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Language matters – part 2

Caffeine and contemplation

Dominique Thompson

Friday, 18 May 2018

AdobeStock_91502683_consultation.jpgWhen writing my previous blog, on the language used around suicide and self-harm, I started to ponder how language around physical illnesses can also be misunderstood, and what we as clinicians can do to minimise this.

The classic consulting room illustration we share with medical students demonstrates medical miscommunication in a harmless manner; ‘So… what brought you here today Mrs Smith?’ ‘The bus, doctor’, but health literacy misunderstandings can have serious and significant consequences of course.

We also traditionally tell medical students that once the word ‘cancer’ is mentioned in a consultation that the patient won’t take in much more information after this because of the shock, and to check understanding of the consultation so far, but what if the opposite happens. What if a cancer-related word is mentioned (‘malignant’, for example) and the patient does not realise that this is equivalent to the ‘C’ word? I have certainly had to manage a situation where someone with known malignant melanoma had not realised that this was ‘skin cancer’ and thus I inadvertently broke the bad news to them by calling it skin cancer. This underlined for me how important checking understanding with patients is, especially when discussing significant diagnoses.

Some diagnostic labels are challenging in terms of understanding because of their non-medical language use, such as Chronic Fatigue, or Chronic Kidney Disease, where chronic, to our clinical minds, implies ‘long-term duration’, but to many people signifies ‘really really serious’. Similarly, might the use of the word ‘accident’ in CVA (cerebrovascular accident) imply fault somehow on the patient’s behalf, in their interpretation of the medical term? Could they have done something to avoid the occurrence of the ‘accident’? Is the use of a descriptive term such as ‘irritable’, in relation to bowels or bladder, potentially judgmental, and what about the term ‘lazy eye’ in squint? Do such traditional words inadvertently cause patients and their families distress or anxiety? I don’t have the answers, but it has made me think about the language we use daily as clinicians.

Certainly, there have been well documented examples of the misunderstanding of ‘positive’ and ‘negative’ with regards to the results of pathology samples and biopsies. Former New York Mayor Rudolph Giuliani is documented as saying that when he was told he had a ‘positive prostate biopsy’ he interpreted that as meaning he was cancer-free, when in fact it was the opposite. Such misunderstandings are understandable, and it is crucial that when we interpret results for our patients that we elaborate on the ‘positive’ or ‘negative’ statement, with a lay interpretation of what they mean, if necessary.

Previous studies have shown that between 46-87% of people surveyed did not know what ‘unconscious’ meant, depending on the parameters measured (i.e. whether the patient would be able to talk/ have eyes open/ stand up etc), so even terms that have everyday common usage can be misinterpreted (relevant if phoning in a 999 call for example). Similar confusion has been identified for ‘fracture’ versus ‘break’ as many people considered them to be different.

Not surprisingly, I will conclude by encouraging colleagues in all specialties not to make assumptions about what patients hear when we talk to them, nor about what they have understood (is it or isn’t it cancer, for example), but to check understanding, break things down into lay terms where necessary, and use words that minimise potential judgment, distress or anxiety.

By getting people to repeat back to us what they have understood, whilst acknowledging that we have given a lot of information, we ensure correct and safe interpretation of the consultation, and minimise potential patient embarrassment that they may have misunderstood. ‘I know I’ve given you a lot to take in, it would help me if you could summarise back what we have said today/ tell me your understanding of our discussions. Thank you.’

This collaborative approach may help and protect us all.

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Dominique Thompson

Dominique has been a student health GP since 2000, developing innovative new services to treat eating disorders and personality disorder in primary care. She was the GP member of the NICE Eating Disorders Committee 2017. She was a Pulse ‘GP hero’, in 2014, and a ‘Rising Star’ in 2016. Dominique writes about young adult wellbeing and mental health, in both the medical and non-medical press. Her latest adventure is as an independent consultant in student health and wellbeing www.buzzconsulting.co.uk. She is fuelled by caffeinated drinks.
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