The Language of Medicine: Getting to the Heart of Physician-Patient Communication
July 6, 2010 4 Comments
An article in the Wall Street Journal, Taking Medical Jargon Out of Doctor Visits, emphasizes that the use of medical jargon leads to poor communication between physicians and patients, and consequently leads to ineffective medical care. Federal and state officials are now pushing healthcare professionals to use simpler language to communicate medical advice to patients.
I could not agree more with this mission. The gap in understanding between physicians and patients is only widening in an era of increasing medical knowledge, advanced medical technology and imaging studies, and the increase of laparoscopic, robotic, and endovascular surgeries. It is becoming difficult for physician themselves to keep up with the jargon, let alone translate it appropriately to their patients.
I cited poor physician-patient communication as one of the primary reasons for medication noncompliance in an earlier post, The Story Behind Medication Noncompliance. Recently, I cared for a patient in the intensive care unit with severe pulmonary hypertension who did not understand (1) why she was having so much trouble breathing and (2) what exactly we were doing to try to help her. The words “pulmonary hypertension” meant nothing to her. Physicians walked into the room every day to discuss the risks and benefits of floating a Swan-Ganz catheter (a device used to measure pressures in the right atrium, right ventricle, and pulmonary artery). They discussed the possibility of starting new medications, including sildenafil (Viagra) and esoprostenol. They sent her all over the hospital for a variety of procedures and tests – multiple cardiac catheterizations, cardiac echos, chest x-rays…you name it. She talked to all kinds of physicians, from her primary care doctor to her cardiologist to a pulmonary critical care specialist. She did not understand what was going on until I explained it to her in basic terms: the heart works like a pump, and when it pumps against the high pressures in her vessels (caused by the pulmonary hypertension), it has a difficult time pushing blood to the lungs to give it the oxygen it needs – making her short of breath, and it eventually begins to tire out after such hard pumping – leading to heart failure. Prior to our interaction, no one had successfully explained to her this process before in language that she could understand.
To be a good physician, you need to be a good teacher. There is an art to breaking down all the complexities of medical science into something that a third-grader can understand. There is also an art to modifying your explanation depending on the patient. A plumber has a very good understanding of pumps and water pressure – this can serve as a good analogy for the heart. Athletes might understand better if you describe the heart as a muscle that contracts to perform a certain amount of work over time. Electricians might understand cardiac arrhythmias and conduction abnormalities if you explain to the them that a small electrical current makes the heart pump, and if that current is disrupted, the “circuit” breaks and the heart does not pump appropriately. Artists sometimes understand better if you draw a picture and talk them through the circulatory system, image by image. As for a heart attack – everyone knows the phrase but few people understand what it actually means: that the heart has its own blood supply through three main pipes (or vessels), and when one of these pipes gets blocked off, the heart does not get enough oxygen, and heart tissue begins to die.
There are all kinds of ways to explain medical illnesses to patients and their families – and our job, as physicians, is to start at a very basic level and build up depending on patients’ own level of interest, curiosity, and education. For patients who do not ask the right questions (why they might need a procedure or what the risks of a procedure are), it is imperative that we answer these questions for them anyway.
Using analogies, images, and simple language does not come easily to all physicians – but one of our roles in this profession is to serve as a translator for our patients and to minimize medical jargon so that we can be on the same page with our patients and help them make informed decisions. Developing concrete tactics and communication skills for physicians in their fields of specialty may help to facilitate this important change.