by Sarah Teasdale, MD
She was at home with her 4-year-old who had a sore throat and was throwing up. I could hear my niece retching in the background, the dog was barking and her infant son crying. My sister was worried and needed reassurance. I was in medical mode, speaking in technical terms: ‘Is she febrile? Is the emesis bloody or bilious? Any sick contacts?” I was making her more nervous. A dish fell to the floor on the other end of the phone and my sister sighed. “I’m just going to call mom.” She hung up.
My sister has plenty of education, and as a journalist she has a large vocabulary. She knows what the word “febrile” means, but she wanted me to say “fever.” She wanted the clearest possible language because, in the middle of all the vomiting, crying and barking, she had no time to focus on translation.
All professions have a language. It’s an essential part of effectively communicating with our colleagues about our area of expertise. I don’t understand my car mechanic half the time; he uses terms I’ve never heard. Usually I’m okay with that, especially when he fixes something. If the news is good, I don’t care so much about how we got there. But when the news isn’t good, the conversation gets more complicated. He starts using more words I don’t understand and our ability to communicate unravels. My interpretation is that he’s saying, “I get this; you don’t, so stop asking.”
Too often I’ve heard physicians–including myself–sound as if we mean “I get this; you don’t, so stop asking” when we’re really just not doing a good job of translating our jargon. Unlike my car mechanic, who I’m fairly sure does look down on me for not getting the inner workings of my Volkswagen, our barriers to effective communication with patients are rarely intended. We retreat to the safety of our medical language because it’s what we know. The problem is when we don’t realize we’ve lost our audience.
I recently supervised a first year resident talking with parents about their newborn infant who was admitted with a fever. “The CBC and the CSF look good. But we still need to cover him with the amp and gent until tomorrow,” he said.
The parents looked a little nervous.
“Do you have any questions?” the resident asked.
I asked the resident afterward what he thought the parents understood. His response: that the lab results seem to show there is no infection but that we need to continue the antibiotics. When I saw the parents a few hours later, I asked them about this conversation, if they understood the resident.
“I guess he said he’s doing ok”, they said. “But is “ampengent” that monitor? We would like it turned off if possible, it beeps a lot.”
Apparently all they understood from the initial conversation was “good, but…”
I explained that “amp” is ampicillin, and “gent” gentamycin, the two antibiotics the infant was receiving given the high risk of severe infection in a baby so young. I said that we continue them until the tests from his blood, the fluid around his brain (his “CSF, or cerebrospinal fluid), and his urine show us no bacteria is growing. The parents laughed, maybe a little embarrassed by their error but relieved that all was still going well.
I’m not sure that clarification added much. The parents were pleased with the care. Parents often don’t have questions when the news is good, but they want to know more when there is cause for worry. This is where translation is essential, and where there’s the greatest danger for doctors to shut patients down with shop talk. This is where my car mechanic starts talking about rotors and alignment, and I stop asking questions and think about getting a new mechanic. The key here is that the translation is a dual responsibility: If I don’t get it, I need to speak up. Similarly, patients have to hold physicians responsible for speaking a common language.
The majority of physicians with whom I work are skilled at translation, and they do it without being asked. The best clinicians I have encountered are able to make even the most detailed medical information into a story their patients can follow, regardless of age or level of literacy. They don’t dumb down their language, they speak in lay person’s terms, translating complicated clinical concepts into plain, simple English. It’s a mark of great respect for their patients, and the opposite of “I get this, you don’t, so stop asking.”
That’s the reassurance my sister was looking for.