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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