Cut out the jargon

Inappropriate medical jargon can adversely affect care and alienate patients

In spite of our best efforts to ensure appropriate care for patients, we often find ourselves distracted by a sometimes bewildering array of jargon heard during handovers and clinical presentations. Is there a reason we frequently refer to the culinary arts and acts of violence in our discussions of patient care?

Whatever the reason, it has become a trend. Give students a few months on the wards and they spout jargonese with the abandon of a veteran. This fluency stems from cultural immersion and modeling the vernacular used by their seniors. By listening to us and to more senior trainees, our students become immersed in the unofficial language of medicine.

Every profession has and is entitled to its jargon. It only becomes an issue in medicine if it either affects patient safety or strays into the arena of the broadly pejorative. The issue was thoughtfully dealt with in an article late last year by Luks and Goldberger in JAMA Internal Medicine.

According to the authors, doctors commonly conflate terms such as hypoxia and hypoxemia, acidosis and acidemia, and atrial fibrillation and atrial flutter. “This usage may inaccurately describe the patient’s clinical issues and risk overlooking distinctions that impact disease management. For example, respiratory acidosis may not require intervention when the pH is normal, but does warrant action in the setting of acidemia.

Atrial fibrillation and atrial flutter often warrant different management strategies in the acute and chronic setting,” they say.

Another challenging set of terms are neologisms – newly coined words or old words used in a new way. Medical neologisms, including syncopize, satting, and surgerize, can be confusing to those who have not heard them before and can lead to misinterpretation and error.

“Other jargon is problematic because of its ability to shape the medical team’s perspective in ways that ultimately affect care delivery. Referring to patients as COPDers or CHFers, or placing the term end-stage before the name of a disease, may result in anchoring bias or unintentionally conveying an unavoidable risk of clinical worsening, leading to less-aggressive treatment than warranted,” the authors note.

“For instance, patients with chronic obstructive pulmonary disease (COPD) develop respiratory failure for reasons other than COPD exacerbations, and those with heart failure may warrant aggressive fluid repletion when they present with sepsis. Patients with various types of so-called end-stage disease can live for many years with appropriate medical care.”

Another aspect of medical language is how our words sound to patients and their families. Many of our word choices run the risk of confusing them rather than clarifying the patient’s condition, their diagnosis, or treatment. It is possible that they may even be offended by what they hear.

Military sounding phrases identified by the authors include the use of “big gun antibiotics” instead of broad spectrum antibiotics, or the use of the term “pull the trigger” to signify an all or nothing approach to treatment. “Terms related to guns and violence should not be used with colleagues or patients” is their no-nonsense advice.

“The patient denies drug abuse” implies the person is actually a drug abuser, but refuses to admit it – a fairly hefty charge sheet in a medical setting, when you think about it. And “the patient endorses pain” – how many patients have you come across that are in favour of pain? Or, “the patient is a poor historian” – historians gather and interpret information; the patient is the source of information, but there could be many reasons why they cannot provide data.

“Transferring to the floor” is a phrase used when a patient is ready to move from ICU; however, a floor is first and foremost a hard surface on which we place furniture and not an appropriate place for a patient (even when there is a chronic shortage of beds).

So how do we build a culture of clear and accurate patient- and family-centred communication? According to Luks and Goldberger, the solution likely lies in a combination of modeling and feedback. Those of us at mature stages of our careers probably need to choose our words carefully and with purpose. Conscious efforts on our part can redefine the standard learners seek to achieve.

Feedback also has a role, the authors say. “Those who use inappropriate terms and phrases yet never receive feedback may not understand that their communication is problematic… feedback that is well timed, directed toward the most problematic language, and delivered in a safe space may chisel away at the problem.”

And wisely they suggest that such feedback might carry more weight if trainees saw it delivered among all levels of a medical community rather than only in a top-down manner toward those in training.