AAOS Bulletin - December, 2005

Close the ‘Communication gaps’

Eliminate medical jargon to facilitate communication with your patients

By Kathleen Misovic

At the end of an office visit do your patients leave with a clear understanding of their medical problem and the treatments available to improve their condition? Or do they leave with a puzzled look on their faces, thinking, “What did he just say?”

“When patients leave their doctor’s office, their No. 1 complaint is that the doctor didn’t spend enough time with them,” said David L. Nelson, MD, a foot and ankle/hand and wrist specialist in San Francisco. “Their second complaint is that they didn’t understand anything their doctor said.”

If your patients are confused, part of the problem may be that you’re not speaking their language.

Why the communication gap?

Orthopaedic surgeons don’t purposely set out to confuse their patients. “I think we take medical terminology for granted because we’re used to talking back and forth with colleagues,” said Eric H. Gordon, MD, a specialist in sports medicine at the Southern California Orthopaedic Institute.

“We do tend to use way too much medical jargon; for doctors that’s shorthand,” added L. Randall Mohler, MD, who practices general orthopaedics in San Diego.

Trauma/oncology specialist, Walter M. Virkus, MD, uses an implant device to explain a procedure to a patient.

“We don’t do it intentionally. We get hurried and throw in things we’d never say to a friend or family member, because we know they’d never understand it.”

Some orthopaedists may overestimate their patients’ medical knowledge. “I think one of the biggest communication mistakes doctors make is they assume people know a lot more than they actually do,” said Jay F. Pomerance, MD, a hand surgeon who practices in the Chicago suburbs. “For instance, a doctor may think his patients are familiar with the human skeleton. But I think most people think of a skeleton as the thing hanging outside for Halloween.”

So why don’t confused patients speak up if they don’t understand what their doctor is telling them? It’s probably due to a combination of awe and fear some patients feel toward their physicians, plus some personal embarrassment.

“Many patients look up to their doctors because the doctors have had a lot of education, and patients tend to put them up on a pedestal,” said Laura M. Gehrig, MD, who specializes in general orthopaedics and trauma in Shreveport, La. “These patients are often afraid to take up too much of their doctors’ time, or afraid their doctors will get angry if they are asked to explain what they said. Some patients are also embarrassed that they don’t have the same education level as their doctors.”

Avoid jargon

Although certain orthopaedic terms may seem obvious to you, don’t assume your patients will understand even the most basic ones.

“Probably every orthopaedic surgeon has told patients they’ve fractured a bone, only to be told, ‘Oh no doctor, they told me in the emergency room that it’s broken,’” said Dr. Gordon.

Many orthopaedists have found easier terms to explain common orthopaedic problems. For instance, rather than telling patients they have a distal radius fracture, tell them they have a broken wrist, suggested Dr. Gehrig. Or, instead of telling the patient you’re going to perform a fusion, tell them you will weld two bones together, suggested Walter W. Virkus, MD, a specialist in trauma and oncology orthopaedics at Rush University Medical Center in Chicago.

Some orthopaedists also find it useful to explain what actually happened to the patient’s body in an injury. “When I talk to patients about ankle sprains, I explain that a sprain is when the ankle twists, rolls or turns beyond its normal rotation,” Dr. Gehrig said.

Dr. Pomerance tries to adapt his language to terms his patients hear daily during their work or play. “If I have a carpenter or a construction worker as a patient, I try to relate their joints to terms they would use, such as sockets and ball joints. If I’m talking to kids, I compare the way their joints work to an erector set.”

Speaking in analogies also helps. “If I’m putting a rod in a patient’s leg, I’ll tell the patient the bone is hollow, like the cardboard tube from a paper towel roll. So it’s possible to put a rod down the middle of the hollow part to line the bone up,” said Dr. Virkus.

Although you should simplify your language, you shouldn’t talk down to your patients. “I try to give my patients both a simple term and the medical term for body parts and procedures,” said Dr. Nelson. “They’ll see the medical terms on their reports, so using both helps them learn.”

“Depending on how educated my patients are, sometimes I can get more complex with my explanations,” added B. Stephens Richards III, MD. “It brings a smile to my face when a patient says, ‘well, I’ve been reading about this,’ and then fires a specific question at me.”

As a specialist in pediatric orthopaedics at the University of Texas, Dr. Richards has the added challenge of adapting his communication to the level of children and teenagers.

“When dealing with adolescent patients, I talk primarily to them, very clearly including the parents. I think the adolescent is old enough and is due that respect,” Dr. Richards said. “I don’t talk to the parents in front of the adolescent, about the adolescent.”

Dr. Richards believes that communicating directly with his younger patients helps the physician-patient interaction. “I think that adolescents accept the doctor more into their circle if they are addressed as the main person. The adolescents say, ‘this doctor is OK, he’s talking to me and he’s answering my questions. He’s on my team.’”

Stop talking

Some people learn better by looking at pictures and demonstrations, rather than just listening to a speech. As visual-aids, Dr. Pomerance keeps a supply of hand drawings in his office. “That way I can mark what happened to the patient and draw in what is going to happen during surgery,” he explained. “So if someone cut their tendon while slicing a bagel, I can draw in the tendon, show them how it functions, then draw in the sutures I will put in to repair the tendon.”

Several of the orthopaedists said they will sketch a patient’s injured bone on the exam table paper, or draw on a copy of their patient’s X-rays to show where they will insert screws, rods and other surgical hardware. Dr. Gordon said he uses models of body parts to demonstrate his patients’ injuries and their treatments.

After you discuss or demonstrate your patient’s situation, stop talking and start listening. “If you’re a good listener, your patient may tell you more than you think they know,” Dr. Pomerance said.

All of the orthopaedists said they ask their patients if they have any questions before the office visit ends. And Dr. Gehrig goes as far as to make her patients repeat back to her what she told them. “That’s a good way to find out if they were paying attention and if they understood you,” she said.

Look for special circumstances

Even if you are making efforts to speak in an understandable manner to your patients, there may be more going on to impede the communication than you realize. Dr. Gehrig related her experiences in trying to communicate with elderly patients, only to realize they had trouble hearing or seeing. She has also dealt with patients who didn’t understand English, or couldn’t read.

“I try to be diplomatic about it if I think patients can’t read,” Dr. Gehrig said. “I’ll ask if their eyesight is failing and ask if someone can read to them the take home materials I provide.”

Dr. Gehrig said if she believes patients are not treating their vision or hearing impairments, she will suggest they seek a medical specialist. If the condition is being treated, she simply exercises patience.

It’s frustrating to realize that no matter how well you may communicate, some patients will leave your office remembering only about 10 percent of what you said because they’re so overwhelmed with their diagnosis. “It’s hard to remember a lot when you’re in pain or on medication,” said Dr. Mohler. “I often advise my patients to bring a friend or family member along with them as an advocate who will help them remember.”

Dr. Mohler believes orthopaedic surgeons are already at a disadvantage in developing a relationship with their patients because they first meet their patients when a problem has already occurred, rather than on a preventive basis, as primary care physicians do. So when treating patients for a nonemergency condition, such as arthritis, Dr. Mohler encourages them to write down their questions at home and bring the list to their next office visit. “This helps them organize their thoughts and focus on points that are important to them,” he explained.

No matter what communication techniques you find work best for you and your patients, they all help you provide better care to your patients. “At the end of the day, what do you want? You want your patients to follow your directions,” Dr. Nelson said. “If you say it in Greek, they’re not going to follow your directions. If you say it in plain English, draw them a picture and give them reference to the Your Orthopaedic Connection Web site for more information, they’re going to do what you want them to do.”

Tips for communicating

Avoid medical jargon. Use words that people easily relate to and understand. For example, here are some medical terms and their substitutes:

Instead of

Use

fracture

break

ability

skill

ambulate

walk

contusion

bruise

diagnosis

problem or condition

elevate

raise

fundamental

basic

laceration

cut or tear

rehabilitate

restore

sutures

stitches

tear of ligament

sprain

therapy

treatment


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