Understanding a doctor can be a challenge.
There are very few simple questions that are hard to answer, because “what do doctors say?
These words are natural and almost automatic. Whenever relatives go back to the doctor’s office, they almost automatically pop out of our lips. Whether we know it or not, the answer is likely to lead us to our own mortality.
But why is the answer so hard?
The usual suspects – patient education, cultural differences, health literacy – ignore an important fact: medicine is a foreign language. Because of the “big word”, it is not foreign – its polysyllabic alcana can always be translated into simpler terms. Instead, doctors’ reflexive use of hedging, blurring and other linguistic means hides the simple meaning of their words.
Let’s use a simple exercise to illustrate this point, using primary school help to remember that “every good child is worth playing”.
Teachers use this tool to help students learn about music’s letters: EGBDF. Language hedging may turn the restrictive “every” word into a more inclusive word, such as “qualified”. Similarly, the loaded word “good” may become a “grateful” judgment. By continuing this trend, we might get something like “qualified boys for fun”. While preserving the practicality of the EGBDF, we have completely lost the gist of its meaning.
By repeating the practice in an ambiguous way, we can limit the phrase “every good boy” to “every good child, or the child will not be disqualified”. Through the process of the extension to the predictable absurd conclusion, we may get a “qualified grateful boy, will not be disqualified, whether through direct or indirect means, the concept of equivalent may be considered to be similar to the interesting”.
The scary part is that the structure might be similar to the language used by doctors. In a commentary published in JAMA, we cite a quote from the clinical practice guide that provides a good example:
“About the possibility of reducing… Drug decisions should be accompanied by discussions with the patient (if clinically feasible) and the patient’s acting decision maker (if relevant) with the opinion of the patient’s family or others. ”
In this statement, the ambiguous level is varied and abnormal. 1: the guide does not recommend action, but suggests a decision. 2: this decision did not solve the problem of the gradual reduction of the drug, which solved the possible problems. 3: it suggests making decisions while discussing with the patient (as if there is a moral choice). 4: it points out that discussion can only be conducted if it is clinically feasible (as with other options). 5: it suggests that the patient’s acting decision maker is the party to the decision (ibid.). 6: it points out that decision makers should be involved only when they are relevant, as if people will do something intentionally or unintentionally. And 7:
How do you describe such language? Byzantine? Rococo? Boring? Although each may be a fair description, these recommendations represent the best efforts of doctors. They come from clinical practice guidelines developed by experts. These experts, through a tedious process, have been refining the language for months, under the auspices of a professional society, until they believe it is worth publishing.
So how can these recommendations be communicated to patients? Science, we don’t know. The research is small and small. Perhaps most important, they were influenced by the medical version of the hawthorne effect: when doctors knew they were being observed, they behaved differently. In the wild, their communication skills may be worse than those in clinical studies. Based on experience, we know that effective communication is difficult when doctors and patients meet. Problems raised by doctors may lead to poor communication.
The patient’s fault?
But don’t know what the doctor said, can you let the patient down? When he or she answers the question of a loved one, the patient is at least honest and says, “I don’t know”, this can be a solid step towards recovery.
When patients do not understand their medical problems, they may seek a second opinion, which may not be clear. Instead, it may introduce a conflicting proposal, leading to more confusion, frustration and so-called “analysis paralysis”. Patients may feel compelled to choose to do nothing, and take the least threatening option, equivalent to a leap of faith. Neither option is good.
A good option would be a technique known as feedback, in which physicians ask patients to describe evaluation and treatment plans. The doctor corrects misunderstood or missing elements, and the patient repeats the process until the doctor is in sync with the patient. The process is simple and proven to be effective.
Getting a doctor to participate in a repetitive process, such as returning to education, can be difficult, especially since it usually happens at the end of a fast, 15-minute date. Patients may also have difficulty admitting they don’t understand.
But “I don’t understand” may be a remedy for “I don’t know”.
•Klasco is an assistant professor of emergency medicine at the university of Colorado school of medicine. Glinert is a professor of linguistics at Dartmouth college.