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    The simple words that save lives

    September 24, 2019

    Lessons from “expert talkers” could make all the difference when helping a person in crisis.
    In 1984, Dallas, Texas, a call to the emergency services went catastrophically wrong. An elderly woman had stopped breathing, or was struggling to breathe, in her home. Her son, clearly distressed, called 911. The conversation between the caller and the dispatcher quickly spiraled out of control.
    Both parties appeared to argue for several minutes over the condition of the woman. The caller, increasingly exasperated, refuses to give straight answers to many of the dispatcher’s questions. The dispatcher, equally frustrated, eventually hung up with a curt “'kay, b'bye”. Thirteen minutes later paramedics were sent to the home where the woman in question was pronounced dead.
    “He didn't hear that the nurse’s questions were about helping the mother as best as possible,” says Tanya Stivers, a sociologist at the University of California Los Angeles, US. “The nurse was trying to establish some basic information about the mother. He found her questions antagonistic. Sometimes things that are transparent to one party, the nurse in this case, are not to another.”
    At one point the dispatcher tried to speak to the elderly woman: “[You] can't, she's… seems like she's incoherent,” said the caller. When asked why she is incoherent, he replied: “How the hell do I know?” When chastised for cursing he said: “Well I don't care, ya stupid-ass questions you're asking.”
    The incident received extensive coverage in the Dallas newspapers and on national TV news at the time. Officials expressed bewilderment as to how an emergency call could have been conducted this way.
    The caller had given enough information – their address and that there was someone who had stopped breathing – to elicit a “Marine Corps response”, in the view of the Fire Surgeon for Salt Lake City Fire Department. This maximum response would include the dispatch of an ambulance, fire engine and paramedics.After an investigation, the dispatcher in question was fired.
    The caller had given enough information to elicit a “Marine Corps response” (Credit: Javier Hirschfeld/ Getty Images)
    But how could an emergency call have gone so wrong? The failings on both parts subtly shows how the way we ask questions can have a big impact on the answers. Choosing certain words over others can help us persuade, win over and even cajole people we are talking to. By looking at similar miscommunications, and drawing on the experience of “expert talkers”, there are lessons for how we can ensure our own encounters do not end with dire consequences.
    Keep talking
    When dealing with persons in crisis, the strategy for police negotiators is to keep the subject talking. If you examine the recordings of these negotiations, however, you will find that “talk” should be avoided. Two researchers, Rein Sikveland and Elizabeth Stokoe, collaborated with British police to analyse recordings of conversations between persons in crisis and crisis negotiators. They saw that negotiators often use “talk” to begin a conversation: “Can we talk about how you are?” But this often gets pushed back by the person in crisis: “No, I don’t want to talk” or “It’s not genuine action, man, you’re just talking”.

    Persons in crisis resist the request to talk because, as Stokoe points out, cultural idioms encourage us to put little value on “talk”. After all, “talk is cheap” and “talking the talk” is less meaningful than “walking the walk”. However, a single word substitution could be enough to save a life.

    Perhaps because we do not have equivalent cultural idioms, “speak” seems to work. In real conversations between a negotiator and person in crisis, when the negotiator says “speak” (“I wanna come down and I wanna speak to you…”) they get their desired response. In some cases, the person in crisis interrupts the negotiator to begin talking. Despite being near-synonyms, one word is loaded with context that makes it ineffective in these scenarios, while the other is free of those associations.

    Being willing

    Mediators have also found power in words to turn around someone who is disengaged. These professional facilitators might assist in business negotiations, family grievances or disputes between neighbours. They are experts in making sure conversations reach as positive a conclusion as possible. In the UK, for example, all people in child custody disputes must first attempt to reach an agreement through a family mediation service.

    (Credit: Javier Hirschfeld/ Getty Images)
    Simply by introducing the word "willing", someone can be talked into agreeing to something they were hesitant about (Credit: Javier Hirschfeld/ Getty Images)
    Usually, an initial call with a mediator follows a set pattern. After introductions, the mediator explains how their service works. They then ask: “Does that sound like something you and the other party want to do?” To which the caller might reply: “Oh, I’m not sure the other party will ever agree to this, they are very difficult to deal with.” From a position of looking like the conversation might be shut down, the mediators can turn it around with: “Okay, but you would be willing to come in for a preliminary meeting.” “Oh of course,” replies the caller, “I was never not willing to try.”

    The caller is probably not too enthused by the prospect of speaking to a mediator, and has shown that they do not really want to go down this route. Often when we do not want to do something we look to blame someone or something else. Here, they have pinned the blame on the other party – the other parent of the child.

    It is effective for several reasons; it is not a question, it is a statement, and it allows the caller to frame themselves as a good person while not having to backtrack on blaming the other party.

    Cultural idioms encourage us to put little value on “talk”

    Usually, once one party has agreed to take part in a session, the other party follows, says Jan Coulton, chair of the College of Mediators in the UK. Coulton has been a mediator for almost 30 years, specialising in family mediation since 1998.

    “We look at the way things are put by each party – the way they describe their problems – to move from negatives to positives,” says Coulton. “People in conflict can be very focused on the negatives. But when you look there are a lot of matters in common, often the children. They love the kids. We hang the pegs on the positives. There may be differences around how things are done. We may do that when we summarise. We do that in a very positive way back to them at the end.

    Coulton says the principles for a positive and constructive discussion are framing your conversation in positivity, not to look for immediate resolutions – often mediation sessions will end with both parties agreeing to come back with alternative solutions to their problem – and to reach an agreement together.

    Unintended consequences

    Sometimes, the way that an answer to a question is phrased will also lead to unintended consequences.

    Analysis of conversations between doctors and parents talking about the wellbeing of a child reveals they can often look like negotiations, even though they are not intended to be. Very specific behaviours on the part of the parent lead to a significant increase in prescriptions of antibiotics. What sets them apart from a negotiation is that the parents will not explicitly ask for antibiotics. In fact, when questioned before the appointment, they might not even say that they are hoping to receive antibiotics for their child. However, the doctor will often interpret the parents answers as an attempt to get the prescription out of them.

    (Credit: Javier Hirschfeld/ Getty Images)
    In real conversations between a negotiator and person in crisis, when the negotiator says “speak” they get their desired response (Credit: Javier Hirschfeld/ Getty Images)
    “They may present it with a name of an illness – they might say ‘I’m worried it could be a sinus infection’,” says Stivers, who has studied these conversations between doctors and parents. “As soon as parents are talking about infection doctors are more likely to think the parent expects antibiotics.”

    The use of medical terms indicated to the doctors that the parents expected antibiotics. But, this wasn't true. Parents’ concerns were for getting the best possible treatment. Stivers describes this interaction as a good example of miscommunication between an expert and layperson. The doctor hears “infection” and immediately makes the connection with antibiotics. But for parents, that association does not exist.

    “I always like to remember that doctors are people before they are doctors,” says Stivers. “We don’t like to deprive people of what they want, so it is not always about what is medically correct.”

    Is there something else?

    As with “speak” and “talk”, one word can make all the difference. In one study, physicians in the US were instructed to solicit extra concerns from patients making visits to their practice. One group of physicians were instructed to say “Is there anything else you want to address in the visit today?” and a second group were instructed to say “Is there something else you want to address in the visit today?”. A third group acted as a control and said nothing to solicit further concerns. In doing so, the researchers were able to test the effectiveness of the words “any-“ and “some-“ when used in open-ended questions.

    The results were quite clear. “Anything” was as effective at soliciting extra concerns as saying nothing at all – 53% of patients mentioned their additional concern. Clearly, some patients did mention other ailments, but much less frequently than those who were asked the “some-“ question. In this group, 90% of patients with extra concerns raised them.

    (Credit: Javier Hirschfeld/ Getty Images)
    “Is there anything else I can help you with?” was as effective at soliciting extra concerns from a patient as saying nothing at all (Credit: Javier Hirschfeld/ Getty Images)
    Conversation analysts, like Loughborough University’s Elizabeth Stokoe, suggest this is because the word “any-“ has a closing-down function. It tends to be used as a token gesture. Think about meetings that end with the chair asking “Any other business?”. How often are other issues raised at this point? Perhaps, with one word substitution, we would be more willing to raise extra concerns – “Is there something else you would like to raise?

    The right question

    Emergency service dispatchers are trained to deal with people who are experiencing “the worst day of their lives,” says Heidi Kevoe-Feldman, an associate professor in the department of communication studies at Northeastern University, in Boston, Massachusetts. Kevoe-Feldman collaborates with dispatchers taking real life emergency calls to find better ways of handling those calls. Callers are often emotional, so their answers might be incoherent. If they are unable to answer the questions, the dispatcher has to think on their feet.

    Questions with “Yes” or “No” answers are very useful for getting information quickly, like whether the person in trouble is breathing. But more subtle questions, such as what colour the person looks, might need further prompting. In this case, a “menu” of possible answers is required, but it is important that the menu contains at least three options, otherwise it might lead someone towards an inaccurate answer.

    Take this exchange from the fateful Dallas call described at the start of this article:

    Dispatcher: “Okay is this a house or an apartment?”

    Caller: “It… it is a home”.

    This is a fairly innocuous question to establish whether or not to dispatch paramedics with light stretchers that can be taken up flights of stairs, or more robust stretchers that are only suitable for use in houses. The caller does not know that.

    If they are unable to answer the questions, the dispatcher has to think on their feet

    “The location question is so critical,” says Kevoe-Feldman. “Inside, outside, in a basement, in a car, what floor you are on. The help that you get is very dependent on how you answer this question.”

    One of the problems is that callers often misinterpret why they are being asked questions in the first place.

    “There were multiple things where it went wrong with the Dallas call but at the heart of it call takers ask a lot of questions and callers sometimes act like this is gate keeping,” says Stivers. “They think they need to answer these questions in a certain way to get what they want.”

    It is worth remembering that the Dallas call is not representative of most calls to emergency services. It is also standard practice to tell the caller that an ambulance is on its way as soon as one has been dispatched, to allay fears they are not going to receive help, and then to continue asking further questions to get a greater level of detail.

    Kevoe-Feldman says that if you want to be an expert talker when speaking to emergency services dispatchers; know your location. The best way to save a life is to say exactly where you are.
    How do we measure language fluency?
    There are many ways of categorising someone’s linguistic skills, but the concept of fluency is hard to define.
    Mayor Pete Buttigieg’s youth, military record, and marital status may distinguish him from the other 2020 US Presidential Election candidates, but it’s his rumoured proficiency in seven languages that really has people talking.This seemingly magical feat is especially impressive in predominantly monolingual countries like the United States and the United Kingdom (where, respectively, roughly 80% and 62% of the population speaks only English). But where such enviable talent creates an aura of mystique, it also inevitably arouses curiosity. When former US Senator Claire McCaskill asked Buttigieg to comment on his language-speaking ability in a 14 February instalment of MSNBC’s Morning Joe, he replied: “it depends what you mean by speak!” and added that he can “still kind of read a newspaper in Norwegian… but only slowly” and that he has gotten “rusty” in his Arabic and Dari. That shows humility, but not so much that Buttigieg and his camp definitively dismiss the polyglot rumours.
    This is not to deride Mayor Buttigieg. His perceived fluency interests me because I’m a former language teacher – having taught English for 11 years in Japan and Italy – and I am also a Cambridge English exam speaking examiner; a role which requires me to dissect variables in candidates’ second language production such as pronunciation, discourse management, and grammatical range. Buttigieg is clearly fascinated by languages, willing to learn, and is brave enough to practice with native speakers on television – qualities that would have made him the star of my classroom. But – like so many of my ex-students who expected to go from “beginner” to “native” proficiency in two months – Buttigieg may have underestimated what it means to “speak” a language.
    I can relate all too well to overestimating one’s own abilities. A “heritage speaker” of Italian, I’d been living in Italy for two years when I overheard a receptionist refer me to me as “that foreigner who doesn’t speak Italian”. I was confused, then gutted. That one casual sentence launched a journey that resulted in my being forced to acknowledge that while I had grown up speaking Italian at home and was fluent, I was not by any means proficient.
    Pete Buttigieg can reportedly speak Norwegian, Spanish, Italian, Maltese, Arabic, Dari, and French (Credit: Getty Images)What does the word “fluent” actually mean? In lay circles, this term has come to equal "native-level proficient", with no grey area between the bumbling beginner and the mellifluous master. An outsider overhearing a conversation in a foreign language only hears a fog of sounds, thus perceiving anyone who can cobble together a sentence as “fluent”.

    But Daniel Morgan, head of learning development at the Shenker Institutes of English – a popular chain of English schools in Italy – says that fluency actually refers to how “smoothly” and “efficiently” a second language (L2) speaker can speak on “a range of topics in real time”. While fluency may denote a degree of proficiency, it does not automatically imply accuracy – the ability to produce grammatically correct sentences – nor does it imply grammatical range.
    How important are accuracy and grammatical range? That depends on the speaker’s needs. If they simply wish to converse in social settings, their focus may be solely on achieving fluency, but if the L2 is required for business or academia, accuracy and range are crucial as communications full of
    When talking a foreign language, you may be well understood by locals, even if you make lots of grammatical errors (Credit: Alamy)
    These errors can include literal word-for-word translation from their native language (“I go in Spain”), and language switch (“I want eat ringo”). Bungled verb tenses, prepositions, plurals, and articles are a natural, even essential, part of the learning process.
    Many learners, however, fall into the trap of assuming that because they are understood, their speech is “perfect”. And it isn’t only the speaker who glosses over mistakes; in the Handbook of Second Language Assessment, Nivja de Jong – senior lecturer at the Leiden University Centre for Linguistics – argues that grammatical errors usually won’t prevent comprehension on the part of the listener, who is automatically able to “edit out” mistakes. In English, a sentence like “I have 17 years” is incorrect, yet one nonetheless understands that the speaker wants to say that he is 17 years old. Furthermore, friends and teachers tend to encourage L2 learners rather than discourage them, which may also contribute to inflated self-assessment.
    I think of the popular memes comparing how we envision a story or scene in our head, to the way we tell it or paint it. Those first crucial years of learning a language, you may be thinking in glorious brush strokes but speaking in scribbles.Measures of linguistic proficiency typically consider both the accuracy and the range of the language that you can use So when can someone say they “speak” a language? That’s the million-dollar question. Can someone consider themselves a Spanish speaker if they’re conversational but often can’t understand native speakers because they “talk too fast”? If they use only two verb tenses and every sentence contains mistakes?
    The answer may be less “yes/no” and more “how well?”Luckily, scales for measuring spoken fluency and overall proficiency exist. “Fluency is an abstract concept, so we assign observable variables,” explains Daniel Morgan. Two of the most reliable factors are “speech rate” and “utterance length”. Speech rate can be defined as how much (effective) language you’re producing over time, for example how many syllables per minute. Utterance length is, as an average, how much you can produce between disfluencies (e.g. a pause or hesitation). You could look at accuracy as being subsumed into fluency, in terms of grammatical accuracy, lexical choice, pronunciation, and precision.”

    De Jong describes the unconscious process any speaker goes through before speaking: conceptualising what to say, formulating how to say it, and, finally, articulating the appropriate sounds. All of this takes place in roughly six syllables per second. A speaker of a second language who needs to convert their thoughts into an unfamiliar language faces an even greater challenge in meeting these strict time constraints. They must also often overcome inhibition and pronunciation challenges. Accuracy may still be lacking at this stage, but make no mistake – achieving L2 fluency is a colossal feat.
    The Council of Europe’s Common European Framework of References (CEFR) for Languages groups language learners into concrete proficiency levels, where fluency and accuracy are just two of many examined criteria. The CEFR – available in 40 languages – divides proficiency into six “can do” levels – A1, A2, B1, B2, C1, and C2. A corresponds to “Basic” levels, B to “Independent”, and C to “Proficient.” Observable skills include:
    A1: Capabilities range include basic introductions and answering questions about personal details provided the listener speaks slowly and is willing to cooperate.
    A2: Can describe in simple terms aspects of his/her past, environment and matters related to his/her immediate needs and perform routine tasks requiring basic exchanges of information.
    B1: Can deal with most daily life situations in the country where the language is spoken. Can describe experiences, dreams and ambitions and give brief reasons for opinions and goals.
    B2: Can understand the themes of complex texts on both concrete and abstract topics and will have achieved a degree of fluency and spontaneity, which makes interaction with native speakers possible without significant strain for either party.
    C1: Can understand a wide range of longer texts and recognise subtleties and implicit meaning; producing clear, well-structured and detailed text on complex subjects, showing controlled use of organisational patterns, connectors and cohesive devices.

    C2: Can understand virtually everything heard or read, expressing themselves spontaneously, very fluently and precisely, while differentiating finer shades of meaning even in highly complex situations.

    Geraint Thomas, a Cambridge English speaking exam team leader, explains: “We look at things like cohesion, response rate, discourse management, and pronunciation, but each variable has sub-variables. You can break pronunciation down into stress and individual sounds.” He emphasises that the progression is gradual. “You can expect a good B2 candidate to have certain things under control; the present tense, maybe. However, they might not have their second conditional, and you’re aware that this is a progressive thing.”

    (Credit: Alamy)
    What is the span of your conversational abilities? Are you equally happy talking about economics and politics? (Credit: Alamy)
    Thomas adds that individual second language speakers can display different strengths: “You can get students who are very accurate but so afraid of making mistakes that their fluency suffers and others who throw themselves into something, who are quite fluent, but their language is full of mistakes.”

    According to research from the University of Cambridge English Language Assessment, it takes 200 guided hours for a motivated learner to advance from one level to the next. Key word, motivated: language acquisition varies dramatically between individuals. Is the learner open to new structures? Will they build upon what they’ve already learned instead of clinging to basic “good enough” grammar? Will they commit to consistent study and practice? Bottom line: there are many steps between “The pen is on the table” and penning a perfect thesis on a piece of literature.

    Proficiency scales provide an excellent gauge for assessing L2 ability, but I believe that the quickest, dirtiest fluency and accuracy “tests” are real-life situations with native speakers. How smooth and lengthy are your interactions in your L2? Do you avoid or “blank” at certain topics and situations because you don’t have the words? Do you find yourself grasping for “key words” and content yourself with understanding “the sense” rather than the entirety of the conversation? How well can you understand a film without subtitles or read a book without a dictionary? If you write an email and ask a native speaker to proofread it, how many errors will they find?

    As for me, while my Italian grammatical range has improved dramatically in my nine years in Italy, as a writer I yearn for flawless, native-like accuracy and syntax. I’m not there yet, and there are many days where I despair that I never will be.

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