The Case for "If" and "When"
© 2008 Kathy Quan RN BSN
All Rights Reserved

English is a very difficult language to learn. This is true even for those whose first language is English! Like most other languages there are various dialects and even spellings. For instance, the English spoken in Great Britain can be very different from that spoken in the U.S., Canada or Australia. Terminology is different; slang terms are widely diverse, and spellings are similar but not the same. Beyond that, accents or pronunciations can make the same word sound entirely different.

For example, foreign-born nurses coming to the U.S. who have learned English from British sources may have no idea why Americans say they aren’t speaking English!

Learning to speak a language and adapting it to the culture of a specific geographic area can present challenges. It is important not to become defensive or to “grow a chip on your shoulder” about it.

Communication is essential to feeling confident about someone’s skills and abilities. It is also essential to providing quality patient care.

A Personal Example
A few years ago I became ill at a baseball game. It was extremely hot that day and at first it was thought I had experienced heat exhaustion or possibly heat stroke. I was given IVs and transported to a hospital. I was in and out of consciousness and was aware that at one point the paramedics could not get a blood pressure reading.

At the hospital it was discovered that I had a rash all over my body and was perhaps having a severe allergic reaction to something. That explained why my tongue was swollen and I was having difficulty speaking. I was then given some epinephrine, solumedrol and benedryl.

The RN who admitted me to the ER, discovered my rash, and administered the medications came into my room sometime later to say that she was now turning me back over to my nurse who had been on a break. The RN who took over was very sweet and kind, and I’m sure quite competent. She told me she was new to this country, but very proud of her ability to learn English quickly. She was from Korea.

I had been told by the MD that I was recovering nicely from whatever had caused my allergic reaction, which they thought might be peanuts or hot dogs even though I had been eating them for years with no issues. I would be discharged in an hour or so when the IV had finished.

When my nurse came back in to take vitals a few minutes later, she asked if I was having any chest pain or shortness of breath. I had never had chest pains in my life and not had any at anytime during this episode and I reported this to her. Her response was “
When you have chest pain, you will need to call me right away so I can tell the doctor.” She was quite concerned.

This alarmed me. I wasn’t thinking clearly and wasn’t sure what she meant by all this. Why was she
expecting me to start having chest pain? What was wrong that they weren’t telling me? She just repeated, “when you have chest pains call me,” and left it at that.

I got very worried and my heart rate began to race. The doctor came back in and I asked her. She calmed me down and said…
IF I was to have any chest pain I should let someone know right away. They didn’t expect me to have any chest pains now. My EKG was normal and there wasn’t anything to be concerned about. The nurse just didn’t word it right.

If vs When
There is a big difference between “when” and “if.” These are just two words in English that are often erroneously used interchangeably. In a medical situation this misuse can be a problem.

The word
when implies that something is expected to happen. On the other hand, if implies only a possibility that something may happen.
Someone who has no medical knowledge might not have become so distressed about being told to call when they have chest pain as opposed to if they have any. But using the words incorrectly can affect the effectiveness or outcomes of your patient teaching.

Learning a language is difficult. (English is a very difficult language to learn and to master!!) Being overly confident that you have mastered it can be disastrous.

Take the time to understand the little phrases and past, present and future tenses that can make a big difference in your communication! Ask your co-workers if the terms you use make sense.


©2007 by Kathy Quan RN BSN PHN, all rights reserved. No portion of this document may be used in any format without written permission.
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