I hate jargon. I especially hate medical jargon. It creates a barrier between patients and health care professionals. An article in JAMA Network Open (Nov. 30, 2022) is titled “Accuracy in Patient Understanding of Common Medical Phrases.” The authors make it clear that medical jargon causes unnecessary confusion that can have “serious consequences.” Doctors know this and yet they seemingly cannot refrain from using big medical words when talking to patients and families. It is long past time to put an end to this archaic practice.
50 Years of Resisting Medical Jargon!
This time 50 years ago I was getting ready to teach pharmacology to second year medical students at the Universidad Benito Juarez of Oaxaca, Mexico. (Terry Graedon was gathering data for her PhD thesis in medical anthropology.) I was also working on the first edition of a book that would eventually be called The Pe0ple’s Pharmacy.
Page 4 of the Introduction stated:
“This book is meant not to replace a trip to the doctor, but rather to explain in understandable English just what those pills your doctor prescribes really do. The medical profession has too long ignored people’s curiosity and concern about their illnesses and the drugs they are supposed to take. Unfortunately, people have too readily assumed that they were incapable of understanding ‘medical language.’ It is time medicine was demystified. One need not be familiar with the gigantic words doctors so commonly employ to describe the best treatment for pyrosis or dyspepsia (heartburn) or cephalalgia (headache).”
Here we are 50 years later and I fear we have made very little progress penetrating the wall of medical jargon.
Doctors Know Better!
Most physicians recognize that they should not be using jargon. They know it creates a barrier to understanding. But they do not always realize when phrases they are accustomed to using seem mysterious to patients. Patients are often reluctant to seem “ignorant” by asking what a word means.
The authors of the article published in JAMA Network Open (Nov. 30, 2022) state:
“The mismatch between our intent to avoid jargon and the reality of our frequent use of it has been called jargon oblivion. One potential reason for this disconnect is that, as health care professionals, we simply assume our patients understand the terminology we are using. No matter how intentional we are about minimizing jargon, we will not avoid using words and phrases that we fail to recognize as jargon in the first place.”
Confusing Medical Jargon:
To assess problem described above, researchers from the University of Minnesota questioned 215 attendees at the Minnesota State Fair about their understanding of selected phrases. A few of the statements were generally well understood. For example, almost all the participants realized that negative cancer screening results meant no cancer.
However, only about a fifth of them understood that an “impressive” X-ray was bad news. Fewer than 10% knew that febrile meant feverish.
When the researchers offered plain English phrases, these were understood much better than the usual medical jargon.
They conclude:
“These findings suggest that several common phrases are misunderstood when used in a medical setting, with the interpreted meaning frequently the exact opposite of what is intended.”
Taking Nothing For Granted:
I will never forget the example of the woman who observed her medical chart with the terminology “grossly symmetrical breasts.” She misinterpreted this to mean that there was something very wrong with her breasts.
Here is another example from the recent research of how the word gross can be misunderstood:
“The use of terms that mean something different in common usage than in a medical context—or medicalized English was a frequent cause of confusion in our study. More people believed that the phrase ‘had an occult infection’ had something to do with a curse than understood that this meant that they had a hidden infection. Fewer than half knew that their neuro examination being ‘grossly intact’ was a good thing, possibly because the word ‘gross’ more often means “unpleasant” than ‘in general’ in common usage.”
Let’s Ditch Latin in Medical Jargon!
Once upon a time anyone who wanted to be a doctor had to study Latin. It was the language of learning. It also created a mystique that patients could not penetrate.
It’s been decades since Latin was required for pre-meds. After all, it’s a dead language. So why do doctors cling to big words derived from Latin and Greek?
Secret societies have ways of excluding outsiders. Rituals, codes and passwords are ways to do this. Special uniforms also create these boundaries.
White Coats & Stethoscopes:
Physicians have been especially good at such tactics. The white coat and stethoscope immediately signal who’s in charge. And the special language doctors use when making a diagnosis or writing a prescription helps reinforce the message.
But big words don’t improve communication with colleagues or patients. Does it help to refer to a heart attack as a myocardial infarction or a stroke as a cerebrovascular accident?
Look up drug side effects in the Physicians’ Desk Reference and you will discover words like tinnitus (ringing in the ears), syncope (fainting), dyspnea (shortness of breath), epistaxis (nosebleed) and anosmia (loss of smell). Is there any reason to use these fancy words, even when speaking with other doctors? It’s not like epistaxis is any shorter or more descriptive than nosebleed.
Patients can become alarmed when confronted with medical jargon. The doctor who writes a prescription for one tablet every six hours for urticaria and pruritis may frighten a patient into thinking he has something serious when in truth it’s just itchy hives.
If it were just a question of doctors showing off, it probably wouldn’t be a problem. But when doctors use Latin codes in their prescriptions, not only does it create confusion for the patient, it can also lead to pharmacy errors.
Let’s Ditch Abbreviations Too:
Common expressions like ac (before meals), po (by mouth), hs (at bedtime), prn (as needed), and qid (four times a day) seem streamlined, but may provide inadequate information. Does “qid” mean you should get up in the middle of the night to take that fourth dose? For some antibiotics, that is essential. For other medicines, it isn’t necessary.
Though doctors sometimes claim that they don’t have time to write everything out, we disagree.
The most respected pharmacology text in the world says:
“Abbreviations should be avoided since their use frequently results in error…the directions to the patient should always be written in English. The use of Latin abbreviations serves no useful purpose.”
Despite this warning, many doctors find it hard to break this bad habit.
Final Words About Medical Jargon:
Health professionals must communicate clearly. Lives depend on it. Latin codes and big words create confusion instead of clarity and should be avoided.
The authors of the study in JAMA Network Open (Nov. 30, 2022) conclude:
“Medical jargon remains a common source of confusion for patients, and care should be taken to avoid using it with patients to prevent misunderstanding. Many commonly used jargon phrases are associated with poor understanding by the general public, and more people understood jargon-free versions of common medical phrases than expressions using jargon.”
What do you think? We would love your perspective on medical jargon. Whether you are a health professional or a patient, please tell us what you think in the comment section below.
