February 1999 Bulletin

Medical jargon clouds effective patient relations

Ask questions, give patient choice of treatment options

Are you using medical jargon instead of everyday language when communicating with your patients?

If so, maybe that's why your patients are not completely satisfied with their office visit-they have a hard time understanding you.

So says Barbara M. Korsch, MD, a pioneer in the study and teaching of doctor/patient relationships since the 1960s. She is a professor at the University of Southern California School of Medicine and a practicing pediatrician.

"Physicians tend to be too technical in language for their patients," explains Dr. Korsch, who also is co-author of the book, "The Intelligent Patient's Guide to the Doctor-Patient Relationships, Learning How to Talk so Your Doctor Will Listen."

"In lots of our studies there were hundreds of words patients didn't understand. Patients didn't want to ask their meaning, because they didn't want to seem stupid or feel they mistrusted the physician."

For example, in a study co-authored by Dr. Korsch and Vida Francis Negrete, entitled "Doctor-Patient Communication,"1 she says, "Terms such as nares, peristalsis and Coombs titre were Greek to the patients. A 'lumbar puncture' was interpreted as meaning an operation to drain the lungs. In more than half the cases we recorded, the physicians resorted to medical jargon. This did not necessarily leave the patient dissatisfied; some patients were impressed and even flattered by such language."

Stresses Dr. Korsch, "There's no question that unless the patient understands you, the clinical diagnosis or treatment will be poor. So, talk English-instead of medical."

What causes communication breakdowns?

"Not listening," responds Dr. Korsch "The most important thing is to listen and understand the patient's concerns. For example, their underlying concern [about their medical problem] may be something different than their chief complaint."

She suggests finding out what they expect from you: to cure them, do tests, do medicine or to make sure their medical condition is not something serious. "Once you know this information the patient/physician communication process becomes much easier," notes Dr. Korsch.

Another bit of advice from Dr. Korsch: Avoid the famous doorknob phenomenon. "Patients who are on their way out may have one more thing they want to discuss," she says. "But this can be avoided if you ask them if they have any questions and listen to their questions. Often the doorknob question is the most important one asked."

According to Dr. Korsch's studies, she found that only in one-third of visits did doctors ask the patients, "Do you have any questions?" She stresses the need to "ask questions," and above all, "listen, listen, listen."

"All good studies say, effective communication takes less time than ineffective communication,'" says Dr. Korsch. "Work smarter-not harder."

In discussing the treatment options, Dr. Korsch recommends getting the patient's input.

Giving patients choices for treatment is also important says Dr. Korsch.

Make the patient feel comfortable because the medical visit is "often intimidating to patients," says Dr. Korsch. "When the patient is scared, they don't listen or do so well." She suggests doing everything in your power to make the patient feel comfortable and to lower the level of anxiety.

According to the results of one of Dr. Korsch's studies that examined the patient/physician relationship and time spent with the patient, she found, "The amount of time you spend is not that crucial. It's what happens and not how much time it takes. If the physician gets down to the bottom tasks-it's [the visit] much quicker. If they listen to the patient when the patient says, 'But doctor, but doctor, you don't understand,' and communicate with the patient, the visit will be shorter," she says.

Dr. Korsch says you can save lots of time and potential problems by watching your patient's nonverbal expressions. "For example, if you say 'take this pill four times a day,' and if they look at you funny, you know something is wrong," she says. "Ask them, 'What is your concern?'" She also suggests physicians watch their own body language. "Nonverbal expressions go a long way," she says.

1 Scientific American, 1972, Vol. 227, pp. 66-74.


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