Lost in translation: using plain language

Where jargon must have been invented.
[The Tower of Babel, via wikimedia]

One of the things I really care about as an SP is the use of accessible language. It's very easy for SPs to become accustomed to medical terms and concepts that a "real" patient would be uncertain of or that are different in the patient's daily context. I believe addressing health literacy makes a positive impact on the relationship between doctors and patients and provides better outcomes for patients.

My advice to learners is to use "living room language," or language targeted to a 3rd-grade reading level. How would they explain this to a 10-year-old? A patient will usually give clear cues if they feel they can handle more complex language.

At this point most students I work with know better than to use abbreviations or really ridiculous medical jargon. But there are still words students use as if they are common knowledge. Some patients might be able to understand them in context. But even if they do, every time a patient has to spend mental energy interpreting a doctor's question, that reinforces the power differential between them. The greater the power differential, the more difficult it is to establish trust and safety. More importantly, a patient may not actually understand what a doctor has asked -- but attempts a reasonable guess so s/he doesn't look stupid, and then the doctor mistakenly believes they share an understanding when they really don't.

So when a student uses a word I think a patient might have trouble immediately understanding, I have a few ways to respond while still staying in character depending on the school, the student, or the scenario:

•  a slight pause before I answer
• a questioning look
• an ambiguous answer based on the more common meaning of the word
• "What does that mean?" or "What do you mean?"
• "I don't know what that means."
• "You mean [restates question in a patient-centered way]...?"
• "Well, I don't know what that means, but [answers question as if student had asked it in a more accessible way]

Some schools don't want SPs to react when a student uses technical language for a variety of reasons: because they're being taught to use precise language like that, because it eats up precious time in a short encounter, etc. And because SPs are inconsistent in reacting to technical language, if you are the SP who looks confused when the student keeps insisting on using the word "palpation," students may think you are deliberately playing dumb.

But I feel like to best prepare students to communicate with their patients, students need to practice translating the language they are learning into a language patients understand. My job is to remember what it was like the first time I encountered an odd word and react in a similar way for all encounters afterwards. Allowing students to shortcut this skill in SP encounters sets them up badly when they encounter patients in clinics.