We should not underestimate the importance of culture and language in healthcare provision ("Foreign doctors help fill a need"; Nov 25).

Patients' confidence in a doctor is determined in the first few sentences of any consultation.

If there is any hint that the doctor cannot understand their medical needs, their confidence is shaken and treatment effectiveness is compromised.

In our society, where there is a diverse range of languages and dialects, communication with patients can be challenging even for local-born doctors, what more foreign-born doctors.

Translators only partially solve the problem and the need for translators increases consultation time and waiting time.

I propose the following guidelines if we are to look to "foreign-born, foreign-trained" doctors to ease our shortage:

First, junior doctors employed from overseas should fill only junior positions. Specialist training positions should be left for local-born doctors.

The foreign doctors should be allowed to apply only if there are vacancies after local doctors have filled the training positions.

Second, ideally, fully qualified foreign-born specialists should not be employed by our system.

We should train our local doctors to fill senior positions. If there is a shortfall, foreign doctors should be employed on a fixed contract.

Third, foreign-born specialists should not be allowed to practise in private hospitals.

They are employed to fill the shortage in the public sector and should remain there as long as they are practising in Singapore.

This is how we can address the shortage of doctors here and meet the needs and expectations of our local doctors.

Gerard Chee (Dr)