The other day my wife and I were talking about a health article about health problems for newborns she was reading in the local paper.
“What’s hyperbilirubinemia?” she asked.
“That’s when a baby has too much bilirubin,” I replied.
“What about phototherapy?”
“Well, that’s sunlight or some other form of light which helps for this problem.”
She looked at me for a moment and said, “You people and your secret language! Is there any reason we couldn’t just say high bilirubin levels and light therapy?”
Being a licensed medical provider, I felt a little defensive, but after a few seconds, I couldn’t help but agree. And there’s no denying it: the language of medicine is often ridiculously arcane, and sometimes seems designed to make simple things seem, in fact, very mysterious.
More often than not our language confuses patients, and it undoubtedly often leads to suboptimal results and even harm. It also leads to the mystification of medicine, which serves only those of us who speak the secret language, and keeps those who don’t speak it, feel like outsiders.
I hear myself saying ridiculously complicated words and questions to patients every single day. When talking about the relationship between certain medications and Torsades, I hear myself saying “it is thought that those patients at the highest risk are patients who have a history of heart problems themselves.”
Some patients just look at me and smile, but really don’t understand what I’m saying. Why couldn’t I just say “if you’ve had heart problems before then it’s more likely you will have this problem?”
Our secret language doesn’t just affect patients who have difficulty reading, or those with low levels of education. In fact, evidence suggests that even patients with the highest levels of education leave our offices without a clear interpretation of what we just told them.
I know that when I go see my medical team, I leave each visit with at least one thing that I really don’t get.
“Did they say put two drops in every four hours, or was it four drops every two hours?”
And when I look at the bottle, it often hardly helps, with the murky language only prescription bottles speak. Even when I know that I don’t understand something during the visit, I’m hesitant to bring it up, not wanting to appear unable to speak the secret language.
As providers, things that seem as simple as saying “yes” or “no” are puzzling, and often mislead patients.
For example, in a job I had treating pain in post-op patients with chronic pain, I would often use the term “max” to mean “at the most.” My prescription might read like this:
Oxycodone 5 mg tabs. Take 1-2 tabs po q4h prn for post-op pain, max ten tabs per day, total #30
I’ve been prescribing like this for years, but recently a patient said that even though their pain was decreasing, they were continuing to take all of the medication, because they thought “max ten per day” meant they HAD to take ten per day in order to comply with my prescribing.
This was not an uneducated patient, nor was it patient who struggles to read or write. And it really hit me at that point, that even when we try to write and speak in ways that are intelligible to our patients, sometimes we are just not capable of seeing the challenges we are putting in front of them.
There are many excellent techniques to help reduce this dangerous problem, including the “teach-back” method, where we have the patient explain in their own words what it is that they think we are asking them to do. Even then, there is the risk that we won’t anticipate something in our directions that patients won’t understand, and that we’ll miss this in the teach-back.
One of the other challenges is that it’s hard to get medical providers to set aside fancy foot work when we talk to patients. We worked really hard, and spent way too much money earning our degrees and certificates. Our secret language is what shows the world how much we know. But, it also serves to show patients how little they know, and it builds a wall between us and them, and puts patients at risk.
So, maybe the next time I start to say “tell me with what frequency you urinate,” I’ll try instead to speak plain English, and see if I can’t help my patients figure out exactly it is I want them to do.
Jim Anderson, MPAS, PA-C, ATC, DFAAPA, is founder of Physician Assistants for Health Equity and is a clinician and manager at Evergreen Treatment Services in Seattle.