Words are important: Improving doctor-patient communication

On the first day of medical school, one of my anatomy lab professors emphasized to us, “Words are important.” If we accidentally identified the “flexor carpi radialis” muscle as the “flexor carpi ulnaris” muscle on an anatomy practical exam we received no credit. Not even partial credit.

And heaven forbid we mix up the coracoid process, a part of the scapula, and the coronoid process, a part of the ulna. As we progressed in medical school, we learned new words to describe processes and symptoms that we thought that we already knew how to describe. In the world of medicine, a patient is never sweaty; he or she is diaphoretic. A patient does not faint or pass out; he or she syncopates.

There are benefits to this medical jargon. It enables more concise communication. For example, words like macule and papule spare us the burden of having to describe whether a skin lesion is flat or raised, how large it is, and what might be causing it. If I say that a patient has a papule, my colleague can immediately visualize a raised lesion less than 10 centimeters in diameter and can infer that the patient may have a wart or a mole.

However, the language of medicine also creates a barrier between the patient and doctor. If you have ever watched someone serve as an amateur translator between two people, you have seen how difficult it is to switch back and forth between two languages.  Physicians are in a similar situation, except there is no interpreter. Doctors need to take in what a patient is saying, interpret it using their medical training, then re-translate to non-medical language to communicate with the patient.

In medical school, I had a patient with cancer of her ovaries that had spread with resulting complications. If I was communicating with a medical professional, I would say that this patient had an ovarian malignancy metastatic to the right ureter resulting in intermittent episodes of hydroureteronephrosis complicated by pyelonephritis.  But very few of those words mean anything to someone not in medicine.

Ultimately, this patient had been admitted to the hospital three times to have a stent placed in her ureter to keep a blockage and infection from developing. On this fourth admission when I saw her, she was refusing the procedure because she had no idea what procedure she had been getting and why she needed it. No one had ever communicated it to her in a way she understood.

The first information any medical student is taught to get from a patient is the chief complaint, or the main reason the patient is seeking medical attention. But what does it mean to complain? Merriam-Webster defines complain as “expressing dissatisfaction or annoyance about a state of affairs.” Synonyms for the word complain include protest, whine, and gripe.

Are our patients protesting to us about their high blood sugars? Are they whining about their serious chest pain? And are they griping about the blood in their stool? In most instances, our patients are uncomfortable, anxious, and are sincerely asking for our help. To say that a patient is complaining of their medical problems only gives their vulnerability a negative connotation, and I have heard doctors comment on how much their patients complain. Perhaps chief concern would be a more appropriate phrase.

The way we use language impacts the way we perceive and interpret the world around us. Our ability to communicate medical information in layman’s terms determines the extent to which our patients understand their medical conditions. And the way we communicate information to each other impacts the way we view our patients.

The philosopher Ludwig Wittgenstein said, “The limits of language mean the limits of my world.” We need to broaden the language we use to stretch the limits of how we can serve our patients and how we can convey to each other that we care about our patients.

– By Holland Kaplan, M.D., internal medicine resident at Baylor College of Medicine