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Jargon alert: How doctors speak could cause 'harm' for patients

"You could be the smartest doctor in the world, yet you're useless if your patients don't understand what you are saying," a University of Minnesota researcher said.

The words some doctors use are often misunderstood by patients and their families, leaving them feeling confused and vulnerable, according to researchers.

In a study published Wednesday in the journal JAMA Network Open, University of Minnesota researchers found that the language doctors often use tends not to translate easily into everyday English.

A positive test result, for example, generally suggests something negative: A disease like Covid, for example, has been detected.

The disconnect in terms has long bothered Dr. Michael Pitt, associate residency program director in the department of pediatrics at the University of Minnesota. He teaches medical students how to communicate effectively with their patients and their families.

"You could be the smartest doctor in the world, yet you're useless if your patients don't understand what you are saying," Pitt said. "It's always driven me nuts."

Pitt and his research team tested how well people understood medical jargon by going to one of the largest gatherings in Middle America: the 2021 Minnesota State Fair.

They surveyed 215 fairgoers on their knowledge of potentially confusing health terms. None of the participants had medical training, but all spoke and read English.

While nearly all, 96%, of the respondents understood that a negative result on a cancer screening was actually a good thing, the medical meaning of other common words and phrases was often misinterpreted.

An 'impressive' chest X-ray

Take the word "impressive." To most of us, getting straight-A's in school, making a half-court shot in basketball or running a marathon are all "impressive" accomplishments.

But when doctors say a patient's chest X-ray is "impressive," they really mean, "This worries me."

That translation was lost on 79% of survey respondents.

The word "impressive" is a particular pet peeve for Dr. Giridhar Mallya, a former family physician and current senior policy director for the Robert Wood Johnson Foundation.

"It borders on disrespectful because we're describing something as impressive that is causing real harm for patients," Mallya said.

What's more, 21% of survey respondents did not understand that the phrase, "Your tumor is progressing," meant that cancer was getting worse.

"If our patients don't understand what we think is going on, what our treatment plan is, what we're asking them to do to get cured, better, healthy," Pitt said, "we actually could be causing physical harm."

"They might be less inclined to actually follow up on the actual steps necessary, which could delay care," he said.

"It is so clearly obvious why people can misunderstand" such language when "our typical terminology is the direct opposite meaning of the medical terminology," said Dr. Holly Andersen, director of education and outreach at the Ronald O. Perelman Heart Institute at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City. Neither Andersen nor Mallya were involved in the new research.

"We as a profession have jargon oblivion," Pitt said. "We forget that there was a time when we learned these words, and didn't know them."

Is it a hidden infection or witchcraft?

Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, Tennessee, is frequently called upon in the media for his ability to help translate complicated science in terms that anyone can understand. He said the new research is "very important."

"It's a message to medical professionals that they need to speak very clearly with their patients, rather than to them," Schaffner said.

By far, the most misunderstood medical term in the study was the word "occult," a word that conjures up an idea of witchcraft in most people.

"People thought it meant demonic or that we thought you were possessed," Pitt said. In medicine, "occult" simply means that a problem was hidden, or not immediately apparent to health care providers.

'We're gonna put you to sleep'

Pitt, a pediatrician, takes the lessons in effective communication to heart when treating children.

"A phrase that could be heard very differently by a kid would be 'we're gonna put you to sleep' before a procedure," Pitt said. "Think about ways that they may have heard that before. It probably means their dog was killed."

Patients should feel empowered to ask doctors, nurses and any other health care personnel to explain themselves clearly, even if it feels uncomfortable, Schaffner said.

"Don't hesitate," he said. "If somebody is using medical jargon, a phrase that you don't understand, feel free to say, 'Excuse me, I don't understand what you're trying to say. Could you be a little more clear about that?'"

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