Masseter Angina with Mastication? The Benefits of Jargon Reduction

If I were to ask a patient about masseter angina with mastication, I would not be surprised to get slapped in the face. Although that is an extreme example of "doc talk" simply asking about cheek muscle pain with chewing, too many of us physicians forget what it was like being a person before medical school. For example, before medical school, despite my bachelor's degree in physics and minors in chemistry and biology, I didn't really know what "perfusion" meant. I certainly didn’t know any acronyms that I routinely hear thrown around multiple times per day, like “IR,” “PO,” “MS,” “DNR,” (meaning in my mind “infra red,” “post office,” “masters of science,” and “department of natural resources,” respectively) and the list goes on.

I routinely hear senior medical students and those beyond in their training use medical jargon while talking to patients like "distal perfusion," "catheterization," or completely foreign concepts like "enzyme leak," and then get frustrated later when the patient voices concern that no one told them anything. The thing is, we can talk 'at' our patients all day with our big, fancy vocabulary, but that is not really telling them anything.

In the book 7 Habits of Highly Effective People, Dr. Covey's 5th habit is to seek first to understand, and then to be understood. Too often, we don't bother to understand what patients' do or do not understand, and rather just spew medical jargon, since it is our second nature. In that case, we may be being a well-educated physician, but not a well-meaning 'doctor.' 'Doctor' comes from Latin for "teacher." The Japanese have a similar concept--the word 'sensei' meaning "master," is used both for teachers and doctors.

In communicating with our patients, we often forget to assess their level of health literacy, even the well-educated and highly-literate ones. Health literacy is the ability to understand as well as do things that make one healthy. Many of us physicians forget how other people haven't been to medical school, and forget that only 12% of Americans are adequately literate when it comes to health. So 9 times out of 10, you would be correct in your assumption that the patient has no idea of what is really going on.

Why am I talking about this on Physician's Money Digest? It turns out that doctors that take time to communicate are less likely to get sued, regardless of the number of their mistakes. In his book, Blink, Malcolm Gladwell highlighted research showing that doctors that truly communicate are much less likely to get sued.

As one example, a way I have found diabetes mellitus explained that makes sense to everyone is to start with the explanation that sugar is sticky (everyone understands that). Too much sugar or even not-sugary food, converted by our amazing bodies into sugar, then causes poor blood flow (notice I don't use the word 'perfusion') because of stickiness inside our blood. Poor blood flow long enough to the eyes leads to blindness, heart attacks if flow is slow to the heart, kidney problems leading to dialysis, pain in the feet, or even amputations if the blood flow there is so bad. This explanation has given countless patients "a-ha!" epiphany moments, to where they understand better why they need to get their sugars better controlled.

So if you feel like your patients don't get it, look in the mirror and ask if you are to blame for not giving it--giving information they can understand. In the end, it could save you money, headaches, and oh-so-joyous interactions with lawyers. So keep calm, and eschew obfuscation.