Language – a double edged sword

Doctors are like a number of other professions in that they have a specialized language which helps them to communicate all sorts of complex information to each other, and helps them to be precise in what they are describing to one another.

The process of learning this language can be confusing.

Recently some medical students were asking what was meant by the term ‘pulmonary congestion’ and how this was different to ‘alveolar oedema’ or ‘pulmonary oedema’ or ‘interstitiial oedema’ or   I struggled to provide a decent explanation for each of the terms other than that they were basically all the same thing.

We then discussed how you might go on to explain such a process to a patient – out came a reliable phrase: ‘fluid on the lungs.’  The conversation continued, and we started to discuss how you might explain a pleural effusion to a patient…  And again – “fluid on the lungs”

So there, we go – doctors have managed to reduce two incredibly different and distinct processes which require entirely different treatment modalities, and hold very different implications to a single ‘simple’ phrase to communicate these things to patients.

The common term for describing technical language is ‘jargon’ – defined as language or terms which are  ‘not likely to be easily understood by persons outside the profession

If we look at how this affects doctors and patients – we can see from a few studies, and from experience that using jargon can reduce patient understanding in consultations – this review highlights some of the points about patient-doctor communication which would be sensible to keep in mind when talking to patients and this consensus statement offers a framework for key elements of communication in medical encounters.

There is less guidance for what phrases we should use to describe pathological processes to patients – and so a vocabulary has arisen which is in common usage but seems to be oversimplified and hence confusing to patients and students alike.

So what is the solution?  Well jargon – as well as being a tool of exclusion to keep students on their toes, can also be useful.  It is sometimes helpful to be able to discuss elements of a case with colleagues using a ‘code’ instead of graphic detail – and this is done all the time in front of patients, and in corridors.  Jargon, therefore can be useful – if it is justified is more contentious.

However, when explaining things to patients, I really think that we don’t have to oversimplify things – using diagrams, simple language and examples from other areas of everyday experience it is possible to communicate quite complex processes to patients.  If we do not take the time, and instead use phrases which are so simple as to be opaque, we are at risk of misleading patients, causing confusion and therefore reducing their chances of understanding their disease.

Higher rates of health literacy and effective education have been associated with better outcomes in some areas but in others, may have contributed to non-adherence following discharge from hospital (possibly a good thing – health outcomes weren’t measures in this study- but prescription inaccuracy was quite high!)

Ultimately, jargon is here to stay.  For those interested in the NHS, and respiratory medicine in general there is a fantastic glossary published and kept up to date by IMPRESS.

Without being aware of how we are using language at work – either through excessive complexity, or inaccurate simplification – we are at risk of excluding patients, colleagues and students from the conversation, at the very points where they should be integral to it.

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One thought on “Language – a double edged sword

  1. Great post again. I spend a long time trying to be precise but simple with explanations to patients (& their relatives) and explaining that pleural fluid is between the lung & the chest wall isn’t difficult to do. If you don’t explain things simply, what hope is there for informed consent? Consequently, my consent forms say”coughing up blood” not haemoptysis “collapsed lung” not just pneumothorax & “low oxygen levels/ difficulty breathing”.

    However, there are times where precision demands the use of complex language- and for me this conflict is highlighted when writing letters copied to patients & trying to make them understandable to the patient, but also convey critically important detail. For example, I will tell a patient that the glands in the centre of their chest around their airways are enlarged, but I also need to describe that they have enlarged pretracheal & right paratracheal glands so that when they come for EBUS, I know where I wanted to sample.

    I almost think we need a “patient version” of the letter in simpler language, but I generally end up describing what I told the patient using the same language used in the consultation & then listing the precise medical terminology in the diagnoses list.

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