I just love this. Which is to say I don’t love it at all – you need to imagine the sneer in my voice if I were actually saying that out loud to you. What I don’t love at all is this example of a real life physician (a cardiac surgeon in Indiana) who is answering a patient’s online question on the website called HealthTap (a site that appears at first blush to be about medical Q&A, but is actually more like a matchmaking service between doctor-shopping patients and the doctors who want to woo them).
The patient asks HealthTap:
“What caused my arm pain during my recent heart attack?”
And the cardiac surgeon replies to the patient:
“The pericardium is innervated by C3,4,5 (Phrenic nerve). There may be some neuronal connections to the intercostobrachial nerves.”
So my follow-up question to this cardiac surgeon would be something like:
“Are you frickety-frackin’ kidding me?”
A distressingly large number of people who have the letters M.D. after their names actually say these kinds of things out loud (or online) to those who have never been to medical school (a.k.a. “patients”).
And worse, even patient education materials made available to those needing to learn more about a specific medical condition can be so jargon-heavy that it makes such material virtually useless to the average patient. Online resources can be even more confusing.
That’s what New Jersey researchers led by Dr. Charles Prestigiacomo found when they used a number of readability scales to test materials published by 16 different medical specialty societies, specifically looking at how challenging these materials were to read.*
Easy readability is important, particularly for health messages, because their complexity can be an impossible barrier for those of us among the great unwashed who need this information. According to the Centers for Disease Control and Prevention, nearly nine out of 10 adults have difficulty following routine medical advice, largely because it’s often incomprehensible unless you’ve been to medical school.
But even those who have been to med school are not immune to being baffled by medical bafflegab, as neurologist Dr. Richard Senelick found out when he accompanied his wife to her medical appointment. He wrote:**
“As my colleague rattled off a detailed explanation of ‘pH, calcium metabolism, oxalate ratios and the effect of citrate,’ I realized that even I didn’t have a clue what he was talking about.
“Unfortunately, like most patients and families, I didn’t want to show my ignorance, so I sat quietly and nodded my head. As we walked to our car, I was unable to explain the results to my wife. I did not have a clue.
“I was the poster boy for the fact that inadequate ‘health literacy’ is not restricted to the poorly educated.”
That’s why an increasing number of government agencies are now pushing public health professionals, doctors and insurers to simplify the language they use to communicate with the public in all patient handouts, medical forms and health websites.
My favourite readability scale used in the New Jersey study, by the way, has been in use since 1969 and is called “SMOG grading” – which stands for “Simple Measure Of Gobbledygook”.
Now, that I DO love!
In fact, the Royal College of Physicians of Edinburgh suggested in 2010:
“Web developers should consider routine monitoring of content readability with SMOG to increase the accessibility and ease of comprehension of online consumer-oriented health care information.”
Dr. Ivan Oransky reported on the New Jersey study recently in Pacific Standard magazine, in which he wrote:
“The average reading level of the online materials by groups ranging from the American Society of Anesthesiologists to the American Psychiatric Association fell anywhere from ninth grade to the sophomore year of college.
“That’s far above the fourth-to-sixth grade level recommended by the American Medical Association and by a number of government agencies.”
In an ironic and unintended example of what the researchers were highlighting, one of the study’s authors told Reuters Health:
“We might not be cognizant of the population reading our articles, who might need something more simple.”
Okay, according to my own unofficial SMOG grading system, using words like “cognizant” immediately identifies you as a person who is not cognizant of the population reading that statement. Or, as one of my former editors liked to say:
“Never use a twenty-five cent word when a nickel word will do!”
As study author Dr. Prestigiacomo said in his interview with Dr. Oransky, using simple analogies can be an effective way to cut through the clutter of scientific jargon to make medical information easier to understand. For example:
“There are only so many ways you can describe an aneurysm. I tell patients such ballooning blood vessels are ‘like a blister on a tire.’
“The problem is that it’s not quite perfectly accurate. But sometimes we have to realize that simplifying it to an analogy may be the best way for patients to understand it.”
Dr. Oransky also quotes Dr. Lisa Gualtieri, a Harvard-trained assistant professor at Tufts University School of Medicine. She teaches courses like Online Consumer Health and Digital Strategies for Health Communication. Her take on the New Jersey study:
“The organizations represented should be happy that people are visiting their websites. It’s high-quality, reliable information, and there’s a lot out there that isn’t.
“But they often use jargon. They end up using the language they’re accustomed to as opposed to (the language) the people they’re trying to reach are accustomed to using.
“You have to think about reaching people where they are.”
Dr. Gualtieri also told Reuters Health that she recommends that those who produce such materials consider why people are coming to their sites in the first place, and what they’re looking for. She echoed the study authors’ suggestion that such sites also use pictures and videos.
Remember Dr. Richard Senelick and his story of being stumped by medical jargon during his wife’s appointment? Here’s his very useful list of tips on how to get your own doctor to stop using jargon:**
- If you do not understand what your doctor is saying, immediately stop them and ask them to use simpler language. Don’t pretend that you understand when you do not.
- Be assertive, but friendly. Let them know if you still have questions.
- Tell the doctor what you think they said to be certain that you understood them. This is called a “teach back.”
- If you feel you need more time, ask to schedule another visit in the near future.
- If the doctor is very busy, ask if there is a nurse or assistant who can answer your questions.
- Take a friend with you for another set of ears and always take notes.
- Ask who you can call if you still have questions when you get home.
* Charles Prestigiacomo, MD et al: “A Comparative Analysis of the Quality of Patient Education Materials From Medical Specialties.” JAMA Internal Medicine. May 20, 2013.
** Dr. Richard Senelick, MD: “Get Your Doctor To Stop Using Medical Jargon”. Huffington Post. April 25, 2012.
This was picked up as a guest post by The Center for Advancing Health’s Prepared Patient Forum on November 14, 2013
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