Systematic reviews on medical communication highlight that unclear medical language negatively impacts health outcomes and patient safety. In consultations, two languages coexist: everyday language and technical language, often termed medical speak. Thus, general practice consultations require significant linguistic work essential for achieving shared understanding. This competence is especially crucial for general practitioners (GPs), who serve as the interface between patients and the healthcare system.This study aims to identify the linguistic processes employed by GPs during consultations to reduce discourse opacity.We conducted an ethnographic study of GP consultations between March and May 2024. Inclusion criteria included GPs with over five years of practice, native French speakers, and medical training in France. Each physician, recruited through direct solicitation, was observed over several consecutive days. Consultations were observed, and verbal exchanges transcribed in field notes. Observations continued until data saturation was reached. Transcripts were analyzed with an inductive approach inspired by grounded theory, with data triangulation.Three levels of linguistic processes were identified, corresponding to three levels of opacity: 1) Vocabulary translation: vocabulary and grammar cause misunderstandings requiring translation activities (adjacent synonyms, paraphrastic reformulation, explaining abbreviations). 2) Semantic clarification: polysemy (e.g., "negative") causes confusion. GPs clarify meanings through simplification and popularization. 3) Perspective alignment: divergent perspectives cause misunderstandings and false assumptions. Overcoming this requires linguistic strategies to explore the patient’s viewpoint and make the medical perspective explicit (clinical scripts, internal reflection, automatisms).Strengths of this study include an innovative methodology rarely applied in primary care, capturing real-world data, and co-supervision with sociologists. Limitations include small sample and the Hawthorne effect. Future perspectives involve training to enhance verbal communication in GPs clinical practiceVerbal language is key to patient comprehension. When consciously used, it opens a window into the patient’s world, restores symmetry in the physician-patient exchange, and fosters genuine mutual understanding.

In a town in the countryside of Brazil, a significant part of the population preserves the Pomeranian dialect as a central element of its cultural identity. In 2023, the Family Health Strategy in primary health care of that locality identified low adherence to hypertension and diabetes treatments among Pomeranian-speaking users. Frequent medication errors and avoidable clinical decompensations were contributing to increased demand for urgent care. After reviewing performance indicators, medical records, and spontaneous patient reports, the team concluded that linguistic barriers were a key determinant of poor medication adherence.The experience began in April 2023, following an analysis based on national performance indicators for hypertension and diabetes. Initial data revealed that only 39% of hypertensive patients and 13% of diabetic patients were adequately covered. Recognizing the need for a communication strategy adapted to the local linguistic context, the team developed bilingual medication labels containing simple Pomeranian words and illustrative symbols representing dosage and schedules. The objective was to facilitate understanding, reduce errors, and strengthen the connection between professionals and patients. New evaluations conducted in the first quadrimesters of 2024 and 2025 showed substantial improvement. Adherence coverage increased to 53% for hypertensive patients and 73% for diabetic patients in 2024, reaching 68% and 82%, respectively, in 2025. These results demonstrated the positive impact of the intervention.The bilingual labels improved clarity of communication, reduced the need for repeated explanations, optimized staff time, and decreased medication administration errors. They also contributed to preventing complications and unnecessary hospitalizations while reinforcing the principles of effectiveness, comprehensiveness, and equity in the Brazilian health system.An important qualitative outcome was the strengthening of trust between the team and the community. By valuing the cultural and linguistic identity of Pomeranian-speaking patients, the intervention fostered inclusion and belonging.This experience illustrates how integrating cultural and linguistic aspects into primary health care can enhance equity and access. It offers a replicable, culturally sensitive approach for other settings characterized by linguistic diversity.

Lyme borreliosis remains highly controversial, with many chronic symptoms frequently attributed to it. The gap between patients’ narratives and physicians’ discourse contributes to diagnostic and therapeutic uncertainty in practice.To quantify, through lexicometric analysis, the discursive distance between patients and physicians regarding Lyme borreliosis, and to understand how these representations are constructed.Descriptive qualitative study combining focus groups and semi-structured interviews with chronic-course patients (CCP), general practitioners (GP), other medical specialists (OMS), and Lyme doctors (LD). Transcripts were analysed using IRaMuTeQ, with descending hierarchical classification according to the Reinert method, and co-occurrence mapping based on the Russell-Rao and Jaccard indices.Thirty-seven participants produced 137,913 occurrences. GPs oscillated between clinical prudence and distrust towards foreign serologies and parts of the pharmaceutical industry, while struggling to maintain an alliance with patients. OMSs relied on serological evidence, diagnostic exclusion strategies and rehabilitation-oriented approaches within guidelines. LDs denounced perceived scientific censorship, built a community-based “counter-expertise”, and advocated prolonged antibiotic therapies. CCPs described clusters of polymorphic symptoms, long diagnostic wandering, delegitimising encounters with institutions, and a heavy financial burden, but also gratitude towards physicians who took time to listen and acknowledge uncertainty.The analysis reveals an epistemological fracture in which conventional physicians accept uncertainty and methodically exclude other etiologies, while LDs group heterogeneous clinical presentations under the label “Chronic Lyme” without a threshold for refutation, providing patients with narrative coherence and recognition. This asymmetry of legitimacy and evidence fuels generalised mistrust, encourages recourse to heterodox pathways and exposes patients to iatrogenic risks and financial vulnerability. Empathic listening, work on “grey zones”, and multidisciplinary consultations in primary care emerge as pathways towards reconciliation and safer shared decision-making.The Lyme borreliosis controversy forms a conflictual ecosystem in which asymmetrical discourses maintain a dialogue of the deaf and undermine trust. Creating encounters between scientific rigour and patients’ lived experience could help transform this controversy into a medicine of uncertainty rather than a battlefield.

In 2023, According to the WHO, 1/6 of laboratory-confirmed bacterial infections worldwide were resistant to antibiotic treatment. In France, in 2015, the number of multidrug-resistant bacterial infections was estimated at 125 000, and the number of deaths attributed to antibiotic resistance at 5,500. In 2021, France was the fourth-largest consumer of antibiotics. In 2022, (75.5% of prescriptions  by general practitioners). Upper respiratory tract infections are very common (e.g. 9 million cases of pharyngitis diagnosed in France each year) and are particularly affected by inappropriate prescribing and misuse of antibiotics.  Multimodal interventions targeting clinicians, including educational programs on both knowledge and communication skills, have shown positive effects on the quality of prescriptions.  In this context, an interactive, serious game was developed (RAMPAR), featuring emotional immersion based on situations of antibiotic misuse in adult pharyngitis, using biomedical data and communication skills (based on assertivity) for french general practioners.Evaluate the impact of RAMPAR on antibiotic prescriptions for pharyngitis in adults at 12 months.The RAMPAR study is an interventional, pragmatic, comparative, randomized study conducted among general practitioners. This study is funded by the Interregional Primary Care Research Call for Projects - ReSP-Ir.Primary endpoint: Overall antibiotic prescription rate for patients aged 16 to 65 years old, Pay for Perfomance-P4P indicator at 12 months. Secondary endpoints: Overall antibiotic prescription rate for patients aged 16 to 65 years old, P4P indicator at 24 months.An average overall antibiotic prescription rate for patients aged 16 to 65 of 27.2% was observed in 2022 (P4P indicator). The target set by the P4P is 20%. Therefore, our intervention will be relevant if it reduces the overall average antibiotic prescription rate to at least 20%. With the following assumptions: average rate of 27.2% without intervention vs. 20% with intervention, for an alpha risk of 5% and a power of 85%, it is necessary to include 253 physicians per group, or 506 in total. This calculation was made using the biostatgv website.This 36-month project aims to improve general practioner-patient communication and maintain the relationship; reduce the misuse of antibiotics in adult pharyngitis and combat antibiotic resistance.

Japan’s rapidly increasing foreign resident population continues to face substantial barriers in accessing healthcare. Clarifying their language-related and clinical needs is essential for improving primary care accessibility.To identify nationality-specific (1) language-support patterns in a multilingual medical consultation hotline and (2) barriers to accessing healthcare.We conducted a retrospective descriptive study using FY2021–2024 records from a non-profit multilingual hotline in Japan. “Easy Japanese” (simplified Japanese for non-native speakers) and English were available daily, while other languages were offered once or twice weekly. Analyses were limited to consultations from foreign residents.Among 4,297 total consultations, 2,987 (69.5%) were from foreign residents representing 82 nationalities. The top 10 nationalities accounted for 65% of cases, with notable increases from Chinese and Vietnamese callers. (1) Language-support patterns: Of 2,987 consultations, 1,751 (58.6%) were made directly by individuals and 1,236 (41.4%) by proxies such as family, friends, or healthcare facilities. Language-use analyses focused on self callers only. Language use varied markedly by nationality. English was used in >95% of consultations from English-speaking nationalities. Despite limited service days, >70% of Chinese, Brazilian, Vietnamese, and Peruvian callers received mother-tongue support. When unavailable, these groups shifted more to Japanese than to English. Among nationalities without mother-tongue support, some relied predominantly on Japanese (e.g., Nepal), whereas others depended on English (e.g., Bangladesh). (2) Barriers to accessing care: Three consultation purposes—medical facility information, interpretation requests, and facilities offering care in “Easy Japanese”—accounted for ~80% of calls. Interpretation requests were minimal among English-speaking nationalities (0–8%) but exceeded 25% among Chinese, Brazilian, and Vietnamese callers, with >40% initiated by healthcare facilities. Requests for “Easy Japanese” care were especially frequent among Vietnamese (24.5%), Brazilian (15.1%), and Chinese (12.4%) callers. Clinical specialty needs also varied: psychiatry was more common among Chinese and U.S. callers, whereas obstetrics/gynecology and pediatrics were more frequently requested by South and Southeast Asian callers. Our findings demonstrate that  healthcare systems must adopt flexible, multi-tiered strategies—incorporating mother-tongue services, English, and “Easy Japanese”—to address diverse communication needs among foreign residents. Flexible, multilayered — rather than uniform — language-support models are essential to improve healthcare access for foreign residents.

The language barriers is a major obstacle to accessing healthcare. To address this issue, on-site and telephone professional interpreting services were introduced in 2017 in the Pays de la Loire region of France.This study explores healthcare professionals’ perceptions of these services within ambulatory care settings.A qualitative study was conducted using focus groups and semi-structured interviews with community-based healthcare professionals who had previously used interpreting services. Participants were recruited by email based on program activity records. Data were analyzed thematically, and categories were derived from emerging themes. An explanatory model was developed through integrative analysis and illustrated in a diagram.Seventeen healthcare professionals participated (13 general practitioners, 2 midwives, and 2 speech therapists) through two focus groups and five individual interviews. Participants reported improvements in communication, the therapeutic relationship, and intercultural understanding, identifying interpreting as a versatile tool well suited to medical consultations. Its use was progressively integrated into daily practice and associated with both professional and personal satisfaction. However, structural and organizational barriers limited broader implementation. Additional challenges—such as longer consultation times, concerns about added complexity, and fears of disrupting the therapeutic relationship—were also reported.Professional interpreting appears to act as a catalyst for more humanistic and culturally responsive care. It strengthens patient–provider communication and supports vulnerable populations, while encouraging greater awareness of intercultural dynamics in medical practice.Professional interpreting enhances communication safety and strengthens the therapeutic relationship, thereby helping to reduce healthcare inequalities. Broader adoption, adequate financial support, and increased awareness among healthcare professionals are essential to ensure the long-term sustainability of these services.

Generative and agentic artificial intelligence systems are being tested to assist physicians in managing patient e-messages. In family medicine, these tools could ease workload but may also inherit human-like communication biases. Patient tone and wording are known to influence clinicians, yet their effect on AI models remains largely unexplored.To examine how patient communication style affects AI-generated decisions for clinical e-messages and sick-leave requests in family medicine.We developed 500 standardized patient e-messages covering common family-medicine problems and sick-leave requests, validated by two family physicians. Each message retained identical clinical content but was rewritten in eight communication styles (like neutral, urgent, emotional, threatening..) and processed by five large language models using identical prompts. Structured outputs captured clinical decisions like triage urgency and medication choice for clinical messages, and other ouputs for sick-leave requests. Statistical differences from the neutral control were assessed using chi-square tests with false-discovery-rate correction and Cramér’s V for effect size.Communication style significantly altered model behaviour. Threatening, urgent, and demanding messages prompted markedly higher rates of same-day-clinic recommendations (+37–51 percentage points; V = 0.40–0.69, p < 0.001), fewer self-care or routine visits, but shorter follow-ups (fewer 1–2-week reviews, more 24-hour advice; V ≈ 0.39). Models also issued more prescriptions under directive tones. In sick-leave requests, threatening language reduced approval rates (–7.6 pp) and granted days (–0.22 days; p < 0.001), while emotional language elicited slightly more lenient and empathetic replies.Agentic LLMs appeared to mirror patient tone. Assertive or hostile messages seemed to lead to more resource-intensive outputs—such as urgent visit recommendations, shorter follow-ups, and increased prescribing—while emotional messages may have encouraged more empathetic responses. These patterns resemble behavioural tendencies previously observed in human clinicians.لإhese tone-driven patterns may mirror those seen in human clinicians, but the magnitude of change in LLMs appears larger. As such models may soon operate autonomously, they could be vulnerable to intentional or unintentional prompt manipulation. We assume that growing public awareness of how LLMs respond to tone could amplify this risk. Recognising and mitigating linguistic bias will be essential before these systems are integrated into everyday family medicine communication.