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Tuesday Nov 10, 2015

Cut the Jargon and Let Patients Hear What You're Saying

The X-ray report made sense to me. It was a hairline fracture. I hurried to tell the patient in emergency department room No. 3 the news.

"Are you sure?" he asked. "I didn't even injure my head."

I sheepishly clarified what a hairline fracture was and silently scolded myself for falling into the trap of using medical jargon.

For a seemingly straightforward profession, the language of medicine is deceivingly vibrant. We are taught an endless barrage of culinary medical metaphors in our early education: the currant jelly stool of intussusception, the port wine stain of a capillary malformation, the cottage cheese discharge of vaginal candidiasis, the strawberry tongue of Kawasaki disease.

Medical school is a paradox of changing the language we speak while at the same time struggling to enhance our cognizance of broader populations. Unfortunately, communication skills actually decline(www.ncbi.nlm.nih.gov) as students progress through their education. As a result, entire lectures in medical school are devoted to communication: working within interdisciplinary teams, breaking bad news, avoiding medical errors. But gaps in communication permeate every corner of our profession.

The way we communicate often makes little sense to patients. Negative test results are actually a good thing. A patient being transferred from the ICU to the "floor" may not even change floors when switching units. By now, car insurance companies probably understand what a "restrained driver in an MVA" refers to, but patients likely do not. It's all jargon sprinkled with cultural slang.

One of the most deeply ingrained metaphors in medicine is the "war" with this or that disease. When doctors diagnose and discuss treatment for cancer, it is framed as a battle. Many patients with cancer embrace this metaphor -- they describe themselves as fighters and survivors. But on their death, I cringe when others describe it as a battle lost. My patient with cancer who died shouldn't be reduced to a cliché because society is uncomfortable with direct terms.

It's not necessarily that all metaphors negatively affect our dealings with patients. In fact, one study found physicians who use metaphors had better patient ratings(www.ncbi.nlm.nih.gov) regarding communication. However, our imprudent use of language has the potential to influence patient decisions. This is especially obvious when it comes to end-of-life conversations.

When a physician asks if a patient wants "everything done" or "heroic efforts," it's difficult to say no. After all, don't all patients deserve heroes? Even the term "DNR" elicits inaccurate thoughts of isolation, of a journey where physicians exit and the patient drives alone -- although that is simply not true.

Rather, it is better to frame end-of-life discussions in terms of patients' values. Ask them if they would prefer to allow natural death. Explain that "life support" is actually organ support. Most importantly, listen. The role of clear communication is most critical during challenging times when even the most basic uses of our ingrained vernacular can lead to confusion.

Although physicians carry the responsibility of appropriately guiding patients, the extra effort we make in conveying a clear message will ultimately change the doctor-patient relationship into a partnership.

Natasha Bhuyan, M.D., is a board-certified family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan(twitter.com).

Posted at 01:08PM Nov 10, 2015 by Natasha Bhuyan, M.D.

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