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The art of the code-switch is one many of us have. It is a learned behaviour. It’s both a subconscious and conscious practice. What is code-switching and when does it become harmful?

The term code-switching first appeared in literature in 1954. It originally referred to multilingual individuals switching between languages to adapt to their surroundings, allowing the speaker to engage better with the given audience. Code-switching has also been used to describe people from marginalised groups adapting their voice, persona, image or behaviour to their surroundings to optimise the comfort of others and improve interactions.

Code-switching can have both positive and negative consequences. It can help build relationships, foster closer bonds and make communication more effective. However, it can also result in a loss of identity, feelings of exclusion and confusion, and low self-esteem.

There is no one answer to whether code-switching is harmful. It depends on the individual and the context. If you feel like you’re constantly having to adapt your behaviour to please others or fit in

A picture of two women in hijab talking

Most of us adapt our speech patterns and language to our audience. Our behaviours change hugely when we interact with toddlers and teens, peers and professors. We constantly switch between medical jargon, child-friendly language, informal chats with a cup of tea, and professional presentations. This can be cognitively exhausting.

In marginalised groups, code-switching helps them “fit in” to clinical environments and teams. It can result in a dilution of self and promotion of behaviour that is more similar to the dominant culture. In this way, they are deemed “professional” and receive equal treatment. It may translate to behaviour changes when talking with different staff members or patients. Code-switching may not be about overt changes in pastimes but in more subtle things such as manner, accent, and use of language. A Canadian study, by Baquiran and Nicoladis., looked at breaking bad news scenarios. Chinese-accented doctors were judged to be “less competent” than those with Canadian accents despite exactly the same words being used. This bias is unacceptable and unjust and validates those who change their language, tone and accent when working in an environment where they are a minority.

Humans like to mix with other humans that they feel are like them. Opportunities and promotions are given to individuals who seniors feel they can work with. McCluney’s 2019 survey, published in the Harvard Business Review, found that “black employees with high career aspirations for leadership and promotion opportunities actively avoided conforming to black stereotypes to a higher degree than those with low career aspirations”. Whether this is a conscious or subconscious action, this constant adaptive behaviour contributes to emotional burnout and exhaustion. It also adds to the already huge daily cognitive load of our careers.

Dr Italo Brown described code-switching as a “survival tactic” in emergency medicine. He described multiple instances in which he amplifies certain personality traits and behaviours to ensure a smoother working life This was uncomfortable for him but he explains, the desire to preserve the team’s comfort dynamic outweighed the desire to uphold my own identity.” Do we foster a culture where marginalised groups can be true to themselves whilst still feeling a part of the team? Or is the dominant culture the most present, the most successful, and the most rewarded?

For many people with marginalised backgrounds, code-switching in the workplace is innate, often unintentional and sometimes unidentifiable to themselves. It is a learned response to negative experiences of being your “wrong” self at the wrong time. It is reinforced by seeing others succeed who fit the status quo. 

Whilst inclusion is vital to improve the experiences of our colleagues in healthcare, they must feel they are able to be their true selves at work.

Diversity is not enough. Inclusivity needs to be promoted at all levels. Consider your biases when you make assumptions based on the “professionalism” of a colleague’s language or behaviour. Embrace different accents. Encourage safe spaces where conversations can be had to talk about code-switching. Reflect on whether your treatment of a team member is based on who makes you feel the most comfortable, and why this could be. Redefine your ideas of what “professional communication” is.


Baquiran, Chin and Nicoladis, Elena. (2019). A Doctor’s Foreign Accent Affects Perceptions of Competence. Health Communication. 35. 1-5. 10.1080/10410236.2019.1584779.

Brown, Italo M. MD. MPH. Diversity Matters: Code-Switching as an EM Survival Tactic. Emergency Medicine News: January 2021 – Volume 43 – Issue 1 – p 7 doi: 10.1097/01.EEM.0000731740.47326.45

Hewlin, P. F. (2009). Wearing the cloak: Antecedents and consequences of creating facades of conformity. The Journal of Applied Psychology, 94(3), 727–741

McCluney, C., Robotham, K., Lee, S., Smith, R. and Durkee, M., 2019. The Costs of Code-Switching. [online] Harvard Business Review. Available at: [Accessed 8 February 2021].


  • Nadia is a paediatric registrar in London. She is passionate about improving accessibility in medical education, emergency medicine, and finding the best flat white in South London.



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1 thought on “Code-switching”

  1. Great article Nadia, thanks for posting.
    Code switching is really interesting. Malcolm Gladwell’s podcast Revisionist History has an excellent episode on code switching and the ways that we ‘other’ marginalised groups, but also how marginalised groups can end up ‘othering’ their own groups to by social capital with the dominant group. It’s a fascinating, heartbreaking listen :