"Dr. Carter" (Lil Wayne)
Where's my coffee?
Good Morning Doctor Carter (hey sweetie)
Looks like it is going to be a long day (ah another one what we got?)
Your first patient (yeah)
Is suffering from a lack of concept (uh-Huh)
A lack of concept? Sometimes, interpreting the doctor's medical jargon can feel like trying to understand the lyrics of the popular rapper, Lil Wayne. A few months ago, my wife asked me to accompany her on a visit to the doctor to help interpret her test results. As my colleague rattled off a detailed explanation of "pH, calcium metabolism, oxalate ratios and the effect of citrate," I realized that even I didn't have a clue what he was talking about. Unfortunately, like most patients and families, I didn't want to show my ignorance, so I sat quietly and nodded my head in affirmation. As we walked to our cars, I was unable to explain the results to my wife -- I didn't have a clue. I was the "poster boy" for the fact that inadequate "health literacy" is not restricted to the poorly-educated.
Health Literacy is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." It sounds simple, but according to the Health Literacy Fact Sheet, 9 out of 10 individuals lack the health literacy skills to manage their health and prevent disease. It is not surprising that people with the worst health literacy skills have more health problems. They have:
• An increased use of services that treat as opposed to services that prevent disease
• More hospitalizations and rehospitalizations
• Excessive emergency room visits
• An increased sense of shame about their lack of health literacy skills
Jargon is pervasive in all professions, but it has its greatest impact when doctors try to communicate with patients -- people whose lives are at stake. Health care professionals have their own verbal shorthand that may be highly effective when they speak to each other but causes confusion when used with laymen.
The use of jargon begins in medical school. A medical student can quickly rattle off that, "Mrs. Jones had a syncopal episode last night without any evidence of arrhythmia. I don't think it was vagal but I ordered a 2D echo and holter. I still can't rule out a vertebrobasilar event." Everyone wearing a white coat understands this secret language, but the patient lying in the bed may feel terrified and confused. Over time the doctors and nurses do not even realize they are speaking in a language that no one else understands.
The average American reads and speaks at an 8th or 9th grade level, yet doctors with 20 years of education not only use jargon, but assume that their patients will understand their obscure communication. Health care professionals must become "medically bilingual," that is, learn to speak both medical jargon and plain language. I like to ask myself, "How would I explain this to my mother?"
Jargon Is Everywhere
Multiple studies have looked at the use of jargon by doctors and the failure of patients to understand them. One study of 249 emergency room patients reported that 79 percent did not know that the word hemorrhage was the same as bleeding and 78 percent did not know that a fracture was a broken bone. In case you think these were illiterate, underprivileged people, 45 percent of the people in the study were college educated. We cannot assume that the lawyer or English professor has any more understanding than someone with less education.
In another study that looked at cancer screening, patients had difficulty with "jargon" words like: mammogram, tissue, biopsy, prostate and rectal. I was surprised because these words seem like "everyday" common terms to me, and I have to wonder how many times I used jargon when I thought I was speaking "plain language."
I could list hundreds of examples, but try this list and see how you do:
• Erythematous = red
• Renal = kidney
• Neuropathy = disease of the nerves
• TIA = symptoms that warn of a stroke
• Nephrology Department = kidney doctor's clinic
• Health Information Management Systems = where you go to get your medical records
How to Better Understand Your Doctor
Physicians do a terrible job at assessing a patient's health literacy. We are educating a new generation of doctors and nurses to use plain language, but in the meantime there are some steps you can take so you don't fall into the same trap that I did. One simple program is the "Ask Me 3," program that provides you with three questions to ask your doctor.
• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?
Unfortunately, you may still get jargon-packed answers, so here are a few more tips to make sure you walk away with a clear understanding of your problems.
• If you do not understand what your doctor is saying, immediately stop them and ask them to use simpler language. Don't pretend that you understand when you do not.
• Be assertive, but friendly. Let them know if you still have questions.
• Tell the doctor what you think they said to be certain that you understood them. This is called a "teach back."
• If you feel you need more time, ask to schedule another visit in the near future.
• If the doctor is very busy, ask if there is a nurse or assistant who can answer your questions.
• Take a friend with for another set of ears and always take notes.
• Ask who you can call if you still have questions when you get home.
Last Note: The Final Quiz
While reviewing articles on the use of medical jargon, I came across an article on "Interprofessional jargon: How is it exclusionary? Cultural determinants of language use in health care practice." The abstract included this sentence. "A hermeneutic research approach was used with a convenience sample of international key informants representing 6 disciplines." I have no idea what it means, do you?
For more by Richard C. Senelick, M.D., click here.
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