grandpa who gives needles’. A different GP was sought for the boosters!

Hepatitis B

Liver with Hepatitis B infection highlighted inside human body and close-up view of Hepatitis B Viruses, medical concept, 3D illustration

In 1982, a serum derived hepatitis B vaccine was registered for use in adults and in 1985, for neonates. In 1986, vaccination using 3 doses was recommended for at-risk adults, e.g. Aboriginal and Torres Strait Islanders, immigrants and refugees from high risk countries, healthcare workers, IV drug users, recipients of factor VIII or IX blood products and household and sexual contacts of hepatitis B carriers. Between 1987 and 1988 two recombinant hepatitis B vaccines were registered in place of the serum derived vaccine. I was given the 2-dose vaccination against Hepatitis B in 1987.


In June, 2006 a 4-valent human papillomavirus vaccine was registered for use in females aged 9–26 years as a 3-dose schedule. I was not in the age group to receive this vaccine, but my daughter was proud to receive the vaccine which had been developed by the University of Queensland in Australia by Professors Ian Frazer and Jian Zhou.


And now, today I have received a new type of vaccination.

‘Pfizer is collaborating with German biotech company BioNTech to focus on a technology called an mRNA vaccine. Unlike conventional vaccines, which are produced using weakened forms of the virus, RNA vaccines can be constructed quickly using only the pathogen’s genetic code. Many standard vaccines work by injecting a dead or weakened form of the pathogen into the body in preparations that are designed not to make you sick but rather to build immunity. The key to building this immunity is that the portion of the pathogen called the antigen trains the immune system to recognise and respond to the infectious agent.5 RNA vaccines work by introducing into the body a messenger RNA (mRNA) sequence that contains the genetic instructions for the vaccinated person’s own cells to produce the vaccine antigens and generate an immune response.’


How far have we come from the 18th century when Edward Jenner inoculated a 13 year-old-boy in 1796 with cowpox to demonstrate immunity to smallpox. Two years later the first smallpox vaccine was developed.

The virus that the Covid-19 vaccine is fighting is tiny; the coronavirus is 0.1- 0.5 nanometres. (a red blood cell is 7-8 nanometres). To my mind, this makes the development of a vaccine against such a tiny ‘monster’ a miracle!


Thank you to Specialist Language Courses for permission to republish.

It has become a bit of a cliché in OET circles that students and teachers alike face a lack of high-quality preparation materials; a new title by a well-respected author in the field is therefore bound to cause excitement. OET Speaking and Writing Skills Builder (Nursing and Medicine) by Ros Wright is aimed at both self-study and classroom settings and with its focus on the development of techniques required for the speaking and writing OET sub-tests (nursing and medicine)will be welcomed by both independent learners and classroom teachersIt is the companion title to OET Reading & Listening Skills Builder (All Professions), which I have reviewed separately, and this review looks both at the print and the Digibook editions of the book. Like the Reading and Listening book, OET Speaking and Writing Skills Builder was written with input from two medical advisers, who are credited on the front covers.  

Organisation of the book

As companion texts, it is perhaps surprising that the organisation of the Writing and Speaking book differs from that found in the Reading & Listening textIn OET Speaking & Writing Skills Builder, there are eight rather than ten topic-focused units, such as respiratory (covered in Units 1 & 4), endocrinology and psychiatry. There is no cross over with the Reading and Listening book in terms of unit topics, meaning autonomous learners and students on a long-stay exam preparation course using the books side by side may find themselves dealing with two distinct topics at the same time. However, this does mean that they also gain exposure to a greater range of topics.  

Each unit opens with an OET Speaking section, which looks at the skills required to meet the clinical communication aspects of the Speaking sub-test and patient-centred care in the workplace. There is then a Medical Focus section linked to the unit’s topic, sections dealing with Grammatical Expression and Lexis and finally OET WritingThis final section makes significant use of the SBAR framework and also helps students to make principled choices when selecting which information to include in an OET letter. The grammar and lexis areas are largely well chosen, covering the language which many OET candidate struggle with such as articles, softening questions and asking for consent; four sections on dependent prepositions out of eight for Lexis does feel a little imbalanced, notwithstanding the issues many learners face with this language point. Additionally, given the C1 level of OET, the tense review sections seem pitched a little low.

Additional sources

The book is rich in additional resources, audio scripts and answer keys, including some very useful case notes, sample letters and speaking role play cards and a grammar reference, making the book ideal for self-study. I particularly liked the sample letters with their detailed annotations highlighting good practice and the additional further commentaries although I was surprised to see one sample letter of 221 words described as being of an appropriate length given that OET asks test takers write a letter of between 180 to 200 words 


The print edition is attractively laid out in full colour and the pages breathe well thanks to plenty of white space. Additional bite-size hints about exam strategies are presented in the frequent blue Test Tip boxes and are a strength. Learning objectives for each of the five sections are given at the beginning of each unit; the addition of some kind of review activity or reflective task at the end of each unit or cycle of three units would have been a welcome addition. 

All of the book’s contents can be accessed through Express Publishing’s own online platform and Digibooks app. Pleasingly, the code for this online version is provided at no extra charge, bound in with the hard copy edition, and for student accounts is valid for 15 months from the activation date; teachers on the other hand can re-activate the apps for free. CD recordings of the audio tracks are available separately for a small charge of just under 8 Euros. A stand-alone digibook edition is available, with a 15% reduction on the price of the printed edition. 

User experience

The user experience for students is mixed. Students who are studying on their own will welcome the opportunity to access the whole book, including the audio recordings, on a PC or a mobile device at no extra charge and the flexibility this offers is clearly welcome. The digibook edition has flexible navigation, with each activity on its own page. These are accessed linearly using back and forward arrows or via a drop-down menu which makes it easy to jump to a specific exercise anywhere in the book. However, as these pages are labelled with the exercise number only (e.g. Exercise 6.2), it is not self-evident how each activity relates to the five parts of the unit (Speaking, Medical Focus, Grammatical Expression, Lexis and OET Writing). Also, the first number does not correspond to the unit number, making quick navigation difficult. Hopefully, this is an issue that the digibook team can address easily in the future. The serif font used looks dated and the non-responsive nature of the page frame means there is often a lot of empty white space in shorter exercises, giving a rather dated user experience.  On a mobile phone, this lack of non-responsive design meant that I had to place my device on its side to fit the page on screen: holding the phone normally meant constant scrolling left to right. Answers requiring me to type in a word were also problematic: many mobiles default to capitals for the first word in a new field, but the system automatically marks as wrong a correctly spelled word with an erroneous first capital letter.  

Teachers using the digibook to project via a projector or an interactive board/panel will welcome the opportunity to project these unit segments and this will work equally well in face-to-face, online or in hybrid classes. However, the publisher seems to have overcomplicated its LMS, with a hierarchy of users (student, teacher, school manager, school master and parent), each with its own lengthy user manual. I have not been able to trial this with a group of students, but there are options for progress reporting, homework and assignment setting and even attendance checking


OET Speaking & Writing Skills Builder (Nursing and Medicine) is a welcome addition to the slowly growing choice of materials available to teachers and students who are studying independently. Its focus on speaking and writing skills development meets the needs of candidates who are not familiar with the requirements of the relevant OET sub-tests and while the middle sections are sometimes pitched low, they are described as optional. As I wrote for my review of the companion Reading and Listening book, many students preparing for OET fall into the trap of thinking that exam practice alone is the key to exam success and this book provides something different and for that it deserves praise and success.  

Published 2020, Express Publishing.

160 pages; 31,79 Euros for print book and digital access currently reduced to 25,43 Euros (or 25,43 Euros currently reduced to 20,34 Euros for the digibook only); Audio CDs 7,95 Euros 

ISBN-10:  1-4715-8694-1 

ISBN-13:  978-1-4715-8694-1 

Until recently, candidates preparing for the Occupational English Test, plus the teachers supporting them, have faced a relative lack of high-quality published preparation materials. OET Reading & Listening Skills Builder, written by Tom Fassnidge, will therefore be a welcome addition to the growing array of OET materials, as will its companion title, OET Writing & Speaking Skills Builder (Nursing and Medicine).

Tom is an experienced OET teacher and materials writer who has worked for one of the UK’s leading OET Premium
Providers; this new title provides candidates with the techniques required for the reading and listening (all professions) sub-tests and is suitable for either self-study or classroom use.

OET Reading & Listening is divided into ten units which are organised by topic. Besides the usual clinical areas (lifestyle issues and infectious diseases), the topics also include wider issues such as training and best practice plus technology and social issues. Each unit includes a reading and listening focus plus a language/skills
focus. Beginning in Unit One with an overview of the types of texts and questions found in the reading and listening sub-tests, the reading and listening focus sections then look at each part of the reading and listening sub-tests in turn and repeat this structure throughout the remaining nine units. The language/skills focus cover the many sub-skills required for success in OET, including gist, detail and purpose and useful language such as collocations, modals, and semi-modals plus a very useful section on identifying and avoiding distractors. In total, the book provides the
equivalent of more than two complete OET Reading and Listening sub-tests. Of note is the author’s comment in the introduction that the texts and exercises are designed to be “a little easier than the real test” to help students to focus on the development of the techniques required for OET success. This reflects nicely the book’s title, although it is perhaps a little disappointing that there are no complete practice tests at the C1 level provided at the back of the book for students to gauge their level on completion of the book.

Like the Speaking & Writing volume, the hard copy edition of OET Reading & Listening Skills Builder includes additional resources, audio scripts and answer keys, making the book ideal for self-study. Furthermore, all of the book’s contents can also be accessed through Express Publishing’s own online platform and the Digibooks app. Unusually, the code for this online version is provided at no extra charge, bound in with the hard copy edition, and for student accounts is valid for 15 months from the activation date; teachers on the other hand can re-activate the apps
for free. CD recordings of the audio tracks are available separately for a small charge of just under 8 Euros.

Unfortunately, the digibook edition of OET Reading & Listening Skills wasn’t ready at the time of writing this review but the publisher states that the online/app edition will be highly interactive. The teachers’ guide for Express Publishing’s online platform is very comprehensive and perhaps almost overwhelming in its detail, while the platform itself allows students who are part of an taught group to check what has been assigned to them as homework, complete it online, have their answers automatically corrected and see their progress. Individual learners are also well catered for, being able to complete all of the book’s activities (including listening ones) online and receive instant feedback.
The book is attractively laid out in full colour, with plenty of white space on the page for the contents to breathe. Frequent blue Test Tip boxes, presented as speech bubbles, provide additional bite-size hints about exam strategies and are a strength. It was good to see learning objectives for Reading, Listening and Language and Skills presented at
the beginning of each unit; the addition of some kind of review activity or reflective task at the end of each unit or cycle of three units would have been a welcome addition.

I am very happy to recommend this and its companion Speaking and Writing volume to teachers and students who are studying independently. The focus on skills development will be particularly welcome to teachers and students who value a focus on developing their skills. Many students preparing for OET fall into the trap of thinking that exam
practice alone is the key to exam success and this book is brave in providing something quite different and for that it deserves praise and success.

Published 2020, Express Publishing.
158 pages; 31,79 Euros for print book and digital access (or 15% discount for digibook
only), currently reduced to 25,43 Euros; Audio CDs 7,95 Euros
ISBN-10: 1-4715-8693-4
ISBN-13: 978-1-4715-8693-4

Spoonerisms or malapropisms, commonly referred to as slips of the tongue, are a perfectly natural aspect of communication. They’re also the source of much amusement. Who doesn’t enjoy hearing lexically confused celebrities – Justin Bieber once claimed he was ‘detrimental to his own career’ – though I reserve most of my delight for the communicative cockups of politicians. Trump and Bush Jnr are well known for their weird wordery, but here’s a goody from Tony Abbott, former PM of Australia: ‘No one, however smart, however well-educated, however experienced … is the suppository of all wisdom.’ I feel a joke forming – no. Can’t. Too rude. 

Remember former US Vice-President Dan Quale? He famously came out with ’I stand by all the misstatements that I’ve made’ while Richard J Daley, former mayor of Chicago, uttered some gems during his term in office, once calling a tandem bicycle a ‘tantrum bicycle’ and referring to Alcoholics Anonymous as ‘Alcoholics Unanimous’. 

These days, we’re certainly more aware of slip-ups, errors and abuses because so much is being written, not only in emails but on social media, in forums, blogs and newspaper comments sections. We also seem far more tolerant of spelling mistakes and grammar oddities (assuming we’ve spotted them in the first place). If you doubt this, correct someone in the Comments section of a newspaper and see what happens. The so-called grammar police – who really seem more concerned with punctuation and spelling than structure and form – get short shrift when they pop up to correct a misplaced apostrophe.  

Meaning is an altogether more slippery beast

But meaning is an altogether more slippery beast. When communication takes place, and language competency is not called into question – that is to say, both participants are judged to be proficient in whatever language they’re using – each participant assumes that lexical choices are deliberate and appropriate. You rarely see vocabulary being corrected. If you tell me you’ve eaten four doughnuts, I’m not going to be too impressed, but I’ll believe you. I may well seek confirmation – four? FOUR? – but I won’t wonder if you really meant one or that you intended to say sandwich. If you tell me you’re a plumber, I won’t wonder if you meant fitness instructor. It gets trickier, though, when faced with less concrete, stodgy facts. ‘How are you feeling today’ or ‘Does this make me look fat?’ doesn’t always lead to an unequivocal response. I’m likely still confident that you’ve chosen the word you wanted, but I may not always be sure of the accuracy of the message or its veracity. Aside from bare faced lies, there are white lies, half-truths, evasive responses and vaguery. You could write a book on these aspects of communication – plenty of people have. I’ll talk a bit about it in my next blog post. 

But what happens when a mother tongue is not shared, or language competency is not evenly matched? With their multicultural populations, this is a typical scenario in many urban medical encounters in countries like the UK, the US Canada and Australia. Even without the challenges of accent and pronunciation, grammar issues and health literacy issues, miscommunication because of vocabulary is a common source of frustration, confusion and, sometimes, medical error.  Unlike the rarefied atmosphere of the classroom, where students are safe to make mistakes, and where there’s time to investigate the collocations, connotation, range of meaning, register and appropriacy of a single word, a real-time medical interaction permits no such analysis.  

Meaning in medical encounters

When we speak about communication issues in medical encounters, we’re often referring to those interactions where the patient doesn’t understand or fully understand what their doctor is saying. Over the last decade or so, many papers have investigated just how little medical terminology patients understand, and the impact of not understanding on the patient’s health and well-being. (See for example Chapman, K., Abraham, C., Jenkins, V., & Fallowfield, L. (2003)). Studies like these continue to appear in disciplines other than applied linguistics and for a variety of languages and areas of medicine. 

Some linguists and healthcare communication researchers have shifted their focus away from what patients don’t understand and on to what they do understand and how they use the medical terms that they know. (Fage-Butler & Jensen (2016) and Koch-Weser, de Jong & Rudd, (2009; 2010) are well worth reading.) These studies reveal a considerably more complex picture than the standard understand/do not understand dichotomy. The so-called ‘expert patient’ – often a patient living with a chronic condition – has been described as having a kind of ‘vertical knowledge’ which suggests that they can use ( a lot of complex) medical terminology relevant to their condition. In light of these findings, assessing what the patient understands or doesn’t understand should be an essential part of the consultation. As Fage Butler and Jensen (ibid) write:  

Appropriate pitching of terms can avoid the potentially damaging effects of poor communication brought  about by inappropriate (too complex or too simple) use of terms. This is not an easy task. It takes time for  a health-care professional to establish what terminological level is appropriate, which can be problematic  in an already time-pressed consultation. 

The authors also make clear that we need to be cautious in assuming that patients and medical professionals are using medical terminology in the same way. This is a hugely important point. Meaning divergence, as this is called, can often pass unnoticed with both participants assuming a common, shared meaning where in fact none exists. For example, in oncology, talk of disease progression may pass without comment, but the patient may not have understood that this is not something to be pleased about.  Another example of this – and it’s one I like to trot out because it a great example – is the term ‘chronic’. How many international health professionals know that it can be used in certain varieties of English to mean ‘bad’?  If I tell my doctor my pain is chronic because it’s intense, the doctor is likely to understand that I’ve had it for some time and the remark may pass without comment. Dahm (2012) found that people (and that includes medical professionals) are more aware of meaning divergence when they’ve had personal experience of it. She also found that the very concept of meaning divergence can be difficult to grasp for some people. For some, it can mean that the severity of my condition, the intensity of my pain or the impact on my life is not being fully understood or appreciated by you. 

The role of experience in how we understand words

Experience also plays a role in how we all use and understand words. Patients may use terms differently to medical professionals because as patients we emphasise the experience of the condition or symptom, and, just as personal experience of a condition varies from one person to another, so do the meanings attached to the words we use. In the same way, medical professionals will understand different aspects of the same word depending on their experience and area of expertise.  A psychiatrist will have quite a different understanding of the term ‘schizophrenia’ than a GP. The patient with schizophrenia, in turn, possesses a different understanding to both psychiatrist and GP. This is a fascinating area. (Professor John Skelton, EALTHY President, alerted me to this a few years ago, though he expressed it far more elegantly than I have just done.) 

So, as teachers of medical English what can we take from this? Well, the obvious thing is that Meaning is a Minefield (there’s a good summary of just how complex it is to talk about meaning here: ) and our students should be made aware that simple translations won’t necessarily cut it. Words have very intricate relationships with other words and with the context in which they’re used. Developing our students’ awareness of this seems crucial. And as human beings, our relationships with each other and how we communicate are equally as intricate.  We teachers can never hope to give our healthcare students all the knowledge they need to be competent communicators when they leave our classrooms, but we can help them acquire the skills they need to become effective communicators. These skills will develop as their professional skills and experience grow. Medical professionals using English in the workplace, more than anything else in my view, need the linguistic means to negotiate meaning with their patients and their colleagues, and to negotiate meaning with skill, with sensitivity and with the awareness that each and every interaction is unique. 

I’ll leave you with a few medical malaprops that had me in stitches. Literally. Not. (😉 ) 

  • She had postmortem (postpartum) depression 
  • Heart populations and high pretension (palpitations and hypertension) 
  • A case of headlights (head lice) 
  • Sick as hell anemia (sickle cell anemia) 
  • The blood vessels were ecstatic (ectatic) 
  • The patient was treated for Paris Fevers (paresthesias) 
  • It was a non-respectable (unresectable) tumor 
  • Nerve testing was done using a pink prick (pinprick) test 
  • I had smiling mighty Jesus (spinal meningitis) 

As we move further into the Coronavirus pandemic, I started wondering how the world’s populations felt at a similar stage of the 1918 Influenza pandemic. An article titled ‘”Destroyer and Teacher”: Managing the Masses During the 1918-1919 Influenza Pandemic’ (1) highlighted some interested social behaviours.  

I recommend reading the entire article especially the epilogue which may have you shaking your head sadly, especially George Soper’s comment in his 1919 article, The Lessons of the Pandemic (2)that : “.. . This may all seem very discouraging but it need not depress anybody. .. To rightly measure a difficulty is often the first step toward overcoming it.”  

In her article, Nancy Tomes gives a summary of the responses to the 1889-1890 Russian Influenza Pandemic and the 1918-19 Spanish Influenza Pandemic. As you read through the events of the timeline, you’ll no doubt have some ‘light bulb’ moments as you identify some examples of current behaviour patterns which are occurring. 

1889-1890 Russian Influenza 

  • flu thought to be caused by ‘microorganisms floating in the air’ 
  • contagiousness of influenza (the ‘grip’) not appreciated: Public Health (PH) authorities downplayed the importance of the virus coming to the US from Russia and left its treatment to private physicians 
  • medical advice generally to stay home and recover and keep infected people from others. No advice on how to avoid contagion 


  • bacteria causing cholera, syphilis, typhoid and TB discovered; public health movement expands 
  • flu identified as a ‘germ disease’, named ‘x-germ’. 
  • flu described as a respiratory disease which could be transmitted through coughing, sneezing and spitting. 
  • advice for minimising spread: quarantine, isolation, disinfection, ventilation and personal hygiene 
  • other ideas still current – spread of flu on library books and postage stamps 
  • expanding mass media – newspaper reading at an all-time high 

By the 1918s, some of the issues facing current PH authorities and economists were starting to become evident: 

  • flu was seen as a ‘crowd disease’. More people packed into crowded cities.  
  • increase in mass gatherings, e.g. troop ships and theatres. During the 1918 pandemic, a ban on mass gatherings for people of all ages was instituted.  
  • By 1918, it was noted that the US relied on large cities for their expanding economy. Businessmen resisted quarantine measures like the shutting of factories. So, the question is raised about contagion control versus a stable economy (Familiar?) 
  • Comments suggesting people were affected more by fear than influenza started to appear in newspapers. Words such as  ‘fear’ and ‘panic’ were found in newspaper articles (Familiar?) 
  • the public appeared confused by the PH message: unsure about terms such as ‘essential versus non-essential services’ 
  • The pandemic revealed how economically important public amusements had become to local economies.”: in addition, it was clear that city dwellers relied on theatre, cinema and concerts for their social life.  

There were so many parallels in the article with our current situation that I was keen to read the author’s conclusion and/or forecast about any future pandemics, remembering that the article was published in 2010. I think it is worth adding the entire epilogue. Areas in bold are mine and refer to points which may not have played out as the author suggests or which I think the author foretells with unfortunate accuracy. 

Even now, nearly 100 years later, the image of the influenza pandemic as “destroyer and teacher” remains a compelling one. For all the greater knowledge we now possess about its genetic makeup and natural history, the influenza virus still retains the capacity to remind us how difficult disease prevention and control remain in modern societies. Do we have any better chance of controlling a “crowd disease” such as influenza in the early 21st century, compared to 1919? 

In some important ways, the answer is probably yes. To begin with, we have a new line of defense that was missing in 1918–1919, in the form of antivirals such as Tamiflu® and the capacity to produce effective flu vaccines. These measures play an essential role in the modern approach to influenza pandemics. Yet they have their limitations: stockpiles of Tamiflu can be quickly used up by physicians seeking to calm panicky patients, and the manufacture of flu vaccine depends on a complicated and in some ways antiquated system of production. Thus, the discovery of flu wonder drugs and vaccines has by no means diminished the need for nonpharmaceutical interventions. As the Centers for Disease Control and Prevention guidelines for pandemic control make evident, they have an essential role to play in slowing down influenza’s spread long enough for these measures to be perfected and distributed.62 

It may also be easier for people to understand the rationale for social-distancing measures now than it was in 1918. First, the proliferation of fictional and journalistic portrayals of killer epidemics has created a popular apprehension of pandemics in general and influenza in particular that did not exist in 1918. Inventive film makers and novelists have spun dramatic scenarios, some entirely hypothetical, some loosely based on real diseases, about the dangers of rapidly spreading plagues. Books and films, among them Michael Crichton’s Andromeda Strain, Stephen King’s The Stand, Richard Preston’s The Hot Zone, Terry Giliam’sTwelve Monkeys, and Francis Lawrence’s I Am Legend, to name only a few, have taught successive generations of movie and TV watchers to fear the microbe. Real-life pandemics, including HIV/AIDS and SARS, have taught their own lessons about the difficulties of disease prevention in modern mass societies. Along with climate change, pandemic disease has become part of an apocalyptic set of worries far beyond what E. O. Jordan’s generation could have imagined.63 

Yet despite our renewed fear of the germ, the implementation of social-distancing measures still faces many challenges today. Public-gathering bans, school closures, and transportation restrictions are difficult to enforce for the same reasons they encountered resistance in 1918–1919. Nor are we any more likely than our World War I forbears to be able to sustain an exacting hygiene of nose/mouth/hand prevention. Consider, for example, the many studies that show the difficulties of getting health-care professionals to practice proper hand-washing protocols, a problem that has helped make hospital-based infections such as methicillin-resistant staphylococcus aureas so common. Like the mayor who let his face mask dangle and the TB expert who coughed into his hand, even people who should know better forget to be careful. Health-care professionals still have to be reminded to wash their hands frequently.64 Studies have also found that men tend to be more careless about hygiene protocols than women, suggesting that the man/boy problem has yet to be solved.65 

Perhaps fortunately for us, the resources of late modern industrial culture will conceivably make it easier for us to tolerate staying sequestered at home at least on a short-term basis. Compared to troop ships and railroads, air travel is easier to regulate from a public health perspective, especially since the terrorist precautions enacted in 2001. With the expansion of the modern welfare state, local and state governments can order employees to stay at home and assure them they will be paid. Businesses serving health-conscious customers may be slightly more willing to conform to public health directives. Our capacities to stockpile food and entertain ourselves at home with cable television, computer games, and the Internet (so long as the electricity holds out) have grown enormously since 1918. We have become far more familiar with sneezing into tissues and wearing face masks while mowing the lawn or using aerosol sprays. 

Still, should pandemic influenza return in its guise as “destroyer and teacher” we would no doubt have many humbling lessons to learn. Nearly 100 years after the great pandemic, we have no program of national health insurance. Enormous racial and class disparities in health status and access to health care persist. Despite a far greater degree of scientific sophistication, we have been unable to stop the spread of HIV/AIDs, which has generated its own bitter lessons. We still have many reasons to study the great influenza pandemic. To conclude with George Soper’s still-relevant observation from 1919: This may all seem very discouraging but it need not depress anybody. .. To rightly measure a difficulty is often the first step toward overcoming it.”16




Soper GA. The Lessons of the Pandemic. Science. 1919;49(1274):501-506. doi:10.1126/science.49.1274.501 

Tomes N. “Destroyer and teacher”: Managing the masses during the 1918-1919 influenza pandemic. Public Health Rep. 2010;125 Suppl 3(Suppl 3):48-62. doi:10.1177/00333549101250S308