Talk like a real person!

At the medical school I attended, one of the first classes students take is Medical Terminology.  It was taught at the time (I can’t imagine she’s still there now) by a batty old woman from Eastern Europe who everybody adored.  It was easily my favorite class that semester.  For one, I am the very definition of a “verbal-linguistic intelligence” learner.  But more than that, the class was our invitation to understand the arcana of our chosen profession.  On the inside are the few who can use and parse the jargon with ease, and on the outside sits everyone else.  And we all were eager to be in.

Now, while I think the use of jargon is a way any profession can exclude laypeople and its use is a shibboleth to a certain degree, its utility far outweighs these negatives.  It is much more concise to say “mediastinal lymphadenopathy,” for example,” than “collection of enlarged lymph nodes located in the chest cavity between the lungs.”  As abstruse as the terminology is, it actually affords clarity to those who understand it.

But you know who almost certainly doesn’t understand it?  Patients.  Which is why we shouldn’t use it when we talk to them.

As I’ve mentioned, of late I’ve been sitting in on medical appointments with someone I know.  When I go to these appointments, I’m there to support the patient, and not in any professional capacity.  While I can’t switch totally from doctor to patient mode, I experience these visits more from her perspective than the medical provider’s.  It has been a good reminder to me of things I need to make sure I’m doing well in my own practice.

One thing I’ve found very annoying is how often her providers have resorted to jargon when they speak with her.  Since I happen to be there, afterward I review everything they said and make sure she understood all of it.  But I imagine most patients don’t have a physician to schlep along with them and provide ex post facto translation.  What is understandable to me may as well be Farsi to her, and serves only to muddy what should be made crystal clear.

I like to think I do better.  In fact, I often highlight the how off-putting some of the terms and diagnoses sound.  For example, there’s a common newborn rash called “erythema toxicum neonatorum,” which I’m pretty sure sounds like “your infant is going to die horribly any minute now” to new parents.  (“Toxicum” has a particularly calamitous ring to it.)  I generally make reference to how dire and horrible the diagnosis sounds as I reassure the parents that it is, in fact, entirely benign, and will go away on its own without anything being done.  Something about acknowledging how the words I use must sound to them as parents makes my subsequent reassurance more effective.

But I’m sure I’ve not done as well as I should have every single time.  As much as I would want none of my patients or their parents to leave my office confused or unclear, I’m sure it’s happened, probably more commonly and recently than I’d want to know.  It is part of my job to answer every question they have until they are satisfied with their comprehension.  (It’s your doctor’s job, too, by the way.)  However, some patients are too timid or wary of causing offense to press the point, and I’ve probably let some go before I’d really accomplished this goal.

It’s all very well to put “epistaxis” in the chart.  (That’s probably my favorite medical term, a completely superfluous, overblown way of saying “nosebleed.”)  Medical records are meant to contain medical terms.  But I’m grateful for these reminders that my patients deserve to be spoken to like normal human beings, and my language should be as close to theirs as possible.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. My family doctor, after some blood work on my son, left the following message (paraphrasing — its been a year or more, dealing with my son’s issues with lightheadedness, low blood pressure, and dizziness most mornings): “All the tests came back fine, he’s just probably a bit sensitive to his blood sugar levels first thing in the morning.”

    That part was fine. What followed was “Just have him avoid short-chain carbs in the mornings.”. Or it might have been “make sure he gets some”. Didn’t matter. I had no freaking idea what a ‘short-chain carb’ is.

    This was on a message. On his lab service. Designed for us to hear, over the phone.

    I’m still not entirely sure what he’s supposed to avoid in the mornings, or why. Matter sorted itself out — the only reason we had it checked was because a specialist he sees every three months noted his blood pressure was consistently low (he’d see her before school, first thing in the morning) and should probably be checked just in case.

  2. I’ve been very fortunate with my last two doctors. Both are the the type who explain things in real language to their patients, but recognize that I like, and usually can grok, the more technical explanation and medical terminology, so they’re happy to give it to me both ways.

  3. The precision of medical terminology is absolutely needed when two physicians talk with each other (sometimes, “she has this gross thingie on her tata” won’t suffice).

    But when talking to patients, they see the Latin as hostile and dismissive non-communication. Patients want to know timeframes, inconvenience, and prognoses. Once given that context, the Latin can seem reassuring (“See? He knows exactly what it is!”). But, until contextualized, it’s just Greek.

    • Jargon in general is for exactly that. Two coders will speak in jargon. Two mechanics will. Two surgeons will.

      It’s the interface between experts/non-experts that requires special skill.

      I suspect doctor’s have more practice turning Jargon X into Laymen’s term Y than I do explaining, oh, the merits and drawbacks of using binary versus b-trees or why there are so many jokes about “shooting yourself in the foot” in programming.

      (And as I rediscovered just last week, it is true in C++ that it’s harder, but it takes off the whole leg).

      • oh, this ought to be good.
        What didja do?

        (personal favorite bug this week: [ instead of {. Oh, the compiler’s wailing!)

        • I blame the previous designer entirely. *grin*.

          Actually I spent a solid week and a half untangling a rat’s nest of poor inheritance and what was obviously some serious confusion on how objects and arrays are passed to functions, not to mention some godawful violations of object integrity.

          What started it was a simple command to clear what, in theory, should have been a copy of an array of objects. Which turned out to be, in fact, not a copy but a pointer to the real thing. Which contained a few others important aspects, and really that command just caused the entire ediface to come crumbling down.

          I restored sanity. 🙂

          Important lesson kids: Always overload the copy constructor.

  4. Avoiding legal jargon in client interactions is something I work hard at and take pride in as part of my practice. I find that clients don’t know the meaning of, and therefore don’t care about, things like “jurisdiction” and “service of process” even though to me these are very simple, intuitive sorts of things to understand.

    So instead I say things like “We have to give the other guy the lawsuit before the court has any power over him,” they get that.

    The best expert witnesses I hire also know how to reduce their own professional jargon into layman-friendly phrases. An accountant should be able to tell a jury, “The company is losing money because the overhead’s too high,” and an engineer should be able to say, “That post wasn’t strong enough to hold up the roof,” and so on. Just like a doctor should say “Babies get spots sometimes. They go away. No big deal.”

  5. My favorite doctors are always those who explain things in layman’s terms. Not because I necessarily have a need or desire to understand the in’s and out’s of what’s going on, but because that is usually a symptom of a more thoughtful, caring, patient-forward approach. Personally, I don’t mind all the expert jargon if, at they end, they say, “You’re fine,” or “You need to do X,” or even “If it was nice knowing ya!” But I’m probably weird like that.

    In education circles, expert jargon gets throw around a lot. Some of it is done to legitimize the profession, as there is a tendency to not see teachers as experts (in part because many teachers are, in fact, not experts… or not expert enough). But some of it is done to cloud the waters, to put on an air of authority and then falsely appeal to it and/or to disarm the person across from them, often a parent. The former is far more legitimate than the latter and I will totally cop to doing both. With regards to the latter, I think there exists a market for folks to help them cut through the teacher-ese, both real and faux. If I was a parent who was largely uninformed on best practices and special education law, I could never imagine sitting down in a SpEd committee meeting and dealing with the onslaught.

  6. Russell, my dad is an MD (a pediatrician). When I was a kid, and had to go to a specialist (usually an ortho, ’cause I broke a lot of bones), my dad would take me, and even when I was a teenager and old enough to know what the doctor was saying, they’d speak to my Dad in doctorese, and I’d have no clue what they were saying. I found this incredibly frustrating, particularly when, at 15, I fractured a growth plate in my hip, and since a.) I didn’t know I even had growth plates, b.) I didn’t know what the hell they were, and c.) I didn’t know you could fracture one!, the subsequent discussion, in which the only words I really understood were “growth” and “fracture” (and being a basketball player, I was really worried about my future height), really freaked me out, even though if I’d understood what they were saying I’d have known it wasn’t a big deal. After a while, I started asking my Mom to take me to the doctor (she was a nurse, though, so sometimes…).

  7. Every profession has terms of art. Communication of any sort has a specific audience. Write to your audience if you can but some terms simply must be put in technical terms. Euphemisms are especially awful: unless you’re talking to a three year old, use the proper term, with an explanation. But even the three year old has fears and anxieties. Speak directly to the person with the problem, in terms of the problem as they understand it. Lay out what is known and what isn’t. People are always more afraid of what they don’t know than what they do, as Chris points out.

    Even a small child can be shown his own x-ray. “See that business right there? That’s your pelvis. That long bone there? That’s your femur, the big bone in your leg. And that’s the acetabulum. It’s a socket where your femur meets your pelvis. And that, over there, is where you got hurt. Sorta sprung out of there, You’re growing, you see. All these bones are getting larger and heeeere’s where it’s growing, along the edges. This is called an apophysis or a growth plate. Tendons connect muscles to bones. If you were a lot older, you would have injured your tendon and not the growth plate, because it’s still soft. It just needs to heal up, a few weeks on crutches, then some physical therapy, which I’ll tell you right now is not going to be a lot of fun, but dollars to donuts you’ll be fine and playing basketball again.”

    Burt’s on the right track here, so is Morat. I just got finished interviewing six people. I chose two of them based on their ability to clearly explain what they’d done. If you can’t explain it, you probably didn’t do it right, either.

    Use cases come in two flavours: one for the executives, who always think in terms of process, exceptions and summaries, the other for the technical crowd and the ordinary users, who think in terms of roles, rules and detail. But the Happy Path must be in plain English.

  8. How do you know the physicians are not using jargon because you are there; as in by observing you are altering the environment. Maybe there would be less jargon if you were merely a lay friend who provided transport.

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