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.