Shared language between doctors and patients

A while back, my brother-in-law was experiencing low back pain and my sister told me that the doctor had diagnosed it as a “herniated disc.” The conversation eventually evolved into a discussion about the difference between a “herniated” disc and a “ruptured” disc. My position was that ruptured was worse; my sister’s that they were the same thing. Since inquiring minds want to know these things, I decided to look it up and a cursory internet search yielded a variety of explanations from an assortment of people professing to be medical doctors.

The summary of the findings is as follows:

a. there is no medical difference between a herniated and ruptured disc
b. the difference is a matter of degree in the herniation
c. a “herniated disc” also describes a “bulging disc” (therefore making a ruptured disc a type of herniated disc)
d. there is no scientific definition of “bulging,” “herniated,” “ruptured,” or “prolapsed” discs

And, my favorite,

e. The term “herniated disc” is so misused that a patient is better served to just obtain the actual measurements of the protrusion

As the saying goes, “Ask five doctors and get six different answers.” This seems to be a case in point.

But the bigger underlying issue here is communication. For patients that want to be constructively involved in their care, at a minimum, they need to know the diagnosis, understand the treatment options, be aware of the pros and cons of the various therapeutic options, and have access to quality/performance metrics for the providers that would potentially deliver the treatment. Many patients want to be involved in the decision making regarding their care, but quite often feel overwhelmed by the subject matter or don’t know the most constructive ways to get involved. Is it really beneficial if we are all schlepping around the healthcare system with the actual measurements of our protrusion? If so, this expectation needs to be clearly communicated to the patient. And “adherence” to it will likely be much higher if the patient understands why s/he needs to know and communicate this information to other providers.

Does the lack of consistent nomenclature about a condition undermine these efforts? In a quick poll among some of my personal acquaintances, there was general agreement that “ruptured disc” sounded “scarier.” Even if they are the same thing, a patient’s response might be significantly affected by the description of a condition if it is not accompanied by an adequate explanation. My brother-in-law’s doctor essentially told him that he could call it whatever he wanted and it wouldn’t make it hurt any less. He said the discussion “was just semantics” and that the important thing to focus on was that he had “a big issue” to deal with. The doctor may be spot on with that assessment – but only provided that he is also offering information on the possible ways to address this “big issue.”

If I were the patient, would it be a good use of my time to quibble about the appropriate use of the words “herniation” or “ruptured”? The answer is no, but I do need to understand the difference (if there is one) so that I know how to research my condition and so I won’t think it’s a new diagnosis if the terms are used inconsistently among different providers.

Generally speaking, patients and providers both want to achieve the best possible outcomes. Engaging patients in their care in a meaningful way can help accomplish this. Unfortunately, patients and providers are often not well aligned on how best to do this. Improved communication and shared language can have a very positive impact on these efforts – and hopefully even help it hurt a little less.

Beth Austin is a patient and consumer engagement advocate who blogs at Crescendo Consulting Group blog

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  • Steven Reznick

    I think most physicians want to be outstanding educators to their patients and communicate in an understandable and professional manner. The truth is that it is a structural low back problem and or injury that can be treated in several manners all of which according to evidence based medicine show excellent results. I am very fortunate because of the type of practice that I run to have the time to devote to defining the nuances and differences between things like gastritis , erosions , reflux, ulcers when the patient complains of heartburn and dyspepsia. Most practices where providers are seeing 30- 40 patients a day, do not have the luxury of time to do this.  When we explain to a patient that they need to lose some weight ( and review options for doing this), stop smoking, eliminate foods and drinks that reduce lower esophageal sphincter pressure ( by printing out a diet and food choices) , eat earlier so there is not still food and digestive juices in your stomach when you recline and provide medications to reduce acid production we generally do not have the time or resources to clarify the different synonyms for these clinical entities. If the patient or their loved ones wish to research the issues privately and ask questions to clarify their questions and understanding I suspect most practitioners will be glad to answer them at a mutually convenient time.

  • Anonymous

    I agree wholeheartedly with the need for understanding how consumers think – and especially how they speak and deal with diseases.  

    This is why at we have hired a Social Anthropologist from Boston University as our Social Media Strategist (Christine Soya @csoya).  If we are going to provide an in-depth understanding of our consumers and provide ways for pharma companies to engage back with them we need to understand and speak their language.

    Jack J Florio, CBO – LiquidGrids

  • Michal Haran

    Lack of communication and lack of proper use of terminology is unfortunately not only among physicians and patients, but also among different sub-specialties. 
    more than 10 years ago a paper called ” clinicians are from mars and pathologists are from venus” was published. 
    I believe that this problem is even more pronounced nowadays, with more and more complex tests, and sophisticated specialty-specific terminology. 

    That is why I think it is even more important for patients to understand and for physicians to do their best to explain, as many times the patient ends up being the person that has to put together all the pieces of the puzzle he was (non-intentionally) made into by his/her treating physicians.

    when I wrote educational material for my patients, I pilot-tested it on quite a few of them including those that were more highly and less highly educated, before I finalized it. My patient’s awareness and understanding of their condition has helped them tremendously in their encounters with other physicians involved in their care, as did an open line of communication with me, when required. So, that all involved will speak as much as possible in the same language. 

    I never have a problem saying-I don’t understand, please explain. And this is also what I teach my patients and medical students/ residents I have trained. I tell them that there are no stupid questions, just stupid answers. No one can know or should be expected to know everything.  

  • Anonymous

    Ruptured, bulging or herniated disc? Different nuances of same language? Ahhhh but the language of pain is based on the fact that the damaged disc does not work right! It therefore cannot control movement and force like it should and those wrongly applied forces are the real source of a good part of the pain from chronic disc problems. The real problem is that medical profession and patients continue to use the wrong language and we do need a brand new paradigm for discussions of chronic pain!

    That said we do need to stop splitting linguistic hairs when it comes to treatment of chronic pain in all its forms!

  • Anonymous

    In these stupid linguistic loopholes thousands die every year.

    I seriously don’t understand medicine after 35 yrs of practicing as a family physician.
    It’s just money…..that’s it.

    Look at medicne from the economic eyes…and you’ll see what’s good for the patient and what’s bad.

    There is a glaring reality out here people
    There is a 500 pound gorilla in the room

    THERE is something called as old age, aging…..
    We don’t want our patients to know that.
    You take our medicines…you live 75 years
    You don’t take any medicines in your life, don’t buy processed food and try to walk everyday and you’ll live to 90.

  • Kim

    I am fortunate that I don’t tend to get caught up in those linguistic loopholes, owing to my educational background and a tendency to read whatever I can get my hands on about medical matters in general. (I was a wannabe physician who ended up in health information management, aka medical records.) But for those who don’t have the understanding of the language that someone like me does, physicians must do whatever they can to help their patients understand. Sometimes that’s not an easy process, but everyone benefits. It can be a hard thing when your knowledge as a physician is so extensive and you have to find ways to simplify it and encapsulate it in smaller bits so patients can understand their condition(s), especially in the current environment of the 15 minute (if you’re lucky) office visit. And from the patient perspective, there has to be some initiative as well. Gone are the days where we can just take what they say as gospel without being proactive in our own care; there should be some degree of partnership wherever possible (the middlemen and insurance insanity notwithstanding), but one of the steps to making that a reality is breaking down the jargon and really understanding each others’ perspectives. Only then will health care start moving in a better direction.

    • Anonymous

      Kim – I think you’ve hit the nail on the head with your comment. There is so often a disconnect in the patient-provider interaction, and quite often neither party is even aware that it’s happening. Physicians don’t realize where the confusion lies and the patients “don’t know what they don’t know” so they often do not ask the right questions. This is a vexing problem, but as you point out, more time with the physician and more research on the patient’s part can bridge the gap.

  • Pepcice2

    What is common every day language to doctors is not common every day language to patients.  And many patients either don’t know what questions to ask, don’t want to appear stupid for asking or simply aren’t afforded the opportunity to ask.  As an RN I spend a lot of time interpreting what the doctor just said for my patients, family and friends.

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