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Sunday, March 1, 2015

Avoid the Jargon or Explain the Jargon?

The 10th most looked-up word on Merriam-Webster online in 2014 was a medical term as reported in a recent Texas Medical Association (TMA) post titled Avoid the Jargon.

There has been a concerted effort over the past 20 years to train doctors to communicate at the level of our patients. This was based on literacy data showing that the average American communicates at the 6th grade level. So, for two decades and counting we've been taught to avoid medical terms, such as "congestive heart failure" as well as to avoid complex non-medical words, such as "approximately".

So, we've used language like "your heart don't work right" and "your lungs are hurt from smoking".

What has happened in these 20 years of dumbing down our medical conversation is the internet, smartphone, medical TV shows, drug commercials on TV, sideboards on taxis and billboards on highways all containing medical information.

Now when a patient goes online and enters a Google search for "my heart don't work right", nonsense pops up and they are no more informed.

I recently saw an elderly farmer in my office and tested his lung function which indicated he had emphysema. The conversation went like this:

Doctor: The test you just did checks your lung function or how well your lungs work. It tests three thing about your lungs. One, how well you move air in and out of your lungs (I swing my arm up and down my chest vertically to provide a visual aid). Two, the size of your lungs--how big or small your lungs are (I move the palms of my hands in and out across the breadth of my chest as a visual aid.). And, three, how well you're able to get the oxygen you are breathing in from the room into your blood stream.  (As I counted, I held up my fingers to count off one, two, three. I point where on the test report I'm looking and talking about).

Doctor: In terms of the first component, how well you're getting air into and out of your lungs, I find that you have difficulty getting air out of your lungs which makes it difficult for you to breathe well.

Doctor: In terms of the second component, lung size, you have smaller than normal lung size. You should have a six liter lung capacity and you have a four liter size. Now you know what a two liter bottle of cola looks like?

Patient: Nods

Doctor: You have one of those on each side equaling four liters.  (I gesture with my hands the approximate size over my own chest as a visual aid).

Doctor: Regarding the third component, how well you are able to get oxygen into your blood stream, the test shows only half of the oxygen you breathe in from the room is able to get into your blood stream. This is because your lungs are damaged.  Lungs that were once there are no longer there due to damage from smoking.  Lost lung tissue does not regrow or regenerate.

Doctor: All together, the results show that you have emphysema which is damage to lung tissue from smoking cigarettes.  With emphysema your lung go from a normal sponge like quality with many, many tiny air sacs separated by thin membranes to more like Swiss cheese with punched out holes. Normal lungs, like a sponge, can inflate and deflate easily like a sponge you squeeze in your hands then when you let go and it immediately goes back to normal. Image trying to squeeze a block of Swiss cheese.

Doctor: The extent of the damage is rated on a 1 to 4 scale; stage 1 being mild and stage 4 being very severe. (I hold up 4 fingers on my hand as I explain). At stage 1, one may not experience much symptoms and go about your life. At stage 4, one is typically short of breath at rest and may be unable to leave the home due to severe symptoms. You are stage 3 (I hold up 3 fingers).

Doctor: What questions do you have so far?

Patient: I was wondering if I had that (emphysema). I saw commercials on TV and I was wondering if they were talking about what I have. 

Doctor: You will need to know the word emphysema and the stage going forward for the rest of your life.

Patient: And, I'm a stage 3?

Doctor: Yes

Doctor: Now, let's talk about what we can do to help you.

We then enter a discussion regarding disease management and expectations of future health.

I would argue that we shouldn't dumb down the medical terms but use them with an explanation, in common language, of what that term means.

Let's keep in mind the patient has to continue on, sometimes for a lifetime, with this "label" so let's educate them to know what it is so that they may make sense of the multi-media blitz out there regarding health conditions.

I would also set the expectation with patients that they know the key markers of their disease control or disease severity.  For example:
  • for a patient with diabetes: 
    • You will need to know your A1c.
  • for a patient with a blood clot on warfarin: 
    • You will need to know your INR
  • for a patient with congestive heart failure: 
    • You will need to know your EF
  • for a patient with high cholesterol: 
    • You will need to know your LDL 
  • for a cancer patient:
    • You will need to know if your cancer is curable--yes or no.
    • If no, you will need to know: i) cancer stage and ii) life expectancy.

Instead of dumbing down, let's educate, explain and empower.