Observing on rounds one morning, I could see the patient’s mother’s brow furrow and her eyes narrow as the resident presented. “…Respiratory-wise, she’s tachypneic but sats are good, so wean the O2. FEN-GI-wise, we can try something PO, then decrease the D5….” After the presentation the attending physician, sensing the mother’s confusion, said gently, “That’s great. Now let’s just summarize the plan for mom so she can understand what to expect.”
One of the domains of quality health care is patient-centeredness. Including families on rounds and accounting for their preferences in decision-making are important steps toward that. But it is all for naught without effective communication. Patients and families differ in their health literacy, the degree to which individuals can have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. It depends on education, prior experience with medical care, culture, and a host of other factors. But health care providers often make it more difficult by the language they use.
Language is meant to convey information and achieve mutual understanding. In medicine and many technical fields, precision is critical, so words should be chosen to maximize it. While medical jargon, typically derived from Latin and Greek roots, is much maligned, a good deal of it is intended to increase precision. Sometimes the word “skin” suffices, but if it is important to differentiate the layer involved, we might use the terms “dermis” or “epidermis.” Blister is a lay term that describes a fluid-filled lesion on the skin but it gives no sense of size; the more jargon-y terms “vesicle” and “bulla” describe blisters that are small (<5 mm) or larger. So using those terms actually adds to meaning.
Too often, though, it simply confuses. “Tachypneic” means “breathing fast.” They are interchangeable. Using the term “tachypneic” doesn’t add to the precision or convey any extra information. Almost everyone understands “breathing fast”; few people who are not medical professionals, regardless of their educational attainment, know the word “tachypneic.” So if the words are interchangeable, why not use the simpler, more widely understood term when talking with families?
Some of many examples of non-value added medical terms include:
Sometimes a term doesn’t necessarily add precision, but it is more efficient. One of my favorite (albeit obscure) examples is “photoptarmosis”: sneezing due to bright light. A whole concept in one word! But in each of the above examples, the medical term is actually longer than the lay one. No greater clarity, and more effort.
Abbreviations sometimes fall into this category. We love our TLAs*. They can be handy when writing long hand. It is certainly easier to write or say “T&A” instead of “tonsillectomy and adenoidectomy” (or even “removal of the tonsils and adenoids). And in the correct context, one is unlikely to confuse “T&A” the medical procedure for other meanings of “T&A.” But abbreviations can be confusing. Is BMT “bilateral myringotomy tubes” or “bone marrow transplant”? Therefore, they should be used cautiously. The advantage when typing or dictating is probably not worth the confusion. And there may not even be any savings when speaking. “PO” is a term that means “by mouth.” Two letters vs. seven. But both are two syllables. So when talking to a parent, why not say “give something by mouth,” instead of “give something PO”? When you factor in the extra explanation required, it’s clearly not worth it.
It’s great we have interpreters for patients and families whose primary language is not English. We shouldn’t need them for everyone.