Medical Translation in Germany

[Cavesa]

This is one for Cavesa to tackle...

Is it acceptable to require doctors to speak English? I don't know, but it's the common assumption.

IMHO, no. It is a bonus, yes. But in medicine, we don't get compensated for using other languages at work (except for it sometimes mattering on a CV a bit), and I find it extremely unfair to

1.cater to English speakers and not the other foreigners, who speak neither the local language nor English. Why is a Turkish immigrant treated worse than an anglophone expat? It would be highly unethical to put something like this into the requirements for medical professionals, even if it is the unofficial reality in many medical services (unless there is a Turkish speaker accidentally in the team).

If we start demanding officially and obligatorily bilingualism in medical professionals, which by itself is an interesting but controversial (look at the point 2) idea, the point should be to create plurilingual teams, covering with a few people all the languages commonly found in that region/town/community.

2.demand a random medical professional, who has already had to sacrifice a lot and get tons of education, to also work in another language. And to learn it at their own expenses! If you want to get a job in a specific healthcare facility catering to foreigners, sure, it's the same sort of an added rule just like having to wear makeup while working in some private clinics. But it's inacceptable as a general rule. It should be normal to have the right to work in the official local language only, especially as you are not compensated for language skills and for having invested in them.

And yes, it is very annoying when some foreigners/immigrants/expats dare to be annoyed or even openly critical about the doctor not speaking English/Portuguese/Dari. Yes, I've seen all these happen in the real life, the level of entitlement is shocking. They should all bring their interpreter with them ideally, if they are lacking this important skill. The fact I happen to speak English and a colleague happens to be a second generation Portuguese immigrant speaking the language, that's not something you should just count on, when going to hospital (of course, keeping on mind the really life-threatening time-sensitive situations, then you simply do whatever you can).

If you want to impose second work language skills on healthcare professionals, then not just English (point 1), and start with positive motivation, give a higher salary for that. Not likely to happen anytime soon, and the sort of "other language learnign support" currently available in some hospitals to medical professionals is really laughable compared to other fields.

The article really is concerned with the lack of translation services which is filled, in Leipzig, by a volunteer charity - Communication in Medical Settings. The obstacle..:

"We see ourselves as a gap-filler for translation that should be done and paid professionally," Paulina, of Communication in Medical Settings, told DW. "But we see that the gap is there, because neither the state or the health insurers or the doctors' offices or the hospitals will take responsibility for taking the costs."

I think there is a fair argument for having official translation services since they will be faced with all kinds needing medical attention, such as tourists or other visitors linguistically unprepared.

Yes, the situation is bad, and it's bad pretty much everywhere. It's not just the lack of professional skill, which can happen with the volunteers, or when you need a cleaning lady to translate for you (real situation, not making this up). There is also the issue of medical secret, which I do have a problem with, when using those services. There is the issue of professional attitudes and behaviour. I did use the help of a cleaning lady to organise a follow up appointment for a Turkish speaker. I cannot imagine announcing important bad news that way! Or doing a psychiatric exam, or real time translating in a situation requiring my patient to be (semi)naked. Or discuss their sexual history, a violent spouse's attack, discuss the care for their abcess on the ass, or take their family medical history.

The second issue is accessibility. Even those volunteers are not available most of the time, for obvious reasons. Good bye the foolish dreams of getting them right away in your emergency department, getting them at 3am during your nightshift, or getting them comfortably even for the next appointment, which can already be hard to organize even without another person with a full work agenda mixed in.

Yet as per usual several of the same old things are at the bottom of all this. The relaxed language requirements. Such as students and employees turning up before ever starting the language. And then we have this old chestnut with regard to funding a translation service:

"Basically it was blocked in the whole discussion about the budget and the debt brake," he (Bernd Meyer, professor of intercultural communication at the University of Mainz) said, referring to the mechanism that obliges the government to balance the books and places strict limits on new borrowing.

I'm not going to embark upon why the notion of 'borrowing' and 'debt' here is nonsensical and terminological conjuring. Only to state that the 'mechanism' restraint is artificial and self-imposed and if, as is so often claimed, a government were to actually 'balance the books' this would effectively net things to zero and the public would cease receiving financial assets. But let's put this aside.

Oh, there are various cheap/free/not government paid options to help solve this problem!!!
1.the unpopular thing I keep saying: higher linguistic demands on the immigrants, expats, foreign students, basically everyone who is not a refugee or a short term tourist. Learn the language enough to not need the luxury of an interpreter, or get out.
2.obligation to bring your own interpreter (who should btw be part of every refugee caring institution imho) for anything non hyper urgent at the doctor's or in a hospital. This is of course tricky ethically, with the good argument "you cannot tell in advance, that it is not more urgent than it looks". But as we are already at the point of turning away the ok looking (=not like they're gonna die, if they leave now) foreigners that cannot deposit 500 francs in cash at the hospital reception as a guarantee, this point is moot.

3.Make the patient or their insurance company pay for itThe hospital staff treating you in a different language = an extra service, needs to be paid. An interpreter present or even on the phone = an extra service. Needs to be paid for the same reasons your hospital food is paid, it is no less important. We need to stop treating foreign language skills at hospital as just a "nice to have" and "trash not worth paying for, but useful to treat the lower caste of people". It is essential.

Btw, I sometimes hear some priviledged and clueless people from some countries like "no, it is illegal to do medicine in a language you do not have a special certificate in, you have to call the official medical translator or face the charges". How cute and very american, very legal-issues-aware, very trial-proof, and how distant from the real needs of our patients. Ok, but just charge people for treatment in a foreign language, and pay the translator to be there exactly when I need them. Or charge the patient, pay me to do it in my foreign languages, and I'll gladly invest in any medical language certification you want.

Until then, my occassional use of other languages than French at work is just a gesture of good will, mainly towards my colleagues and often the patient (the ones requiring me to use English and then still daring to be annoying or complain without reason are really damaging my day), but it cannot be required of me, it is not in my contract. And no, I will not invest in any language just for your benefit, dear hospital. You refused to give me that good looking medical German online course, with a stupid nonsense excuse "oh, we prefer to give our licenses to people in direct contact with patients, so the chief doctors and not the residents " (while the resident speaks with each patient 5x more often. or more), so I may simply not bother to use German at work here, I'll invest my own money and use it for my job applications elsewhere!

In the article Meyer the professor met a 60 year-old Portugese man who is a heart attack patient and who speaks no German despite working there in a slaughter house for 30 years.

"He basically carried halved pigs around all day, and in the evenings he went to a Portuguese social club and watched football," he said. "He just never had much contact with Germans. Why should he have? His life was OK. He never had a reason to learn German."

Fair enough, it's up to him if he works hard and he does after all have the right to live in the country as an EU member.

The language questions of the EU have been left floating in the air, and increasingly thrown to some 'market mechanism' idea as the structured methods of providing language skills have fallen prey to quackanomics and relying on English

https://p.dw.com/p/4mRvL

Two parts of the solution here:
1.He shouldn't have been allowed to live there for 30 years without speaking German, EU citizen or not. Pass a B2 exam after 2-5 years (whatever is chosen as the limit, but I think 2 years are plenty for anyone appropriately treating their new language as a priority) or get out.
2.As he's already there: Portuguese available either thanks to a fellow immigrant working as a nurse/doctor (not the cleaning person, not a random outsider volunteer) or by a non native Portuguese speaking nurse/doctor, or by a professional medical translator, but of course paid by either the patient or their insurance company.

[Cavesa]

She would have just needed to take a train into the western federal states and English shouldn't have been a problem. I think it's only a problem with old doctors from the DDR (GDR). And she does not want to bring a friend into an intimate medical discussion, but would be ok with a perfect stranger from an interpreting service? Odd.
But generally: why should the German society pay for lazy immigrants? Either learn German or pay for translations out of your own pocket.

Good luck taking a train with blood pouring out of your hand. And yes, it is very common to be more comfortable with a perfect stranger that is a medical translator (=a professional with an obligation to keep your privacy, just like the nurse) than with a friend, who might learn things you certainly don't want them to.

But yes, either learn German or pay for the translations (out of your pocket, or in an insurance) is the right attitude. Too bad they are not systematically applied and put into the laws.

The very point about most immigrants is that 1) the cost is unable to be met and 2) if they are given the option to use English as a way to enter as a student or employee, why should that be invalidated as a 'privilege' for medical encounters?

I would say the language requirement - to at least a basic level - should exist first.

The language requirement should definitely exist.
But about the costs: we have an existing solution for problems like this, it's the insurance. Either extra insurance for translating services, or an obligatory higher health insurance fee for people without B2+ in the local language.

Oh and a thing that should also be taken into account, if any rules are being made: doctors should not be obliged to use Google Translate, the currently very popular "solution" among some patients. I hate to use it, I hate the patients expecting me and sort of forcing me to touch their phone or get it near my face to speak into it (forgot about infections already? our phones are among the most germ covered things we own!!!), I am not convinced your data is not stored and sold (I am technically not allowed to conveniently send your scan to the hand surgeon by my whatsupp, even if we have no other convenient means to communicate and get you operated on asap, but we are really discussing and recording your health on Google just because of your laziness?). And yes, there ARE mistakes in Google Translate results, and who will be legally responsible for those??? You expect humans to be certified to not translate wrongly and in some countries use lawyers and trials as a threat all the time, but who will go to the trial if Google Translate gives you wrong information and you suffer the consequences?

I find it totally okay if an immigrant who earns his living or who enrolls in a study program in a language that's not an official language of the country chooses to not learn the official language(s) of the society he migrates to, but then they have to pay an interpreter or a translator, if needed.

Absolutely. If we are already making the choice of allowing people to live in the country without the basic skills, at least it should not be at the expenses of other people.

Well, we have many doctors in Germany who are Arabs or Romanian or Polish, regardless of the federal state. Most of them probably don't speak English well.
But even if a doctor speaks decent English he probably shouldn't speak it to his patients, because there may be legal consequences. E.g. if you need a surgery, you need to agree to it and understand the possible dangers or problems that could arise. If you don't understand fully what is explained, you are not in a position to agree. If the doctor hasn't explained properly because he doesn't know all of the terminology in English, he could possibly be sued later for not informing the patient properly. I would never risk that if I were a doctor.

That's a nice theory, but I doubt it is applied even in Germany (haven't worked there though, just other european countries). Would you prefer in such a situation to wait hours or days for information necessary to make your patient decisions? And how comes a medical professional would face legal consequences, but Google Translate most likely wouldn't?

As a doctor, of course I risk it. I don't have the luxury to simply sit around and not do my job, keep the patient for far too long in my service, or risk the legal consequences of not informing them in a timely manner or at all.

I'd be all for the hospital requiring language certificates for my other foreign languages, just like they require a French certificate from me as a non-native, but I want some compensation. If you don't pay me (or at least we could discuss other stuff, like paying for my learning and certificate), just be grateful for the extra service I am providing out of my good will. And if the patient sues the hospital, it's the hospital's responsibility they don't have any translator available all the time needed, or doctor langauge certificate requirement in place.

I'm not sure that's legally possible in the EU. You are free the move wherever you want as long as you can hold yourself afloat without social security. The last part is important. You are welcome, but don't be a burden. No special treatment included.

This is the number 1 thing that needs to legally change. If you don't speak the local language, you simply are a burden and you simply require special treatment. Anything done in other than the local language is special treatment. Including being allowed to work in a foreign language. The local colleagues have to work in their language AND English, the expat is required to speak only one of the two, that's special treatment already.

I work in an area with many expats - if you require anything but English as an employer, you don't find enough employees. But they earn definitely enough to pay for special treatment if they need it.

That's why it needs to legally change. In order to save the EU from becoming a sort of omnipresent bi-level culture (the real local cultures and economies, and the expat world), the laws need to change. And in consequence, people will have to learn languages, and the employers will have to pay accordingly. End of the token expats with priviledges! Learn the language and compete with the locals.

Here in Austria you can definitely find doctors who are willing to treat you in English. But you might need to pay them privately (and get a small part of it back from insurance), doctors in the public system are extremely pressed for time (and don't get payed anything more for the additional time it takes to deal with people who are hard to communicate with).

Exactly. Pressed for time=you'll use anything you can, including foreign languages. Especially in the emergency care, but pretty much everywhere else too. You have urgent situations in non-urgent services at any hour, and even in a sort of not urgent service, you cannot just organize your whole day around availability of a translator and they won't be there for the whole time needed.

Of course emergency care needs to work no matter what. But a working verbal communication is not always necessary for that.

Nope. Based on first hand experience having worked in emergency medicine: nope, nope, nope. Verbal communication is essential. A tiny minority of the cases are sort of clear with or without anamnese, a tiny minority are the tvshow cases arriving unconscious and requiring a clear reanimation protocol no matter what info is behind that, with the rest of the care waiting after the first hour or two. In the overwhelming majority of cases, you need to talk to your patient and/or the person coming as their company (family, witness of an accident, etc). It is really bad to do that without information.

How did the patient fall and what exactly was happening right before and after? In what direction did they twist the foot? What were they eating in the hours before the rash started? Have they had the same chest pain before? And a thousand more questions. Emergency medicine is not some sort of "have a look and let the labs and radios tell you everything" magic.

[tiia]

I'ma bit slow when it comes to answering,so the discussion continued already quite a bit...

The official stats have estimated that around 15% of people living in Germany do not primarily speak German at home.

I find these kinds of stats difficult to use in such a case as a point of reference. But it'sprobably going a bit offtopic:
- What is the home language of a single person living alone?
- If it is the language, that you speak with your family: Why should someone suddenly speak some foreign local language with their family, when the family still lives in a different country? (As it is the case for foreign students etc.)
- Why is there often somehow an implied connection between your "home language" and your skills in other languages? Apart from single households, the home language is always depended on a least one other person. If that person doesn't know the local language (enough), you may have perfect language skills in the local language, but still have a different home language. Example: Even a native German may have English (or something else) as a home language, while living in Germany, if their partner doesn't know German.
- What about multilingual households?
So one can assume that those 15% are the maximum that could be in the need of service in a different language, but the actual number is probably way lower.

--------------------------------

What I'm surprised about in the case of the article is, that back in my German university the department responsible for foreign students/academic exchange had a list with doctors, that speak foreign languages. One had to ask to get that list, because they were probably not allowed to publish it, but I know that such a list existed. I'm wondering why the person in the article did not know about that, or whether that uni really didn't have such a list.

In case of Finland the German embassy had a list of German speaking doctors, which unfortunately is not online anymore as far as I know. (I should have saved it...)

When I once decided to use the services of a German doctor here, I had to rely on memory to find that one particular doctor (the only one on the list for that speciality), because the list had disappeared. This visit was quite valuable as the doctor was German and therefore knew the German system and could give me some more advice how to actually use the Finnish system. It was exactly that kind of advice that no authority would write in their official guidelines, but that friends or family would give you.
So the value of this visit was basically more about cultural differences than language.

As I have seen also quite some Finnish doctors in the past years (I deal with these situations in Finnish, if possible). I can nowadays say, "hey, something is off here, can you please explain more what you're doing/how these things work?"
However, this usually does not help a lot. At the dentist I had to learn that I should tell them to treat me like an anxious patient instead, because that did the trick to get enough explanations and patience. (Note, before coming here, dentists were practically the only doctors I had never been afraid of.)


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Generally I'm biased when it comes to demanding English from doctors. I also think that it is often not taken into account that foreigners are often not English natives and therefore do not know the medical terms in English nor in the local language.
It is ok, if there is no other choice. But I have also had doctors switching to English medical terms, when I only wanted to hear the word again in Finnish. I mean not even natives know all the medical terms in their own language...

Otherwise I have been the perfect example of what people already mentioned here: being an exchange student (still learning the language) who then ended up in the emergency room. Originally I only had quite a bad flue. During the check-up 4 weeks later, I mentioned a new symptom, that had just stared two days before. After some examinations, the doctor sent me to the emergency room the next day. That was when I finally realised how serious the issue actually was.
I'm glad though that the doctor wrote all the history in Finnish for the hospital, so I didn't have to explain everything. I would not have been able to do all this in Finnish at that time.
Btw. we used online dictionaries/google translate to translate 1-2 words, just because medical terms in English are really not what you can expect from an engineering student.

There will be always people that will need medical help in a foreign country. Putting language requirements in place for long-term residency may reduce the amount of people needing different languages in health care, but the number of patients needing care in languages other than the local one, will never be zero.

[Cainntear]

Do they "choose" not to learn the language?

They choose to emigrate for economic reasons despite not speaking the language.

And you chose to respond to my post despite not wanting to answer the actual question I had posed.

Saying that they choose to move despite not speaking the language is true, but entirely irrelevant. There is a persistent myth that if you go to a country where it's spoken, you will learn the language. If immigrants fall victim to this common myth, that's not their fault -- they have not "chosen" to believe it, they just do.

[Cavesa]

What I'm surprised about in the case of the article is, that back in my German university the department responsible for foreign students/academic exchange had a list with doctors, that speak foreign languages. One had to ask to get that list, because they were probably not allowed to publish it, but I know that such a list existed. I'm wondering why the person in the article did not know about that, or whether that uni really didn't have such a list.

This is a good point. Selecting a doctor by language is an option, at least when it comes to any non urgent care. Lists of doctors speaking a certain language is not available around here, but the usual websites with lists of doctor contacts of course also list their languages.

So, it is entirely possible to choose your generalist or even some ambulatory specialists by language, and you can realistically expect to find a Portuguese, Albanian, or even Turkish speaking doctor around here, on top of various combinations of the official Swiss languages. I see no problem with this, it is a criteria like any other, and an added service.

The problem reappears in emergency care and all the hospitalisations.

And even more in the elderly facilities. It's not just about the immigrants (who might speak the local language perfectly for decades, but they start losing to dementia). But I've seen the suffering of a German speaker, who had been put in a purely francophone facility due to capacity reasons. It's abuse.

We need a system in place, where the facility is paid for the extra service in another language, and must use that money to hire bilingual employees, or sufficient time of interpreting (ideal for emergency care, impossible for elderly facilities).

Generally I'm biased when it comes to demanding English from doctors. I also think that it is often not taken into account that foreigners are often not English natives and therefore do not know the medical terms in English nor in the local language.

Yes, definitely!!!

Many people are bilingual around here, but in other languages. Languages that actually happen to be much more useful around here, because both the doctor/nurse and the patient are likely to speak them: Serbian, Portuguese, Arabic, etc. The obvious choice that should be enforced if there is no natural common language, should be the local official language.

If you enforce English in non anglophone countries, you are forcing healthcare workers to spend our own time and money on yet another skill we may not even want, and that is actually not helpful to our patients.

It is ok, if there is no other choice. But I have also had doctors switching to English medical terms, when I only wanted to hear the word again in Finnish. I mean not even natives know all the medical terms in their own language...

Not just about random natives, but it is true about the doctors. At the faculty, I was learning many terms just in Latin, I don't know their often stupid sounding Czech equivalents, that are actually used only like at pedagogical faculties.

The switching to English however is again the issue of the very stupid belief that "everyone's strongest language is surely English". Really, the anglophone marketing has conquered us far too much.

I'm glad though that the doctor wrote all the history in Finnish for the hospital, so I didn't have to explain everything. I would not have been able to do all this in Finnish at that time.

Yes, that is absolutely a good point. I hate it, when some of my colleagues are too lazy to write the medical history down properly in spite of having it. If you get the luxury of having the time to get information, having a bilingual person accompanying the patient, or getting a translator, put all the mined gold in the report. The colleagues three reports later might not have the same luxury.

And yes, I also note in the documentation HOW was the history taken, if it is not obvious. In what language, whether through another person, or through the Google Translate that I hate. Why: exactly for others to have a lead, when deciding which version of the history is probably more exact, what communication tools is the patient comfortable with, etc.

Btw. we used online dictionaries/google translate to translate 1-2 words, just because medical terms in English are really not what you can expect from an engineering student.

Yep, that is the good way to use these tools. A term here and there. Of course most people won't know some.

My problem is using GT for whole phrases and conversations, it is a huge problem. It removes all the control away from me, I have no clue what was really told to the patient, what did they understand. And should there be mistakes, I am afraid they'd fall on my head, this tool is still too new to have any clear medicolegal frame.

There will be always people that will need medical help in a foreign country. Putting language requirements in place for long-term residency may reduce the amount of people needing different languages in health care, but the number of patients needing care in languages other than the local one, will never be zero.

Agreed, and nobody is so naive to believe in zero need being possible or even desirable. The only countries with near zero need are the country sized prisons (like what my country used to be decades ago. I have no doubts a Czechoslovak doctor in the 80's didn't have this problem!).

But the first and necessary step is the language requirement, the situation is simply horrible now. Even one or two patients with special linguistic needs are a bit of a strain on the workflow in a busy day. But when you get like half or more of your patients not speaking the local language, it is exhausting, it blocks your efficiency, it is discouraging, and it is imho a burn out factor because you simply cannot do the job right.

A good solution would really be to move the language requirement enforcement on the insurance companies, they are good at stuff like this and might use their bullying skills for good for once . Make it obligatory for the patient to pay for service in another language, make it an obligatory extra insurance. Make the insurance companies enforce taking this extra money and make them pay it to the hospitals with bilingual stuff or the really available professional translators. And watch the immigrants and expats suddenly flock to the language exam centers to avoid paying more money for their laziness every month!

[daegga]

Do they "choose" not to learn the language?

They choose to emigrate for economic reasons despite not speaking the language.

And you chose to respond to my post despite not wanting to answer the actual question I had posed.

Which would be? Please do spell it out for me.
I try to (and yes, choose to) not react on each little sarcastic comment or rhetorical question (and possibly failed right now), otherwise we end up in a personal 10 page discussion shutting everybody else out, as happened in the past between you and LeBaron. You write long responses and have a history of using these rhetoric devices, so I might be primed the wrong way.
But I acknowledge my limitation to distinguish these rhetorical devices from actual questions in written language, I might be lead astray. And not just because the text is not in my native language.

[Cavesa]

When It comes to medication, it is so important to translate the prescription and specially the leaflet that comes with the medication to avoid and side effects.

Welcome to the forum!

But in this case: Explaining the medication sure, and it is tricky with the people not speaking the language. And I always try to do the best I can, but it is often not optimal in those situations. At least the correct use is usually ok to explain, it's not that hard to communicate how many days, at what times of the day etc.

But the other and also important stuff (possible side effects, when to reconsult, what to not consume with the medication, etc) gets tricky with the very weak speakers of the local language, who may suddenly react very emotionally, as they cannot understand the modal verbs, they cannot understand conditionals, etc. If you explain too much, sometimes that A1-A2ish French speaking patient will get agitated and aggressive in Arabic/Turkish/ whatever, because they're convinced you're giving them bad medication and not really trying to help. Add to it some cultural problems of a lot of the "fresh" immigrants (some are simply not used to doctors explaining such stuff, so they misinterpret the whole situation. Or they are not used to a young women giving advice to old men. They are used to antibiotics without any stewardship and are suspicious of other approaches.), and then you suddenly fear for your safety and wish you had a policemen in your office. And again to the topic: nope, enforced English wouldn't have helped, because those patients speak neither.

But nope, no doctor will sit down and spend several hours translating the leaflet into a language we cannot even speak, just because the immigrant/expat has been too lazy to learn the local language. The patients are adults (or the kids have a responsible adult with them), it is their responsibility. They can even find that leaflet online in other languages. The same medication is often available in their country, so they can do so. Not the doctor's job.

The day an entitled person asks me to translate the whole leaflet into another language will probably be my last day as a doctor I'll give up and announce my change of career very loudly and not politely. Fortunately, I am no longer an ambulatory generalist (half a year was enough), so this risk is now much much smaller.

But back when I was, some patients were expecting me to translate or explain even totally unrelated administrative and law documents Really, I think payments for anything in other language than the local ones would be much more powerful than any re-explanation or appeal on decency and responsibility. Make them pay directly or through insurance.

[Cainntear]

Do they "choose" not to learn the language?

They choose to emigrate for economic reasons despite not speaking the language.

And you chose to respond to my post despite not wanting to answer the actual question I had posed.

Which would be? Please do spell it out for me.

Well I could have been clearer on the link between the bit that you chose to quote and the next paragraph which you chose not to quote:

Saying that they choose to move despite not speaking the language is true, but entirely irrelevant. There is a persistent myth that if you go to a country where it's spoken, you will learn the language. If immigrants fall victim to this common myth, that's not their fault -- they have not "chosen" to believe it, they just do.

To me, "they choose to emigrate [...] despite not speaking the language" says nothing about your believe on them choosing not to speak the language. Many will emigrate with a genuine intention to learn the language. Their choice is to emigrate before learning the language, and then reality hits and they never actually do. That's not a "choice" not to learn.

I try to (and yes, choose to) not react on each little sarcastic comment or rhetorical question (and possibly failed right now), otherwise we end up in a personal 10 page discussion shutting everybody else out, as happened in the past between you and LeBaron. You write long responses and have a history of using these rhetoric devices, so I might be primed the wrong way.

I ask questions because I want people to think and I want to know what they think. I don't want them to think because of some Machiavellian device that them thinking a particular way will make them believe my own opinion, biases and all -- I simply want them to think because I want them to understand my point of view before they reject it. I also want to give people a chance to address the core point we disagree on.

My questions are simply me trying to discuss that, but right now, you're crying "rhetorical devices" as a manner of avoiding the topic. If you had responded by moving your position to "people shouldn't immigrate if they don't already know the language, that is something I could see as a reasonable position, but one that I disagree with, and we could discuss the relative merits of our positions.

As it stands, you have chosen not to defend your position, so you've not given me anything to respect.

You said:

Nobody forces them to emigrate and not learn the language. It's their choice.

I challenged that with a direct question, and you did not answer that direct question. I was looking for you to see and accept that not learning a language is not a sign of choosing not to learn -- some may choose not to learn, but some fail to learn not through choice or lack of desire. Yes, there are those who choose not to, but not all of them. Projecting one subgroup onto the whole group is not open-minded.

But I acknowledge my limitation to distinguish these rhetorical devices from actual questions in written language, I might be lead astray. And not just because the text is not in my native language.

The one rhetorical device I had used and referred to was in response to Le Baron asking you about contradictory opinions. I facetiously put the two things into a clearly contradictory statement and said they weren't contradictory when obviously they were. I did this because I wanted you to see how contradictory the two things were.

When I ask questions, it's normally just questions. Yes, I might be looking for something to argue against, but I'm not trying to trap anybody into saying something that lets me "win the argument" by employing some cheap trick -- I genuinely want to know what their argument is, and why they feel what they feel. And yes, I am likely to want to argue against it, because actually discussion stuff is how we end up seeing holes in our own argument. How will I ever see a hole in my own argument if I don't talk about the important details?

[Cavesa]

To me, "they choose to emigrate [...] despite not speaking the language" says nothing about your believe on them choosing not to speak the language. Many will emigrate with a genuine intention to learn the language. Their choice is to emigrate before learning the language, and then reality hits and they never actually do. That's not a "choice" not to learn.
...
You said:

Nobody forces them to emigrate and not learn the language. It's their choice.

I challenged that with a direct question, and you did not answer that direct question. I was looking for you to see and accept that not learning a language is not a sign of choosing not to learn -- some may choose not to learn, but some fail to learn not through choice or lack of desire. Yes, there are those who choose not to, but not all of them. Projecting one subgroup onto the whole group is not open-minded.

I disagree, because it is not about one big moment of choice "I will/won't learn the local language". Many are making this choice every single day. Everytime they don't go to the "obligatory" language class, everytime they lie to their doctor about back pains so bad they just cannot sit in class once or twice a week (no pain during the consultation or sitting in the waiting room), every single time they choose not to study for yet another day.

And unfortunately, nothing forces them to switch their objectively wrong choices for the right ones, these people refusing to learn just feel entitled to special treatment (in their language at the expense of others).

I still cannot really see those crowds of people that you describe as just failing inspite of putting in great efforts, I think there are extremely few of those (if any). They usually lie about that, even to themselves. The results are really a function of effort. People just need to accept that seriously learning a language asap for life in a new country simply requires a few hours of effort per day, not 2-5 hours per month.

The more I think about it, the more I am convinced that pushing them to the right choice through healthcare payments and/or insurance would be great. No need to get into an international politics discussions on kicking people out "just" for refusing to learn the local language, no need for this whole heated and blocked discussion. Just make them regret their bad choices every month, when a high bill for "healthcare services in foreign language insurance supplement" arrives and painfully hits their family budget. And if they are the rich expats still just choose to rely on English, at least their money will go to the healthcare!

[daegga]

To me, "they choose to emigrate [...] despite not speaking the language" says nothing about your believe on them choosing not to speak the language. Many will emigrate with a genuine intention to learn the language. Their choice is to emigrate before learning the language, and then reality hits and they never actually do. That's not a "choice" not to learn.

I find quoting difficult on the mobile phone, so sorry for the selective quotes.

I thought I made my position clear, so your direct question feels rhetorical. I try a last time to clear it up. It's not about that single point, it was one situation of many, it's about standing in for your decisions. Some might genuinely fail to learn the language despite trying, but I think you overstate this situation, maybe based on your experience in Britain which is likely different than in central Europe. But even so, they can't possibly believe they will learn the language in a matter of two weeks. So they need to be prepared for this transitional period at least. Not just expect the government to take care of everything for them. And if it doesn't work out, don't wait 30 years to move on.
It's not so much a solution to the "problem", but a workaround that works right now, without any changes. If you move abroad, for travel or work, get informed, weigh the risks and prepare (insurance, money, whatever). It's your own responsibility.

As an aside, I simply don't see people not learning the language and staying here, so I don't actually think it's a problem except for some corner cases. Maybe it's a bigger topic in other countries. I leave out those working in English and refugees here to not complicate things. But not legal immigrants from poorer countries looking for work. Simply because it's nearly impossible to find work if you don't speak German, even or especially for low skill work. You still need to understand your boss. Or talk with your clients if you are self-employed. The situation in Britain or Germany might be different - but then there is also the question why. Sufficient numbers in big cities so they don't need to communicate with the native population and have an employer with their own background? But then they most likely already have a doctor around who speaks their language. Or is wage dumping allowed? I see no reason to employ a foreigner not speaking the language unless you can offset the risk of miscommunication and their consequences with a significantly lower wage. Or you are desperate because you cannot find anybody. That's unlikely for low skill work if you pay enough.
To quickly touch on refugees. They have less incentive to actually learn the language, so many won't despite free language courses. But legally accepted refugees with clarified status are allowed to work here. So we currently have a lot of low skill workers who know little to no German. Legal working immigrants without language skills will also have to compete against those. Without language skills, chances you make it are quite low. And if you cannot find work, you have to leave again (not the refugees, but everybody else).

As it stands, you have chosen not to defend your position, so you've not given me anything to respect.

Defending a position sounds like anglophone-style debate rhetoric. I don't do debates. I don't try to convince others about my position, I simply propose them and clarify if needed. Others can point out the flaws, agree with it, improve it. It's not about defending it.