Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Thursday, December 13, 2007

Reading and Ranting

I've seen this little toy on other blogs, and although I've played with it, I haven't publicized my results before now. But here it is:



I'm proud of this, and of the fact that according to this calculator, my office web site comes out at the elementary school reading level. Here's why: it means that I have successfully avoided the use of excessive amounts of medical and other scientific jargon, meaning that my blog is accessible (and therefore -- hopefully -- interesting and informative) to individuals without a great deal of formal advanced education. At the same time, I would hope that physicians, scientists and other professionals recognize that I am indeed "one of them." While I am perfectly able to write (and read, obviously) at a much "higher" reading level, I choose not to -- and presumably am still able to make myself understood; both on this blog and in talking with patients.

I learned in a college linguistics course that the anthropological purpose of jargon is a means of group identity; not just, as Wikipedia and "common knowledge" would have it, as a convenient shorthand. It's a "secret handshake" whose use is meant to show others in the group that you are one of them, while intentionally excluding outsiders.

Therefore physicians who use medical jargon when talking to patients are not demonstrating their superior knowledge. They aren't even just being lazy. They are flaunting the fact that they are physicians -- members of a privileged group -- and that the patient is inferior because he is not.

Jargon is not only counterproductive to effective communication, but disrespectful and rude.

12 Comments:

At Thu Dec 13, 09:43:00 AM, Blogger Lynn Price said...

Therefore physicians who use medical jargon when talking to patients are not demonstrating their superior knowledge. They aren't even just being lazy. They are flaunting the fact that they are physicians -- members of a privileged group -- and that the patient is inferior because he is not.

You know, I always suspected this but hated to think that a doc would be so transparent as to exhibit his arrogance in front of me.

A long time ago a doc gave me this long, drawn out spiel that contained no less than six twenty-five dollar words. When he finished, he folded his arms and looked at me, as if waiting for applause. So I stood up and gave him a standing ovation. Then I said, "That was lovely, doc. Now that you have that superior act out of your system, how 'bout putting it in English?"

His shoulders actually dropped...along with his jaw. Guess he hadn't met a smart ass before. I'm sure there must be a cure for it...

 
At Thu Dec 13, 11:10:00 AM, Blogger Dr. K said...

I couldn't agree more, Dino.

Lynn: bravo! I would have paid large sums of money to witness that.

 
At Thu Dec 13, 12:04:00 PM, Blogger The MSILF said...

I already try not to use jargon in my own mind for that reason - so that I stay in the habit for patients. There really is no need for most of it. But I just had a major oral exam, and they gave me an x-ray of a baby with NEC, and I pointed out, "Air in the wall of the intestine," and they jumped all over me for not saying "Pneumatosis intestinalis." Bastards.

 
At Thu Dec 13, 05:26:00 PM, Blogger Candace said...

Even worse, when the groups of MDs get together and discuss the patient in front of him. I always feel so low when that happens....feel the need to lean in and tell him what we're saying. I hate that.

 
At Thu Dec 13, 05:27:00 PM, Blogger Candace said...

BTW, I do enjoy your writing style and find it to be articulate and concise. I don't care at what level. This is a nice, relaxing page to visit with good posts.

I enjoyed the little tool.

 
At Thu Dec 13, 08:06:00 PM, Blogger jmb said...

I agree with everything you say although I do like my physician to use correct medical terms but with a lay explanation when necessary. Got to know the correct term to google you know.

As to the toy, since my blog came out at genius level I have this theory that the level is assigned in rotation for I have seen some blogs which are much more erudite than mine displaying much lower results and frankly I think you rate better than junior high school.

 
At Thu Dec 13, 09:55:00 PM, Blogger Dreaming again said...

That has been my reasoning for my blog coming out as elementary level ;).

I worry about a friend though. She says she doesn't read my blog because I use too may $10 words and it's too difficult to understand. *scratches head*

 
At Fri Dec 14, 01:31:00 AM, Blogger Christian Sinclair, MD said...

This blog reading level is a hack to promote a cash advance site. There is extra code in the widget when you post this on your site. When enough time has passed the image will no longer be there and likely be replaced with a cash advance ad.

http://scienceblogs.com/gregladen/2007/12/so_a_bunch_of_people.php

 
At Fri Dec 14, 06:13:00 AM, Blogger #1 Dinosaur said...

Christian: I removed the extra code for the cash advance site before posting it. Good to know that the image won't last, though. I'll have to add text to indicate what the image says.

 
At Fri Dec 21, 06:30:00 PM, Anonymous the educated consumer said...

What about patients speaking in jargon?

As a doctor, do you find it particularly offensive?

Are we automatically cyberchondriacs if we're able to understand our own lab reports?

I actually prefer the technical terms. It makes me very anxious when a doctor obviously talks down to me--it's hard to feel like you're getting the whole story when everything has been Mickey Moused.

I've had doctors respond in ways that suggest I've affronted them personally by speaking a little Latin, heaping on the medicalese and talking at me rapidly to intentionally try and confuse. And so I've learned to dumb myself down, to try and avoid these unflattering displays of harrumphery, but sometimes when I'm asking a question, a little sneaks out and then I'm afraid I've put another doctor on the defensive.

What gives? Do patients who know medical terms sue more frequently than the rest of the sheep? Why are doctors so touchy?

 
At Fri Dec 21, 09:16:00 PM, Blogger #1 Dinosaur said...

EdCon: I'm talking about the anthropological meaning of jargon, which is to put the patient in an inferior position. I would certainly hope that my avoidance of jargon would not be perceived as "talking down" to a patient.

If a patient started spewing jargon back at me (assuming they weren't a nurse or other medical professional; I confess when that is the case I slip a little in, but frankly it's as much to reassure them that I really am part of the club as it is giving them information) there are a couple of things I would wonder:

1) Do they really know what the words mean, and if they do, how well do they understand the concepts I'm trying to convey? You may have done a ton of internet research, but that still doesn't give you the experience and training to interpret the nuances of some of those labs and how they apply to you. That's my job.

2) Why do they feel they need to impress me? Frankly, my first thought would be that they'd had difficulties with other docs in the past, and I would try to address that issue directly.

But no, I wouldn't get touchy. And I don't generalize about patients (with terms like "sheep") either.

 
At Fri Dec 21, 11:58:00 PM, Anonymous the educated consumer said...

I think, in the anthropological sense, you answered the question I didn't quite ask very well: Is a patient stepping out of their position or walking in the doctor's shoes with the "secret" language? And is this a threat?

You were pretty clear in your entry that you, personally, don't use language in that manner; I apologize if my tone was a touch accusatory. I would expect that since you're comfortable drawing attention to this behavior, you're not an active participant. The "talking down" comment wasn't directed at you; I think I'd have done a better job if I'd have said it differently.

I guess that what I'm trying to say here is that after having a VERY minimal amount of medical education, I can appreciate that sometimes the technical terms work better than the everyday ones. Not always, but sometimes. I admit you can explain complex ideas a lot more effectively when you keep it simple and to the point. I also understand that you are the doctor and I am the patient; you are the one who has been through the ringer in order to make the important decisions. Interpreting the nuances of my labs is SO your territory. Ack! I don't want to make those decisions! That's why ~you~ make the big bucks < wink, wink >.

But as a patient I also feel it is my responsibility to understand, at least in a general sense, what they mean. Normal? High? Low? Normally high (for me) or normally low? Just something to watch for now? I think it's unreasonable for me to present myself to a doctor and say, "Here. Fix it." Rather, "Here, this is what I've been experiencing and I'm concerned because it's usually _____ and, by the way, I also noticed _____."

I feel that the more of an understanding of I have of how my body is SUPPOSED to work, the better I can help you find what isn't working when it breaks down.

Doesn't the extra information help you help me?

Especially now that medical care typically comes from ten doctors instead of just one or two like when I was a kid. Ten doctors who, in order to make a living, see lots and lots and lots of special snowflakes every day, each with their own special nuances and complexities.

What's really eating my lunch here is that I don't like the idea of exclusive, off-limits info, especially when it comes to my health. If I don't understand it all in the office, it's my job to either ask the doctor (as nicely as I can) to explain, or go home and look it up. I'm not so sure I'm trying to impress anyone, and if I were, I learned pretty quick that asking too many questions is not the way to go about it!

I also don't like the passivity I see in other patients. I guess that's why I called them sheep. They don't ask questions and they're quick to run to their doctors' offices asking for that drug they saw on TV last night. We take a lot of drugs and the pharmaceutical industry has a heavy hand in what's broken with medical care in this country. Another problem is unnecessary treatment. "Defensive medicine" comes up a lot in these blogs, so I know you know what I'm talking about. Before I got my own insurance plan, I paid everything out of my own pocket. That meant it was REALLY my job to learn what was going on if there was something wrong with me. If I made a bad choice and refused care, I could get sicker. If I wasn't discerning, I'd end up in the emergency room at 5pm on Friday for the toothache I'd had since Tuesday like we also hear about so much on these blogs. Then I'd have to pay the $2k bill. I learned to pay attention for the signs that my body was healing itself, and when to go to the doctor for medicine because that bronchitis I'd had for two weeks wasn't going anywhere on its own. We don't think this way when we know Uncle Sam or Cigna is picking up the tab. And the medical brokers in the middle are making a killing as a result. (Unfortunately, the "killed" are usually those on the bottom who don't understand how the human body works or how to ask for help when they really need it.)

(And no comment on the ones that ask for help too much. That's for another blog and another troll to deal with.)

I'm sorry to sing the healthcare-is-broken song here; I know it's done to death already. Obviously, I have a lot more opinions than I thought, and I could go on, but I think I've hijacked your comments section enough for now.

Thanks for some perspective from the other side of the line.

 

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