Choosing words wisely: Can healing get lost in translation?

A few months ago, we had an opportunity for one-on-one time with standardized patients (SPs): the trained actors that are well-versed in how us medical school fledglings should and shouldn’t be performing physical exams. It was a laid-back, non-graded session wherein we could ask for advice and even have the SPs walk us through exactly what we should do. So, when it came time for the abdominal exam, I asked my SP, “Okay, is this where I auscultate before pal …”

“Ask-ull-what?! No no no, you don’t say that. I am a patient. I don’t know what that means. Why would you use words a patient doesn’t understand?”

Although I understood (and agreed with) her point completely, I was mildly irritated. In the week prior to that session, I had been corrected for listening and not auscultating. Since this exercise was part of our clinical skills course, I honestly thought I’d earn another stink-eye if I didn’t use the proper lingo again.

Fortunately, the awkwardness of that session had peaked a mere 30 seconds into it, so my poor word choice didn’t make it any worse. What it made me realize, though, was that this was going to be the first of many of the most difficult concepts to learn in medical school: the ones that won’t be found in any clinical skills session or USMLE review book.

As a former linguistics major, seasoned patient, and expert waiting room accomplice, I have always understood quite well the language barriers that exist between doctor and patient (and no, I don’t mean those that arise from thick accents). But I have to say that, even a year in, it’s exceedingly difficult to switch gears from medicalese, which is desired and arguably mandatory in the classroom and on the wards, to the language that the human beings we treat actually use.

Just the other day, without even thinking, I asked a patient at one of our free, student-run clinics if he had hypertension. Pathetically, it wasn’t until I received a look that might otherwise be elicited for me having three too many eyebrows that I thought to blurt out “high blood pressure” instead.

From a linguistics standpoint, there is a somewhat logical explanation: The sterile dialect of our long-coated superiors is not only the standard for precision and professionalism, but it’s also the language in which we learn everything.  Just like how people tend to count in their first, native tongue, no matter how fluent they are in another, those in the medical field stick to the words with which they were taught medicine.

It was esoteric terminology that first disenchanted me with the study of linguistics, and here it is again, wedging itself in the growing divide between physician and patient. This hardly surprises me, though. I have access to hundreds of biochemistry practice problems, but I can only hope for plenty more brutally humbling exchanges with patients.

Granted, it does take some additional brainpower and time to generate a clear translation for patients, but aren’t we all accepted to medical school because of our (sometimes irrational) tendencies to go the extra mile, especially when it comes to helping others?

And even if our LCME-approved, “Patient as a Person” PowerPoint presentations could effectively teach us how to translate between the grammars, would anyone really listen to them? Or would we all tune out in favor of counting the number of cytokines we haven’t memorized yet?

I recognize the need for a streamlined and standardized language when diagnosing illness, but I don’t understand why we are all so quick to forget the words we learned before medical school when healing people.

After all, it is pretty silly to use such a fancy word for making sure we hear lunch sloshing around our patient’s belly.

Allison Goldberg is a medical student.

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  • guest

    I have always thought of medical communication as requiring the doctor to be bilingual. You need to be fluent in the language of medicine, but you also need to be fluent in the language that your patient speaks, and you need to be able to fluidly switch back and forth between the two languages, depending on whom you are communicating with.

    If you think this is difficult, you should try being a parent, interacting with the physicians for your ill child. In my experience, even though a medical parent is probably thinking about her child’s situation in medical language, the child’s doctors are almost always offended by a parent’s communicating with them in their own language. So visits are slowed by having to mentally translate back into “parent language” the history that you want to report in “medical language.” If you think it’s tricky to communicate with a patient, translating your thoughts into lay language, you should try doing it when you know that the person you’re talking to is a doctor.

    • Allie Goldberg

      Wow, that’s an entirely different level of (mis)communication that didn’t even occur to me. (Not to mention translating what you know your children mean to the rest of the world — I’ve always been amazed how moms understand what sounds simply like baby babbles and teenager sighs to others!) I’m sorry doctors prefer that you’d translate back to “parent language”; that’s pretty insulting to you and definitely not making things easier, huh?

      Thank you for the comment! I will keep this in mind whenever I’m studying pediatrics..

  • http://www.mightycasey.com/ MightyCasey

    Words count. Using the ones that your audience can understand – whether in an LCME-approved presentation or to the patient presenting with chest pain – is #1-with-a-bullet on the Effective Communication Must List.

    I’ll admit to knowing *way* more than the usual person-commonly-called-patient might when it comes to medical-ese, driven largely by the need to understand what was being said while I advocated for, and then managed, my ‘rents’ care. When it came time for me to manage my own, I was once again thought to be a doctor, given my ability to trade polysyllabic word flurries with my clinical team.

    Would be lovely if MDs, RNs, and other medicos would speak plain English to the patients they work with – much progress on QI and the current buzz-phrase “patient engagement” might ensue.

  • Arby

    I was a young pharmacy tech in retail when I told a customer (at the direction of the pharmacist; before the Rx counseling law) to not drink for the three days she was on a particular med. She asked “Not even water?”.

    I don’t think I’ve felt stupider and I learned my lesson that day.

    • Allie Goldberg

      Ahh, good point! Even in what sounds like plain language, there can still be plenty of ambiguity! And, for what it’s worth, I think it’s admirable that you recognized this and that you still think that *you* were the ‘stupid’ one in the encounter. I think that’s pretty intelligent of you, Arby.

      Thanks for your comment!

  • Suzi Q 38

    Many physicians and medical personnel are bilingual, or speak even more than two languages. I think that these language skills can only help them and their patients.
    We live in California, so many of us speak Spanish as well as English.
    We are also seeing and influx of patients from China, so mandarin would be helpful.
    If the patient speaks limited English, it is helpful if you speak very slowly, then pause and check for understanding.

    • Allie Goldberg

      Yep, yet another barrier between docs and their patients. English medicalese + another language entirely can be a disaster without an excellent translator. It certainly doesn’t help that foreign language proficiency isn’t emphasized or properly ‘taught’ in the US, as well. Have you found that in-hospital translators are helpful when the medical team isn’t fluent in the same language that the patient is?

      Thank you for the comment and advice!

      • Suzi Q 38

        In hospital translators are very helpful.
        I am an English language teacher, so I warn patients that they might not get a doctor who is fluent in their particular language in the case of an emergency. They must be prepared to speak basic English if necessary.

        It is not a problem getting Spanish, French, Italian, Mandarin, Arabic, or Vietnamese translators. Sometimes, they can be contacted by phone, although this is more risky than in person.

        I sometimes have difficulty finding Cambodian, Micronesian languages, Hindi or Punjabi from India, or some of the languages from various countries in Africa.

        Luckily, I can communicate by using “Language Tools” on Google, or a language app on my iphone.
        These sources only have the more common languages, and the translation is not always accurate.

        As far as the European and Asian countries, many have taken English as a second language as part of their education.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    Excellent post. I teach communication skills to healthcare professionals. I start one section of the program by saying, “My wife shows and breeds Pugs. It is important that the dogs are stacked appropriately. One of our Pugs got a Four-Point Major and then went on to get a Group Win!” The audience looks at me quite puzzled. I mention that I was using dog show jargon and I am sure you feel frustrated. It’s another language. Think about how your patients feel when you use medical jargon.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    It is not just medical words that confuse patients. It is everyday words that are used in healthcare in different ways. For example, I have spoken
    with many patients who told me that their doctors said they were boring. I asked them to explain and they all said the same thing to me, “My doctor told me I was unremarkable.”

    • EmilyAnon

      I would rather be a boring patient than an ‘interesting’ one.

  • http://joannevalentinesimson.wordpress.com/ ValPas

    Terrific post! It helps that you’ve had prior linguistic experience (which probably helped with med school, too). One of the chief problems in medical care today seems to be communication between doctor and patient.This stems from both time constraints and linguistic dissonance, as you illustrated so well. I’m a retired medical school faculty member (basic sciences), and I’m currently working on a book intended to help patients understand the function of the body and improve communication with physicians. I’d be happy for any input.(twitter @javsimson)

    • Allie Goldberg

      Thank you! And yes! I think time constraints are an important factor, too, alongside of the disconnect. Your book sounds like a great idea — and maybe it will also help physicians learn better ways to explain things to their patients. :)