Words to watch: a list

Making a list. Checking it twice.
[Porträt des Erasmus von Rotterdam via wikimedia]

I  care a lot about the use of plain language in SP encounters. Here are some words I feel are taken for granted in a typical encounter.

This is a living list. Last updated July 28, 2017.

History:

• Quality: "Can you describe the quality of the pain?" I maintain patients have never encountered this use of the word "quality," instead equating it to the value of something. So I might say, "I don't know. Pretty high quality, I guess?" Better: "How would you describe the pain you're feeling?"
• Radiate: "Does the pain radiate?" Radiation is not a word I would have ever associated with pain before I became an SP. Does radiation mean radioactive? Does it mean it's warm like a radiator? Does it mean it radiates outward a certain distance? Better: "Where else do you feel the pain?"
• Chronic: "Do you have any chronic conditions I should be aware of?" As a patient, I have no idea what doctors consider to be a "chronic condition" that s/he should "be aware of." Following with examples is better, but I still think it's best to ask the question more clearly to begin with. Better: "What ongoing health problems do you have?" Minus a million points if I hazard a guess like "Does chicken pox count?" or "I twisted my knee in college" and the student waves a hand: "Oh, no, I meant something more serious like...". As a patient, you've just trained me to keep my mouth closed next time you ask something I'm not sure I understand.
• Immunizations: As a patient, when I hear "Are your immunizations up to date?" I think, "Um, I guess so? Is there something I was supposed to get other than what I got for school?" And then I say "yes" or "I think so?" Better: "What immunizations have you had?" is a more open-ended question. I might not know the answer because few patients have any idea what they were required to be immunized for. However, telling a doctor "Whatever I got for school, I guess" is better than a "yes" which really means "I don't know."
• Trauma: "Have you experienced any trauma lately?" For patients, "trauma" almost certainly means emotional trauma, not physical trauma. If left unspecified, as a patient I will feel very confused as to why this question has anything to do with the pain I came in with. Better:  "Have you had any accidents or injuries lately/to that area?"
• Discharge (noun): I think a doctor could use this word and as a patient I would probably know what it means, but it feels very clinical. As an SP I would never use it unless required in a case quote because I don't think most patients would use that word on their own. "I have some stuff coming out of my eyes/ears/nose/down there," I might say instead. If a student hears me say this and feels compelled to say, "So you're experiencing some discharge?" I might say, "Sure, I guess?" But that will add to our power differential because the student is unwilling to use the language that I am using.
• Complications: When a student asks "did you have any complications after surgery?" or mentions "complications of diabetes," as a patient I have no idea what they are talking about. If this is meant to be an open-ended question, then follow with specifics. If it's shorthand for a wide range of possible issues, then mention some of the most alarming or common ones so I don't shrug and say "I don't think so" with some uncertainty.
• Fatigue: please just ask if I've been tired.
• Bilateral: say "on both sides."
• Hypertension: please just ask if I have high blood pressure.
• Inflammation: please use words like red, swollen, irritated, etc.
• Palpitations: Has my heart been fluttering? Have I felt it skip a beat? Have I felt it beating out of my chest? Any of these things are more understandable to patients than the word "palpitations".
• Extremities: ask about my arms and legs or hands and feet.
• Ulcers, lesions: ask if I have sores.
• Cardiovascular: tell me about my heart and lungs instead.
• Siblings: ask if I have any brothers or sisters instead.

Physical exam:

• Auscultate: Just tell me you're listening, or listening with the stethoscope.
• Palpate: If a students tells me "I'm going to palpate now," as a patient I have no idea what s/he is about to do. If left unexplained, I will often react with mild surprise when the student palpates. Better: "I'm going to examine [body part] now."
• Percuss: If a students tells me "I'm going to percuss," as a patient I have no idea what s/he is about to do. If left unexplained, I will often react with moderate surprise when the student percusses me because percussion can be a startling sensation when you don't expect it. Also, while as a patient I can understand why you would want to palpate, percussion can seem like a pretty puzzling procedure to patients. Better: "I'm going to tap on [body part] so I can [reason]."
• Drape: to patients, drapes are things that hang on their windows. If a student hands me a paper drape and says, "Here's a drape" as if I'm supposed to know what to do with it, I pause and give a quizzical look. Better: "Please use this to cover your legs." If you have to call it something, you could call it a sheet. But please please please do not call a gown a drape. Please.
• Positive: If a student provokes pain in a physical exam and tells me "Well, that's a positive sign," as a patient I think "No, it's not!" It keeps me from feeling as if the doctor understands my pain and furthers the gap in our realities.

Treatment:

• Abortive: Women, especially, may have a hard time hearing this word as part of a treatment plan. Just say, "to stop X" or "to prevent X".
• Prophylactic: Similarly, describing a medicine or practice as something meant to prevent  a specific result is more understandable than the word "prophylactic."
• Discharge (verb): just say, "when you leave the hospital."
• Test names: As a patient, I smile and nod when tests are recommended like a CBC panel, MRI, CT scan, etc. because I am not often given an explanation of those tests, and yet I am often asked if I consent to those tests as part of the treatment plan. What is "imaging," anyway? What will the patient experience? Some patients may know, of course, in which case asking "What do you know about X test?" can be a nice open-ended way to make sure the patient truly understands the recommendation before launching into an explanation the patient may not need.
• Attending, Preceptor, etc. That level of granularity may be useful to other professionals, but is confusing for patients. "Your doctor," "my supervisor" or "my boss" are much more understandable labels.

Extra Credit!

• Language that learners think sounds neutral but actually sounds very scary to patients: lesion, masses, etc.

Setting the standard:

An adequate standard would include a list of potential jargon words for every case that required jargon as a checklist item.

A better standard would be a consistent list of words (like this one) applied as broadly as possible for that program's events. Even if the student is not being specifically evaluated for jargon, SPs could still give feedback about it. Additional words could be added based on particular cases if needed.