By Laura Freeman
When your patient gets results saying her mammogram was negative, does she worry about having cancer? When her husband gets news that his chest x-ray was positive, does he take it as good news suggesting he can keep smoking for a while?
Healthcare, like most professions, has a language of its own, and the differences between its vocabulary and that of everyday conversation can make it difficult for patients to understand their diagnosis and follow instructions.
“One popular movie line that is probably the best advice for helping patients understand is ‘Tell it to me like I’m a fifth grader.’ That’s the level most Americans understand. Then get them to tell back to you what they are hearing, and ask them if they have any questions,” Joy P. Deupree, PhD, MSN, RN, said. Founder and Chair of the Alabama Health Literacy Initiative which is working to advance health literacy policy and advocacy, Deupree is Director of UAB’s Health Policy Partnerships in the Office of Clinical and Global Partnerships, as well as a professor in the Department of Acute, Chronic and Continuing Care.
October is Health Literacy Month, an effort to improve healthcare policy and advocacy. A highlight of the month was a webinar on Monday, October 2, on Health Literacy in Government. It was recorded for later viewing online. When available, a link will be posted on the Integrated Healthcare Association website.
“The vocabulary of healthcare may be the primary issue, but there are plenty of other considerations that can get between you and a clear understanding of the meaning you are trying to communicate,” Deupree said. “English is a second language for more patients these days, and important nuances can be lost in the translation. Likewise, declining vision, hearing and cognition may cause communication difficulties. Poor reading skills, dyslexia, other learning disabilities, limited education, and low cognitive function can interfere with understanding and make following instructions on medicine bottles difficult.”
Verbal instructions may not be much clearer when distraction from unfamiliar words, awe of doctors, feelings of inferiority or embarrassment from examination gowns, touches and conversation about intimate body functions are involved.
There are some patients who want to please their doctors and not disappoint them, so getting an accurate report on how they are doing on their new medicine might be difficult. How often do you greet patients by asking them how they’re doing and their response is fine. Just as they are about to leave, you finally hear that they are having “a few dizzy spells” from their new blood pressure medicine.
When it’s necessary to explain something in medical terms, follow it with the plain language definition, such as: “I can see right here that you have a concussion and a bruise they call a hematoma. We need to keep an eye on it while it’s healing up. You have to take it easy. Rest and no hard work. You have to rest your brain, too. No hard studying for tests or anything until I say so? Deal? Okay. If you treat your head right and call me if you have any trouble, you should be healed up in a month or two.”
When the discussion is going to be serious, it may be good to ask patients to bring a second pair of ears to listen and take notes. A tape recorder or pad and pencil can be useful if you are comfortable with it. If you have written materials or an online video you can recommend, it could be helpful.
Remember, even a healthcare provider may not recognize every term a healthcare provider in another field says. Things are changing too fast for anyone to keep up with everything. If you go to a provider and need to ask a question, ask it. Good communication leads to good outcomes.
