In Healthcare, Words, Words, Words:Do We Understand Them?
I attended a lecture today given by Tina Castanares, M.D. for the Providence Healthcare System on the medical/social issues regarding access to care for Latino immigrants. Many of the immigrants know no English or understand English only poorly. She suggested that physicians and other healthcare providers who care for these immigrants should be cautioned not to take for granted that the patient would understand many words that are casually spoken to them as part of professionals discussing the immigrant's care and disposition.
What struck me was that besides Latino immigrants, I am not sure that the English speaking non-immigrants, one born and living all their life in the United States really know what these same words fully mean and represent. By the way, many of the words are readily used in other countries. I decided to create this thread to find out what words that are commonly used in healthcare mean to my U.S. and foreign English reading visitors. Let me know which words are unknown, ill-defined, mis-defined, misunderstood. About which particular words should professionals talking with patients be made aware that the patient may not understand. Good communication is an essential component of healthcare. In terms of potential benefit to the patient, good communication may be as valuable as the drug prescribed as therapy.
Here are the words as Dr. Castanares listed them:
"hospice, palliative care,comfort care,futile care,risks of care,ubiquity of medical error, assisted living,adult foster home, medical social workers, discharge planning,home health,gatekeepers,primary care, care coordination,case management, withdrawal or withholding of life support, patient's rights, ethics, advance directive,POLST,healthcare representative, decisionmaking capacity,informed consent,HIPAA, privacy, confidentiality, records release, intensive care, resusitation"
Words,words,words.. but do we really understand them? ..Maurice.
Addendum 8-4-2008: You may be interested in reading another thread about the new medical care words that patients must learn including a link to a quiz testing your knowledge.
posted by Maurice Bernstein, M.D. @ 3:45:00 PM
6 comments
6 Comments:
As a palliative care physician, I am constantly explaining my role as a consultant as well as that of my palliative care team. Regardless of original language or presence of translator, I do not let the words hospice or palliative care hand without explanation of what they mean.
Now some of the other words you listed, I think many native english people understand but they may have different meanings to different people. Take for example 'social worker.' Many people wrongly see a very narrow definition of a social worker, like someone who takes kids away or is just to help poor people. Social workers have a broad range of skills for complex situations, but they often are misclassified and therefore may not always be accessed as well.
Great points as always Maurice.
I agree. It might seem a case of the pot calling the kettle black (I am philosophy we always use difficult words) but when was young, coming from a medical family I was bewildered by the long titles given to hospital depts. The only one in Britain which is transparent ids "Ear Nose and Throat".
As a physician assistant I am often put in the position of explaining these things. I find that it is always best to explain to the patient any medically specific terminology. Sometimes I feel like I'm talking down to them like they are idiots and on rare occasion the patient will call me out on this fact. They always forgive me when I explain that a lot of people may not understand the language, which often has the effect of stroking the patient's ego. Basically I talk to everybody as if they have no knowledge at all. It's a little more tedious and time consuming but it works for me.
As a pharmacist I have to look at the thought process going on in the patient's mind when I mention words like topical antibiotic, decongestant, etc. However, it is my opinion that if a person/family is in America and wants to live here semi-permanently or even permanently - they need to have be English proficient in order to access the healthcare system. I've had several issues with people (even WITH translators) in which we've had a negative outcome due to a language barrier. The really horrific thing is that I could have been sued for something that was NOT my fault. Pharmacy schools (in America) teach in English and we have to show a proficiency in English. We've done our patients/communities a disservice if we don't encourage assimilation into our culture. We need to embrace our own language and encourage those who chose to live here and access healthcare to show some personal responsibility and learn the language to the best of their ability.
I don't think the average, intelligent consumer understands the healthcare system or all of it's nomenclature. Then a life crisis occurs and the family members and loved ones and thrown into this "whole new world." It then becomes a "quick" learning curve coupled with the heart wrenching emotions of having your loved one ill. It is almost too much to endure.
Over the last 20 years the different organizations and special training and certifications have bombarded the system. You have to have a reference card with you to read all the initials listed after a persons name anymore. Maybe it's getting a little over-done and ridiculous!
I'm honored to have helped launch this inquiry and thread and I completely agree with Maurice in raising the question as to whether ANYONE really understands such jargon. I love the movie PHILADELPHIA, in which the plaintiff's personal injury lawyer, played by Denzel Washington, is always saying (disarmingly), "Explain it to me as if I were a 3rd grader." If we all did that sort of thing -- that is, with technical language at least -- it sure would enhance understanding and, consequently, civic participation, effective decisionmaking, and more.
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