Duke Health Referring Physicians


Approaches for Avoiding Medspeak: Part 2

Editor’s Note: This is the second part in a series about ways to avoid medspeak in the clinical setting. Read part 1.

Using terms your patients are familiar with is vital to their health. If you use words like myocardial infarction, bacteria, and hypertension, will your patients understand you? That depends on your patients' level of health literacy, which isn't always tied to educational attainment.

Don't Assume a High Level of Health Literacy
Clinicians sometimes make assumptions that patients and their loved ones understand what they've been told. It can also be challenging for physicians to detect poor health literacy because even highly skilled professionals have low rates of health literacy. In fact, patients of all levels of income and education, races, and ethnic groups are affected by low rates of health literacy.

Center Your Language on the Patient
Somasundaram Subramaniam, MD, MS, a medical oncologist at the Swedish Cancer Institute in Seattle, WA, explains that slowing down to assess his patients' goals for treatment is especially important. Many times patients ask questions that have a deeper, underlying meaning.

Use verbal and nonverbal cues to check understanding, he says. "For example, if a patient nods along a lot, I know I need to slow down, check if he or she is understanding, and, perhaps, explain things a little differently."

To enhance the doctor-patient relationship, physicians should use patient-centered language that respects the perspectives and personal experiences of patients and explains their health situation in such a way that they can actively participate and share in the decision-making of their care plan. Use the same words that patients do, paying close attention to what types of words patients use to talk about their condition.

Keeping patients engaged in the conversation can also help. To avoid complex, technical jargon, try using images, interactive media, websites, or videos to bridge the information gap and help them draw their own conclusions. Drawing pictures or using 3-dimensional models can also help demonstrate important concepts.

Encourage Questions
Simply asking patients about what questions they have creates the expectation that they should have questions, says Kathryn Pollak, PhD, a professor in community and family medicine at Duke University who also serves as a communication coach for clinicians. "End the visit with, 'What questions do you have?' rather than, 'Do you have any questions?'” explains Pollak, because the former is open-ended and likely will elicit more from the patient.

Asking them open-ended questions can help physicians incorporate these into their discussions about their patients'  health. Doing so keeps patients involved in the conversation and helps them stay proactive about their health care.

Resources for Patient-Centered Communication

Agency for Healthcare Research and Quality: Health Literacy Universal Precautions Toolkit
Healthy People 2020: National Action Plan to Improve Health Literacy
The Joint Commission: What Did the Doctor Say? Improving Health Literacy to Protect Patient Safety
US Centers for Disease Control and Prevention: Everyday Words for Public Health Communication

Communication Methods
According to the Agency for Healthcare Research and Quality, up to 80% of patients forget what their physicians told them during their visits, and another 50% incorrectly remember what they were told.

"During the clinical encounter, patients are trying to remember everything the doctor said, so the more avenues in which we can convey and communicate information to patients, the better," says Pollak. Prioritize information and then confirm that patients understand the information you just explained.

Subramaniam encourages physicians to use the teach-back method to address the barriers created by medspeak. Ask them to "teach back" the information you just relayed to them, and then summarize the most important key points.

Another tool is the ask-tell-ask method, says Pollak. "Ask the patients what they know, tell them what you know, and then ask them what they understood." Physicians can do this in a way that doesn’t make patients feel like they're being tested. Pollak gives an example: "Say, 'I am not always clear when I communicate. Just so I know we are on the same page, do you mind telling me in your own words what you thought I said?'”

It Takes Practice
It takes time to put these recommendations into practice, but Pollak and Subramaniam both agree that they're key to fostering a collaborative relationship. And doing so—delivering health information in an empathic, engaging, and individually relevant way—can encourage understanding and empower patients to take part in their own health care, regardless of their level of health literacy.