For my first blog, I am pondering on a conundrum - a problem I have frequently experienced in my 20 years as a health professional.
Why can we struggle to communicate meaningfully with our patients and their families?
We are 'people' people, we care, we know information that's important for patients to understand and yet how many times have you had a second conversation that reveals they understood very little, if anything, from the first?
Giving out or getting through?
Why can it be so hard to get through to our patients?
Before we are tempted to jump straight into reasons about the patient themselves (of which there may be many), it is always worth acknowledging the 2-way process occurring and consider our own communication style first - let's take a look at what we might be doing to contribute to the communication gap and possible reasons why.
Bigging-up ourselves (yes, that's a word)
When faced with real people, after a year or two in lectures, we suddenly find ourselves in the role of 'expert' and it is a hat we have put on to succeed. We are of course, still the same student who put extremely random combinations of food together for dinner the night before, as it was all you had in the fridge, but our patients aren't to know that, right?
So we put on the hat - we know it looks a bit ridiculous but we try it on for size - pulling out all our rehearsed phrases and cliched patter in the hope that the act is convincing.
A habit soon develops; a style of communicating with patients and families that is based on a desire to blag it - rather than a desire for the message to get through. Success of a consultation is measured by what information is given out - even if other colleagues are repeating the same information to the patient at every ward round.
The 'blagging-it' style is closely associated with the other firm favourite...
Becoming 'jargonistas'
And boy do we know a lot of jargon! Once practicing as a clinician, that go-to list gets longer by the day. A couple of years into the job we may feel the hat of expert fits us pretty well and we can prove it by using all manner of medical terms and abbreviations to show how much we know.
Of course, at times, it will be necessary to refer to medical terminology alongside simpler explanations but using jargon - without every-day translation - only serves as a barrier to communication.
This maybe be obvious to you - perhaps you're already thinking 'I never use terms without explaining them'. Take a look at these words and see if you can say the same:
chronic dose generic topical orally screening acute anomaly static intake
There may not be a single word in that list that you consider jargon or medical terminology but how often are those words used outside the health-related world and, if they are, what meaning do they hold in other contexts?
Junior professionals may rely heavily on jargon to describe processes or conditions because they lack the full working knowledge to give a basic explanation to the patient.
Even Albert Einstein knew this was no way to communicate:
"If you can't explain it simply, you don't understand it well enough."
Jargon can also be used as a barrier during potentially sensitive or difficult conversations perhaps out of a feeling of awkwardness or fear that challenging questions will be asked.
'If I bamboozle them with terminology they'll be too confused to ask me the question I dread answering.'
It certainly isn't a conscious process for most of us and it may be many years down the road before the acuity of hindsight sharpens and we can admit how many of these tendencies we succumbed to. I have a hunch that there is an inverse correlation between the number of years practicing and the level of language complexity used with patients.
What do you think?
I have suggested some possible reasons why we might start out using overly complex language with our patients and considered how this might improve with experience, but the unfortunate fact is health professionals with many years experience can continue using this style of communicating despite the best intentions.
Why does it persist in experienced health professionals?
Being desensitised to the effects on the listener
Spending many years surrounded by the language of medicine and healthcare transforms us into fully competent bilingual speakers. We do not notice the words and phrases that belong to this unique culture and peculiar language environment. Words that we were once using to sound clever are now our mother tongue and we are immune to the strangeness of them to the outside world.
We fail to see how alienating the effect is when we use them. I will use an example of a term I was constantly around when working in rehabilitation environments. It is standard practice to refer to the arm and hand, or leg and foot, as the 'upper limb' or 'lower limb' - including to patients and families.
Clinicians I greatly respected would think nothing of using this term when explaining impairments face-to-face and when writing reports to be sent to the patient. I still wince when I hear it used - for me the phrase is better suited to a coroner stood over a corpse, dictating into his machine - as it lacks any sense of a person being attached to those 'limbs'.
When used outside the professional 'tribe', terms like these not only create a depersonalised style but enhance the 'them and us' nature of the relationship - why use a foreign term for a very every-day object?
Changing just a few words can dramatically alter the tone in written formats too, take a look at these two examples:
"The case is a 50 year old smoker, who complains of emesis for 2 days, though denies any history of previous abdominal surgery."
"Mrs Jones is 50 years old, she has been vomitting for 2 days and has never had abdominal surgery."
Whilst the first example sounds cold and arrogant, the second sentence is shorter, simpler and humanises the patient, therefore appearing more compassionate.
I like this quote from Oliver Wendell Holmes Snr.
"Speak clearly, if you speak at all; carve every word before you let it fall."
There have been significant improvements over the last 20 years in health-related under-graduate teaching to address many of these issues and I am sure awareness of the importance of clear communication has improved in general but whatever the stage of our healthcare career we will always need reminders to go against the flow of the cultural tide we can find ourselves in.
What has been your experience? Let me know what you think in the comments or add your own bugbear words!
If you would like to read more about communicating in healthcare, including in written formats or presentations, why not suggest a topic for my next blog.