We began our discussion with sharing what words we commonly use in each of our particular specialties that may not be understood readily by our patients. Many mentioned anatomic names of the part of the body we care for such as thyroid, esophagus, a variety of bone or muscle names. Then there are the multitude of procedural names that are part and parcel of our practice that are completely unfamiliar. In addition the names many conditions and diseases are often new to many patients. All of these things are readily understood when we speak with our colleagues but when we are discussing these with a patient if we do not explain the nomenclature it is as if we are speaking in a foreign language. Paul had something to say about the value of speaking in a language that is readily understood in 1 Cor. 14:6-11. We discussed how this passage relates to how we speak with patients. Paul’s point is that speaking in tongues is a wonderful gift of the spirit but if your purpose is to edify and instruct we must speak in a language that everyone understands. We therefore spent the evening discussing the importance of clarity in speaking with patients and the road blocks to good communication.
We then shared some instances in our own practice when we sometimes have found ourselves “speaking in tongues” with our patients. We discussed why a physician might use terms and jargon on a regular basis. Some of the reasons that were mentioned were that medical practice places doctors in a authoritarian role and jargon can help support that feeling of authority. Likewise, sometimes a physician feels superior to his or her patients either because of his/her societal position or the perceived lower financial status or class of the patient.. Using medical terminology might reinforce their need to feel superior. The time crunch of modern medical practice was also mentioned. Trying to see a volume of patients over a limited time period with the added burden of filling out EMR records often cuts the available time to explain everything as carefully and fully as one would like. Using terminology and not stopping to explain shortens the encounter.
We then discussed other factors/tendencies that inhibit good communication. Again lack of adequate time was mentioned. This can also lead to failure to listen carefully to the patient’s complaints or answer their questions fully. Instances in which a patient brings a page or two of questions were mentioned as a trying encounter in which maximal patience is needed to insure the door of communications stays open. We mentioned that some doctors do not have good communication skills. Several instances in which we have witness this were related. We talked about the importance of teaching our residents in training not only medical and surgical care but also how to speak effectively with patients. Also, there are a variety of patient factors that play a role in blocking communication. Patients are often anxious and feel vulnerable, particularly at their first visit to the doctor. They do not know what to expect as far as the questions they need to answer and what the examination may involve. Patients are often frightened about their diagnosis or what surgery they may need to undergo. All these emotions can block their receptive ability to partake meaningfully in the conversation with the doctor. Patients sometimes feel inhibited in asking questions for fear that they will be thought of as ignorant. This can particularly come true if the doctor spoke to them using much of the terminology we have mentioned. Another factor that may block meaningful communication is the level of literacy of a patient. Many of us utilize pamphlets and and other written materials with our patients regularly. Yet, studies show that as many as 18% of patients are either illiterate or have such low reading ability that they can not function easily in society without help. Most of us are not very attuned to this issue and the patients are usually too embarrassed to admit to the problem. Lastly, we talked about the difficulty in caring for patients who do not speak english at all. The time crunch factor again came up since everything said must be translated and there is often a tendency to limit the amount of information shared simply because of the translation burden.
Yet we all agreed that all of these factors much be dealt with to ensure our patients receive the care they are entitled to. We talked about the benefits of a well-informed patient. We mentioned that when communication is well done patient satisfaction rises, the patient compliance with their medications and instructions increases and studies have shown the patient has an overall better outcome. We then shared ways we could be better communicators. The keys to recognize a patient that may have literacy problems were mentioned. Building into our schedule additional time when a foreign language patient is coming in is an important enhancer of quality care.
Lastly, we read 1 Cor. 14:19 in which Paul states he would rather speak five intelligible words to instruct others than five thousand in a tongue. If what we are saying is not understood clearly we are wasting our time. As Christian Physicians we are called care for each and every patient to the best of our ability to fulfill the calling on our life. Therefore it is imperative we strive for clarity in every patient interaction.