Medical jargon leads to poor communication between physicians and patients

An article in the Wall Street JournalTaking Medical Jargon Out of Doctor Visits, emphasizes that the use of medical jargon leads to poor communication between physicians and patients, and consequently leads to ineffective medical care. Federal and state officials are now pushing healthcare professionals to use simpler language to communicate medical advice to patients.

I could not agree more with this mission. The gap in understanding between physicians and patients is only widening in an era of increasing medical knowledge, advanced medical technology and imaging studies, and the increase of laparoscopic, robotic, and endovascular surgeries. It is becoming difficult for physician themselves to keep up with the jargon, let alone translate it appropriately to their patients.

I cited poor physician-patient communication as one of the primary reasons for medication noncompliance in an earlier post, The Story Behind Medication Noncompliance. Recently, I cared for a patient in the intensive care unit with severe pulmonary hypertension who did not understand, 1) why she was having so much trouble breathing; and, 2) what exactly we were doing to try to help her. The words “pulmonary hypertension” meant nothing to her. Physicians walked into the room every day to discuss the risks and benefits of floating a Swan-Ganz catheter (a device used to measure pressures in the right atrium, right ventricle, and pulmonary artery).

They discussed the possibility of starting new medications, including sildenafil (Viagra) and esoprostenol. They sent her all over the hospital for a variety of procedures and tests – multiple cardiac catheterizations, cardiac echos, chest x-rays … you name it. She talked to all kinds of physicians, from her primary care doctor to her cardiologist to a pulmonary critical care specialist. She did not understand what was going on until I explained it to her in basic terms: the heart works like a pump, and when it pumps against the high pressures in her vessels (caused by the pulmonary hypertension), it has a difficult time pushing blood to the lungs to give it the oxygen it needs – making her short of breath, and it eventually begins to tire out after such hard pumping – leading to heart failure. Prior to our interaction, no one had successfully explained to her this process before in language that she could understand.

To be a good physician, you need to be a good teacher. There is an art to breaking down all the complexities of medical science into something that a third-grader can understand. There is also an art to modifying your explanation depending on the patient. A plumber has a very good understanding of pumps and water pressure – this can serve as a good analogy for the heart. Athletes might understand better if you describe the heart as a muscle that contracts to perform a certain amount of work over time. Electricians might understand cardiac arrhythmias and conduction abnormalities if you explain to the them that a small electrical current makes the heart pump, and if that current is disrupted, the “circuit” breaks and the heart does not pump appropriately. Artists sometimes understand better if you draw a picture and talk them through the circulatory system, image by image.

As for a heart attack – everyone knows the phrase but few people understand what it actually means: that the heart has its own blood supply through three main pipes (or vessels), and when one of these pipes gets blocked off, the heart does not get enough oxygen, and heart tissue begins to die.

There are all kinds of ways to explain medical illnesses to patients and their families – and our job, as physicians, is to start at a very basic level and build up depending on patients’ own level of interest, curiosity, and education. For patients who do not ask the right questions (why they might need a procedure or what the risks of a procedure are), it is imperative that we answer these questions for them anyway.

Using analogies, images, and simple language does not come easily to all physicians – but one of our roles in this profession is to serve as a translator for our patients and to minimize medical jargon so that we can be on the same page with our patients and help them make informed decisions. Developing concrete tactics and communication skills for physicians in their fields of specialty may help to facilitate this important change.

This anonymous medical resident blogs at A Medical Resident’s Journey.

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  • http://drpullen.com Ed Pullen

    This has been a problem forever. We spent time in my residency 1980-83 discussing this. A nice story, but news? Not really.

    • merlmd

      Agree.

    • http://drpauldorio.com Paul Dorio

      I agree it’s a very nice discussion. But why do you think his and my comments are still relevant? I too have discussed doctor-patient communication, and I am not surprised at your comments that the lack of reasonable discussion by doctors has been a “problem forever.” Perhaps the situation might improve if medical schools teach “Common lingo” and “Medical expression simplified,” in addition to “Complex terms by Professor Mustlearneverything.” Personally, I use simple, everyday terms as often as I can. It starts today with each of us. Go out and communicate effectively.

      • Alice

        Paul said: Go out and communicate effectively.[end quote]

        Alice: Bravo! You get it! You didn’t get defensive…..like my doctors who tell me not to apologize…..they tell me it’s why they are there….to help me. When done well…..the risks and work are worth the rewards, and as you shared communication is really a key factor, not just treatment. Surely, doctors don’t expect a blind trust in what they are doing without the patient understanding their own dilemma?

  • Patient

    I get a little annoyed if an MD assumes I don’t know what he’s talking about and dumbs down his communications with me.
    Keep the jargon or use with discretion.

    Also, don’t flip out if your patient knows what “HLA” is or the name of some feature of anatomy. Which Docs have been known to do, waxing instantly suspicious.

    • http://Www.twitter.com/alicearobertson Alice

      Try going through a peer review where doctors purposefully become linguists in an effort to protect the colleague above the patient. Relying on their education over and above morals, ethics, and integrity. The truth is trumphed in an effort ot use intellect before honesty. CS Lewis, rightfully, warned about this labeling this method as producing “Clever devils!”

  • http://tucsoncitizen.com/tucson-progressive Pamela

    “An article in the Wall Street Journal, Taking Medical Jargon Out of Doctor Visits, emphasizes that the use of medical jargon leads to poor communication between physicians and patients, and consequently leads to ineffective medical care. Federal and state officials are now pushing healthcare professionals to use simpler language to communicate medical advice to patients.”

    Isn’t this old news? I did a dissertation on this back in the early 1990s, and the research papers I cited went back years.

    • http://www.ability4life.com kathy kastner

      ‘Isn’t this old news’
      sigh. what a statement about how far we haven’t come

  • Primary Care Internist

    Great in principle, but ask a doctor who’s been in practice (rather than a resident) and this is the typical story:

    Demented 90-yr-old with septic shock from pneumonia, uncontrolled diabetes with a gangrenous toe, failure to thrive, etc. whose family gets complete and regular explanations, in both laymen’s and medical terms, and their next question? “when can she go home?”

    Some people will just never get it, no matter how (and how much) you explain it to them.

    I can see how a resident might assume otherwise, but among most attending MDs I know (even those for whom English is a 2nd language) communication isn’t the problem, rather it’s understanding on the part of a not-so-educated listener. Very rarely have i seen a primary care doctor being lazy or unable to communicate a clinical situation in simple terms.

    • http://warmsocks.wordpress.com/ WarmSocks

      How can an explanation be considered complete if the individual/family still has questions?

      My experience as a patient has been the opposite. If I have a list of five questions to ask my doctor, his answer to the first question contains the answers to all my other questions, too.

      • Primary Care Internist

        In your world is it possible that the patient/family didn’t understand the simple answers that were given to their questions? Or is everything always failure to communicate properly on the part of the doctor(s)???

        My point is that, no matter what, sometimes people will not absorb what is being said, as you so aptly point out.

        • http://Www.twitter.com/alicearobertson Alice

          Your point is well taken.  You say one thing…the patient hears another.  Stats show the average patient forgets 70% of what they heard in the exam room.

          I wish the first question could sum up our visits.  When it is cancer, and horrific treatments are being discussed I can share your mind goes into such a high gear you really can’t absorb it all.  In a word you are terrified.  

          My doctors encourage email, snd questions…stating I must stay in contact with them.  They are not the norm.  One doctor thought he was there to entertain me…and he did…he is the author of a book on our disease…top of the line with the jokes….but when you were through laughing you and you asked if we could discuss what to do about the spread of cancer he responded that my daughter did not have cancer.   I almost fell off my seat.  He finally opened the EMR and I guided him to the right dates of tests and other doctor’s input.  Two of our specialists wing it and do not have your file open.  That is doctor error because even if the patient listens it is just basic stuff, not your personal, unique status.  They are no longer our doctors….politeness from a patient only goes so far when a life is on the line.  I have to pay for our records, they take weeks to arrive because it is truly the only way to understand it all.  Then research, then scaling the questions down to your particular circumstance, and finding doctors who understand that this may have been covered a thousand times by them….but it is your first…you are acclimating to devastating news….your life is changed forever by what they just shared.  I asked our doctor if he hates his job on days like this (I had just received bad news, and my mind was clicking and desiring denial).  His voice was soft and kind….he said he would not want to be sitting where I am….then responded with some of the kindest words I have ever heard….yes. I listened and heard…because the presenter cared.

          Sure sometimes patients are too angry or distrsught to hear exactly what you said….surely, doctors are trained to help us listen?  I know the two I have now will offer to stay late ot whatever it takes to keep the communication going.  They understand it is more vital that I understand and make this a top priority.  They offer hard headed patients a replacement doctor because they feel personalities can conflict, but few patients move on from the skilled, empathetic good communicator.  

          Quite frankly, I consider our doctors our friends….but when we see two of the others I try to disappear.  So far….we are far from batting 100 and I am at one of the top five hospitals in the country.  Dr. Jerome Groopman shared that in his informal survey 100% of doctors said if they can’t communicate with a doctor they are outta there, and fast!  That’s the motto I think will guide my future visits.   Two doctors who refused to listen to my pleas would have inadvertently killed my child.   Arrogance is not only unbecoming, it’s a killer.   

        • http://warmsocks.wordpress.com/ WarmSocks

          My response was more to your second paragraph. It sounded like you frequently run into a situation with a specific follow-up question – as in your example where you explain a bunch of detail and then the family asks, “when can she go home?” It would seem that your “complete answer” is leaving something out. imo, the complete answer could conclude with “given all these conflicting health issues, it’s likely that she can go home ____.” If people are going to want the information, give it to them. But that’s just my opinion.

          My point is that, no matter what, sometimes people will not absorb what is being said…
          Point taken. As a former math teacher, I heartily agree.

          Sometimes people don’t get it. I think that the person who is incapable of ever comprehending is pretty rare, though. The issues are 1) why didn’t the person understand? and 2) how can that be overcome? When my students didn’t comprehend the material, I could blame them for not listening, or not paying attention, or not doing their homework, or any number of excuses. Blame didn’t really solve the problem, though. The bottom line is that I needed to find a way to overcome the student’s lack of understanding. In the world of pedagogy, there’s a saying: “The teacher hasn’t really taught until the student has learned the lesson.” Perhaps this applies to the medical profession, too?

          Or is everything always failure to communicate properly on the part of the doctor(s)???
          No, doctor. I didn’t mean to imply that at all. I think all people are equally capable of communicating unclearly and misinterpreting what others have said. I suspect that those who are sick or afraid or under the stress of seeing a loved one ill have a particularly difficult time comprehending new information, and even though doctors might give a stellar explanation, patients will retain that information as well as a seive holds water.

          More thoughts on this subject here.

          • Primary Care Internist

            What if i completed the above :

            Demented 90-yr-old with septic shock from pneumonia, uncontrolled diabetes with a gangrenous toe, failure to thrive, etc. whose family gets complete and regular explanations, in both laymen’s and medical terms, ending the conversation with “she’s very very sick, and may die very soon. We are doing everything we can. Do you have any questions?”

            then “when can she go home?” is not an uncommon response (really, not kidding). Is that still an incomplete explanation.

            And ““The teacher hasn’t really taught until the student has learned the lesson” is a terribly naive viewpoint, one the Bush administration has used to scapegoat teachers for societal problems.

          • http://warmsocks.wordpress.com/ WarmSocks

            @Primary Care Internist:
            I think your example is a very good illustration of what the article is talking about. Doctors can spend time explaining the situation to patients/families, but somehow not get through to them.

            If a doctor says, “We are doing everything we can,” that sounds like there is hope. Perhaps those families you mention are clinging to that hope. People go to the doctor for a cure; the doctor says that everything possible is being done. When the doctor succeeds in doing everything he can, the patient will recover and can go home, so it might seem perfectly logical to ask when that will be.

            Of course treatments don’t always work, but laymen don’t draw the same conclusions from a diagnosis (or list of problems) that a physician would. From how you’ve explained the example, it sounds as if something was phrased in terms such that the family failed to understand the situation. If it was a one-time occurrence, then the problem might be in the hearer. Since it sounds as if this happens repeatedly, then the explanation needs closer scrutiny. Yes, I think it likely that the explanation is incomplete.

            It might be as simple as expanding the concluding remarks to, “We don’t expect her to recover, but we are doing everything we can to keep her comfortable.” Some people need everything spelled out.

            The teacher hasn’t really taught until the student has learned the lesson is a saying that was around long before Bush was president.

          • Alice

            Primary Care Internist said: And ““The teacher hasn’t really taught until the student has learned the lesson” is a terribly naive viewpoint, one the Bush administration has used to scapegoat teachers for societal problems. [end quote]

            Alice responds: This isn’t a thread about the state of the schools…..but here goes nonetheless…No Child Left Behind was a teaching to testing movement….. not a “scapegoat to societal problems”. If you want to fault the Bush administration you could say it was unfair as far as incentives go (they were disproportionate), it left teachers with little creativity…then the unions (which I am not completely against) and their tenure problems where just existing means you brought in a paycheck…..to heck with the kids.

            But this whole thread is interesting for doctors because Governors are going to have more state power, and that means more power to deal with the teacher’s unions (I know it failed in DC, but a movement of thought has started because a distrust has been created…and so it is with patients). This will mean more charter schools, and competition for the public schools and incentives for the teachers who get results. This also means outcome-based- medicine with it’s pro’s and con’s may be coming to a hospital near you.

            Basically, the word “outcome” needs defined with the schools and medicine because that’s where the rewards will be. Doctors and teachers will want the best material to work with because the outcomes will be better, but thankfully, there always be doctors and teachers who see the individual and look beyond the incentives into the heart of who they are trying to help.

  • http://fertilityfile.com IVF-MD

    We have to remember not to shove a one-size-fits-all policy down the throats of our patients. SOME of my patients want simple words and dumbed-down explanations. SOME of my patients bring journal articles and criticize experimental design and statistical power in research studies affecting their treatment. I certainly hope you are not advocating some mandatory law punishable by fines and/or loss of medical license if a MD uses any language that could be interpreted by a lawyer as being “jargon”.

    When you say “Federal and state officials are now pushing healthcare professionals”, I welcome them to push gently and give suggestions. But it would be immoral for them to push with a coercive regulation.

    Overall, I agree with you wholeheartedly about the pluses of us being teachers and using analogies and stories to relate to our patients of different backgrounds and occupations. This is another reminder of the advantages of us docs being well-read and well-rounded culturally. This is fine with me, because I find it quite fun to read and expose myself to different cultures.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    From my experience taking care of the other end of the age spectrum, what PCI said.

  • goddessoflubbock

    As a prior victim of wildly inaccurate diagnoses, I learned a long time ago I had to be pro-active and educated about medical conditions that affect me. Far too many doctors are very uncomfortable with that – preferring to send me home with some incomprehensible name for my ailment without helping me understand it.

    Is this communication problem new? Not hardly. But the fact that it still exists is very troubling.

    I, Too, suffer from pulmonary hypertension. My doctor insisted it was my asthma, but I knew different. When I asked for the results of my echo I was only told my ejection fraction was well within normal limits. Oopsy – I guess he didn’t notice my systolic was very elevated? *I* diagnosed me, and it was seconded by a pulmonologist.

    Doctors need to remember they aren’t gods, no one (in their right mind) worships them, and at the end of the day it’s just a job that they need to do well in all facets.

  • http://www.HealthCoachingwithDrJay.com Dr. Jay Warren

    It’s true, part of our jobs is to be teachers and to be effective we must teach in ways (and use words) that reach the student (patient) at their level of understanding. Only by matching them there, may they ever have a chance of making a real change in their health for the long term. If we are to serve our patients, we must cater our service to THEM and not have it be about OURSELVES.

    • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

      Dr.Jay, WarmSocks pretty much descibes my own experience as a physician. I answer questions in such a fashion and in such terms that when I ask the parent if they have any more questions (always the last thing I do), they usually tell me I told them everything they needed to know.

      Even then, when I come back later, they ask the same questions all over again. And that’s okay.

      I think people are not considering one very big factor in successful communication – and the doctor-patient relationship.

      And it’s the first thing you learn in an ED, no matter what age range you are serving.

      It’s not just that some patients will never understand no matter how many times or in how many ways you explain a problem. Patients/parents lie to you. They lie all the time and for every reason under the sun. Oftentimes when they;re caught lying to you, they try to make it your problem – or your staff’s problem (and then it does become about you because you have to defend yourself).

      As several commenters have pointed-out, well-meaning global mandates are not going to fix that.

      Moreover, a lot of us learned we were not “gods” or “worshiped” a long time ago – when no one had our backs for doing our jobs the right way.

      • Alice

        Moreover, a lot of us learned we were not “gods” or “worshiped” a long time ago – when no one had our backs for doing our jobs the right way.[end quote]

        Mary there is truth to this, but in truth, many doctors want treated in a god-like fashion while performing in less than god-like manners. I appreciate the honesty of a doctor who says the most honest words, “I don’t know…….” When I hear that I silently think, “Thank God! They are honest!” But there are doctors who can’t/won’t say those words, and bluff the patient, or just spit out data….more data…….like the answer to my question about radiation………”It’s 97% effective on this type of cancer.” Sadly, we were in the 3% it didn’t work on. But that isn’t the doctors fault, it is the doctor’s fault he sent my daughter home radiating cancer on everyone she came in contact with. We were told to not let her have contact with someone for xx amount of hours, but then after the fact we were told that was complacency on the endo’s part (who will be a chair someday….anyday now).

        Blame your colleagues, put up with the patients because patients feel empowered and I don’t foresee that changing. I do see great change at the Cleveland Clinic in treating patients with great dignity.

        Why do patients lie? For drugs, out of shame? Aren’t the vast majority of patients honest, and many doctors lying in some manner? It’s a business of cover-ups for management and ego? This is why your own honesty is refreshing to me.

    • http://www.ability4life.com kathy kastner

      Thank you Dr. Jay Warren. Before I explain why, a comment: I think it’s a really tough time for hcp of all stripes in this shifting e-voloution. However: while for sure you have to be teachers,I take umbridge at comparison with school teachers: students aren’t patients. Their resistance to, inability to learn stems from completely different issues than patients. We’re the ones at a huge disadvantage – scared, not feeling well, certainly not at our best and without medical training. As one astute patient twitterer put it: it’s worse for the patient than the provider. So thank you Dr. Warren for understanding that it’s not that ‘we simply will not understand’ we’re strangers in a strange land. We need as you’ve said, to be taught at our level of understanding. It’s empathy, not the expectation that it’s up to us to ‘get it’
      (and if you really want to know how I feel ;) ..
      http://www.ability4life.com/2010/11/doctors-and-patients-cross-cultural-event/

  • goddessoflubbock

    Dr Mary Johnson – that’s one of my personal favorites – when the doctor can’t solve the problem it’s never the doctor’s failure, the patient lied!

    I had an endocrinologist who called me a liar every visit. I must not be taking my insulin, surely I’m eating waaaay more than what’s in my food journal. Finally I learned on my own about antibodies to insulin, had my GP test me, and sure enough there was the problem.

    If my endo had listened to me, instead of assuming I was a liar, I wouldn’t have wasted 2 years with high (11+ A1C) blood sugars.

    Communication is a two way street, and as long as doctors continue to write off their patients input, nothing will change.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    I was anticipating some pushback. And I want to thank you for demonstrating another problem.

    And that’s when patients twist what you say to serve their own purposes. For instance, you’re putting words in my mouth that were not there (like “never” and “every” and “write off”).

    It never ceases to amaze me how you can sit down (and with complicated issues, I ALWAYS sit down) with a parent, answer every single question backwards and forwards – ask them if they understand or have any questions . . . and then overhear a conversation between the parent and a third-party that warps almost everything you said into something unrecognizable.

  • Greg

    I think the people in the best position to discuss this are teachers, especially those who work within public high schools, where the students are more representative of the population at large. Do teachers ever struggle with communicating complicated information to their students? Do students, frustrated or confused, ever drop out of high school rather than excel at it? I would think so, and talking to high school teachers seems to confirm this experience.

    Most teachers make a concerted effort to reach their students, and try their best to convey complicated information in a manner that their students would understand, but if it were possible in every circumstance, than every student would be getting an A in every class. Clearly this is not the case. I would suspect some of the difficulty that doctors have in this regard is the same – that the information is somewhat complicated, and while most people can ‘get it,’ others struggle to do so, even when the teacher/doctor takes the time and initiative to make it as simple as possible.

    • http://warmsocks.wordpress.com/ WarmSocks

      Very good comparison. With some effort, most students can be reached. This reminds me of one student I had, years ago. Two weeks into the semester, she was failing all six of her classes: never had pencil or paper, never did her homework assignments. She just sat in her classes staring out the window. The third week I called her house and asked if there was a problem. The mom stammered for a bit, then said, “Well, you see, I’m in a wheelchair.” A few moments of silence, not wanting to come across as uncaring, and I finally replied, “I don’t understand how that prevents your daughter from doing her schoolwork.” The mom gasped, then listened.

      I explained that the kid would have a homework assignment every night, and I wanted the mother to make sure that her daughter had time to complete it.

      The kid started bringing paper and pencil to class. She started doing her assignments and doing well on the tests. At the end of the semester she had earned 87% in my class. She was capable, but nobody had ever taken the time to teach her what was expected.

      It required some hand-holding along the way, and I won’t bore you with those details. But I suspect there are quite a few people out there who might be reachable, even though they’ve been written off by everyone. Both by teachers and by doctors.

  • anonymous

    I’m a writer, and it never ceases to amaze me how people will ignore or completely misunderstand what I’ve written, even when the words are there in black and white and are as plain as I can possibly make them. So I surely sympathize.

    The whole issue of language, health literacy and comprehension may not be news, but the fact that we’re still talking about it suggests that it’s rooted in human nature and people’s differing abilities to actually *listen*, and that there doen’t seem to be any immediate solutions.

    At the risk of sounding like an aging curmudgeon, I think the whole national IQ has slipped several notches when it comes to written and spoken comprehension. Maybe people don’t know how to read anymore, or they’re not learning critical thinking skills, or their brains are warped by the quick ‘n’ easy communication modes of Twitter, Facebook et al. It’s depressing.

    • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

      Anon, I just got home (early) for a change, and am watching an episode of “The Talk” for the first time (it was what was on when I clicked on the TV) . . . and I was thinking just that . . . as I watch the ladies “discuss” a proposed law (I think in California) that would ban male circumcision – even for those parents who do it for religious reasons.

      The conversation was superficial, silly, even crude and did not address several of the salient points in the debate. For instance, not every Pediatrician agrees with all of the edicts and mandate issued from the ivory towers of the Academy of Pediatrics (for instance, I’m very bothered by the increase I’ve seen in UTI’s in uncircumcised baby boys that require hospitalization and subsequent radiological work-up) . . . and the percentages of boys & men with circumcisions is probably decreasing in this country because Medicaid stopped paying for the procedure.

      A huge part of this nation’s problem when it comes to medical matters is WHERE most people are getting their information – and who they are listening to.

      • anonymous

        AMEN. The attention span just isn’t there. I recently wrote about measures hospitals and clinics are taking to collect patient co-pays at the time of service. I was very explicit in explaining this does *not* apply in emergency rooms (EMTALA, ya know) and that most providers are willing to negotiate payment arrangements, yet the reaction was exactly what you’d expect: “How dare they withhold care!” *headdesk*

        FWIW, I think the general dumbing down of the conversation is not helping. The nuances are being eliminated in favor of bland, watered-down, one-size-fits-all information. This doesn’t just apply to health care; I see it everywhere. When this is the information people are getting, no wonder they don’t know any better, and no wonder that intellectual sloppiness is so rampant.

        • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

          Indeed. Absent local journalists with a code-of-ethics or a soul, one of the reasons I’ve been told that the national mainstream media outlets have not picked up my story-of-medical-whistleblower-woe (with all of its nuances very relevant to healthcare “reform”), is because “it’s too complicated”.

          It’s not actually. Fairly simple stuff.

          But you have to care enough to listen.

          • Alice

            But you have to care enough to listen.
            [end quote]

            Again this is the truth, but Mary I am curious. At your blog where you do tell the truth who is the most disinterested? Patients or doctors? Who are the real truthseekers?

    • Alice

      An “anonymous” “writer” who thinks others don’t get it! Hmmm……..it’s hard to type while scratching your head.

  • http://ma-bc.com Sally Brinkmann, R.N.

    When I read the original Wall Street article and the post on this site I was a bit surprised by some of the information presented. My background is in critical care and patient advocacy. I don’t think that we can blame all the problems of medical care on doctor’s using medical jargon. As individuals we need to take responsibility for our own medical care and speak up if we don’t understand something.

    Regarding the story about the patient in the intensive care w/ pulmonary HTN who didn’t understand anything that was being “done to her” or why she was unable to breathe etc., that is just a sad commentary on the critical care nursing staff and all the technicians conducting studies and everyone else involved in her care. To be honest, it could be that others did explain her condition to her, but due to ICU sleep deprivation, medications, and her overall condition she just couldn’t retain what they told her. Regardless, to blame fellow physicians for lack of communication does seem inappropriate. Additionally, as a Resident you are in a position to do more of the patient care and explaining.

    With regard to patients being non-compliant with medications because physicians fail to explain the importance of the medication to their health or maintenance or their health. The reality of the situation is that an increasing number of patients are simply unable to afford medications. More and more prescriptions and refills are left at the pharmacy, never picked-up by the patient simply because they are unable to afford the costs. People have tough choices to make these days. Prescriptions or paying the electric bill.

    As a patient advocate I am not saying that doctors are perfect. None of us are perfect. I do believe that if you go to a physician and you don’t understand something, you owe it to yourself and the physician to ask questions. If you have questions go w/ a prepared list. If you have a family member who is older or a family member that doesn’t communicate well, go to the doctor with them and take notes. Many physician practices have nurse advisors that are there to assist you if you have questions. It is important to remember that you only get help from your doctor if you are honest and forthcoming with them. If you truly feel like you are not being heard by your physician, perhaps it is time to look for a new one, if that is an option.

    • http://drpauldorio.com Paul Dorio

      Excellent comments and thank you. Communication is a two-way street. Each party must do his/her part to communicate with and understand the other.

  • http://nostrums.blogspot.com DocD

    Everyday slang doesn’t work very well either. Back when I was a surgery resident on the cardiovascular surg service, my staff surgeon lost a patient due to a carotid graft infection. I accompanied him to meet the family. In his frustration, he told them, “The bugs ate the string.”

    The family just looked a him. I explained later.

    • http://drpauldorio.com Paul Dorio

      Excellent example of how communication is an art. It is obvious that the surgeon wanted to help his patient’s family understand what happened, he just didn’t know how to do it well. Using “normal” words does not mean simplifying a comment or thought to idiocy. It means that we try to clearly convey our thoughts and facts with words that don’t come straight out of a medical dictionary. It’s not hard, but doctors aren’t taught that skill of word translation. That learning comes later through careful, continuous, hard work.

  • Alice

    This has been an interesting thread. I was thinking about the teacher analogy. I have homeschooled my six children for 22 years. I don’t teach all of my children by the same method. Nor have I used the hand-me-down method with curriculum, because what works with one doesn’t always fit with the next child. It’s the beauty of having the choices and options I have, and the sacrifice I have made to ensure each of my children learn (realizing a large classroom teacher would find this nearly impossible, but the best teachers do try to implement this on a different level).

    It’s nice when students come to class prepared and do their homework, but to expect this from a patient is a bit much. To be honest, it really is your job to communicate at each particular patient’s level to the best you are able to.

    If the patient or student isn’t comprehending then send them to someone who can help them. Isn’t that what medicine is all about? Helping others? There are no surprises for teachers, and none for doctors. Sick people aren’t always the best field to be learning new tricks to help the doctor out (and, obviously, themselves……knowing it’s pragmatic to do so, but I can assure you my elderly parents aren’t studying up before they go into see a doctor and rarely can remember a thing the doctor said. I have to go with them).

    If a doctor can’t sum up a patient and help them on their level, why not recommend a new doctor? Don’t college students try to move on or drop a class if a teacher is arrogant, or they are unable to learn? Sick people are often desperate, or obstinate, and they are paying a doctor to inform them. Most teachers are highly selective of who teaches their children, and so it is with doctors who won’t put up with bad behavior from their colleagues. Something about being on their level that makes it a much more level playing field.

  • W

    Well, if my experience as the Communications Manager of a mid-size corporation is any indication, there’s been an accelerating trend in businesses over the past 3-4 years toward “simplifying” messages to the consumer — to the point that the quality of the communication has degraded significantly.

    It is not unusual for the execs to request that an absolutely clear and bullet-proof instruction manual be reduced to a page or two, because “people won’t want to read all that”. I look at the results and wonder how anyone could possibly be expected to follow the directions successfully.

    The argument, of course, is that people are busy, they don’t want to read, just give them the basics, etc. Personally, I’d rather have the detailed information. If I don’t want to read or hear it all, that’s my choice and I’m responsible for the consequences — but why eliminate the option altogether? Why cater to the lowest common denominator?

    Then there’s the influence of risk-avoidance. Liability is more difficult to assess when the waters are muddy. Great tool for lawyers. Not so good for those who want to understand.

  • imdoc

    All of this discussion suggests a great opportunity exists for a way to improve communication. Perhaps this is the “value add” feature the EMR vendors need. Just a thought…

  • http://Www.twitter.com/alicearobertson Alice

    Then there’s the influence of risk-avoidance. Liability is more difficult to assess when the waters are muddy. Great tool for lawyers. Not so good for those who want to understand.
    [end quote]

    So, the consumers want it pared down…but because of consumers suing they need to keep adding more jargon to protect themselves? Sorta like the credit card contracts most of us have never read?

    It’s this type of jargon that has made the healthcare bill over 2,000 pages long. The Constitution is only a few pages long….makes you wonder about who all that jargon is protecting. Not the patient? Sadly, that took government regulation which adds to the jargon.

    Which leads to the question of torte reform. Will that help with communication? Get doctors out of textbook mode? I did want to add that the specialists I have seen at Cleveland Clinic take paper and draw out the surgery. The neurologist would take a long strip of paper off the exam table and make detailed drawings. I have no clue if other specialists do this, but it’s a great way for a patient to completely understand what to expect.

  • Bruce Small

    Our wonderful physician’s front desk started asking people to bring in their prescriptions with every office visit, and then were astounded when patients brought in plastic bags filled with all sorts of prescribed drugs. True story.

    • W

      Last month I had my first colonoscopy. Went fine, no complaints, but there was a funny/awkward moment when the nurses came to take me from the prep/recovery room to the procedure room. They told me they were ready, so I naturally got off the bed and started walking towards the door. They looked at me like I was an idiot. Well, I had no idea they were going to wheel the entire bed from one room to the next! I’d been lucky enough to stay out of hospitals since 1969.

      The prescription story sounds about the same. Desk staff wasn’t clear, patients were trying to be compliant, and now they’re probably the butt of a joke at the office.

    • http://www.twitter.com/alicearobertson Alice

      Another true story……the medical assistants at the large hospital I take my elderly patients to ask for the bottles, not a written list. They know the elderly rarely get it right, and they must see the prescriptions. Adult elderly services for our county just asked me to bring the bottles in too. They are trying to figure out how to help me with two demented parents and a handicapped brother and asked for the bottles. They want no mistakes.

    • http://www.ability4life.com kathy kastner

      What astounds me about this (omg: true storyu) anecdote is that – as a patient – I don’t know what else I’d be bringing if asked ‘d to ‘bring in all my Rx. What was expected: ahand-written list (possibly not easy to read) , with everything that’s included on the script (generic plus brand name? script #? directions?) somehow taking a copy of label? Asking Pharmacist to print out list? Let me know, so I’ll be able to follow those instructions as intended, rather than as interpreted.

  • Jenny Walsh

    The key to being a good teacher (an important part of being a good doctor), is remembering what it was like to not know and find a way to take others on the journey from not knowing to knowing.  Jargon without explanations, prescriptions without understanding the normal physiology and what is going wrong, and the “because I said so” model of medicine simply isn’t enough.  Patients are putting THEIR lives on the line and they deserve to understand what is going on, why an intervention is recommended, and how the doctor is weighing the risks and benefits of both the intervention and non-intervention.  THEN we might really get somewhere and actually be a team–patient and doctor, together.

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