Finding a cure for jargon-itis
Medical Matters: "All professions are a conspiracy against the layman" - George Bernard Shaw
Each profession and business uses specialised terminology which is familiar to its practitioners but which can be immensely confusing to outsiders, almost as if it is a foreign language. When I bought my first computer, I was so bamboozled with bits, bytes, RAMs, ROMs, memory and capacity that I asked the salesman if he could explain it all in English. He was not amused. Some years ago, when renting a house, I was intrigued to read in the contract that I was not permitted to "levy execution on the premises". A solicitor pointed out that this was not an injunction against capital punishment but merely meant that I could not sell the house over the head of the owner.
Medicine too has its own vocabulary, largely based on Greek and Latin origins and influences, which can cause problems in communication. It is quite common in general practice, when interviewing a patient who has had a prolonged hospital admission and undergone extensive investigations, to hear that "they told me nothing" or "for all they told me, they could have been speaking double-Dutch". Further questioning will reveal that the doctors spent a lot of time at the foot of the bed whispering in code, throwing the odd bit of indigestible information at the patient, who is in a position of weakness, at a disadvantage, and often too cowed by the hospital experience to ask further questions.
It is often left up to the family doctor to decode the jargon and explain what went on in terms that can be understood. This is not always easy, especially when bad news must be delivered or when complex investigations must be clarified.
When doctors communicate professionally, they are quite comfortable using language with which most laypersons will not be familiar. For instance, retinal detachment is a condition whereby the retina, the innermost layer lining the eye, is loosened causing sudden interference with vision. Patients often describe this as a feeling of a curtain falling in front of the eye. In referring such a patient to an eye specialist, I might use the term "retinal detachment", but in explaining to a patient, depending on the level of education, I might say that the lining of the eye has started to peel like wallpaper and needs to be reattached. However, the eye specialist might not be too impressed with me if I sent him a patient suggesting in my referral letter that "the back of his eye has fallen off"!
In any consultation, the doctor must try to avoid dazzling patients with jargon and get the essential message across. This means that he or she must adapt him- or herself continually to communicate successfully with a variety of people of differing educational level, differing ability to digest information, and differing expectations of what medicine has to offer.
Even in discussing such basic functions as excretion, there is great potential for confusion as patients are often reticent about discussing such delicate topics, and euphemisms, slang and pet words, especially for children, are frequently used. In one surgery session recently, I had a wide-ranging chat with an erudite man about bowel motions, fibre, abdominal distension and the function of the colon. Ten minutes later, I had to talk to a patient with similar symptoms, but of much more limited vocabulary, using terms such as "guts" and "shit", as use of the more general terms was greeted with blank stares. Happily, the message must have got across, as I can report that both patients are now eating muesli for breakfast.
Most doctors are not born with this chameleon-like ability to employ different levels of verbal sophistication, often learning the hard way as their careers develop. This did not matter much in the me-doctor-you-patient paternalistic era of medicine now thankfully coming to a close, but in the modern medical era, when patient knowledge is much greater and the threat of litigation is ever-present, communication skills are becoming vital. The need for such skills is being increasingly recognised at undergraduate level and is now an important part of the curriculum.
Analogies can be useful. The heart functions as a pump to provide blood to the rest of the body. An ailing pump can be fixed, propped up, rewired, and even replaced. These terms can quite validly be applied to heart disease. The genito-urinary system is full of tubes carrying urine and other fluids. These tubes can get blocked by stones, sludge, growths and external pressure and can be unblocked by procedures very similar to those used in plumbing.
In mathematics exams, students can get the answer wrong but still get marks if the method of solving the problem is basically sound. Similarly, in medicine, misdiagnosis can occur but this does not necessarily imply negligence. For instance, abdominal pain can be an early symptom of both cystitis and appendicitis but the natural course of each condition is entirely different. Cystitis misdiagnosed as appendicitis merely leads to tedious time spent in casualty, whereas a missed or delayed diagnosis of appendicitis can have very serious consequences. A doctor accused of such a mistake is best advised to come clean, admit that the diagnosis was incorrect, but made in good faith with the evidence available at the time. Attempts at evasion, obfuscation and use of jargon can only get up the nose of the complainant and are more likely to lead to the possibility of litigation.
In an era where technology tends to overrun traditional diagnostic methods, Sir William Osler's assertion that if you listen to the patient he will tell you the diagnosis, has never been more true.
• Dr Muiris Houston is on leave