7 steps to better doctor-patient communication

How to ensure you and your doctor are speaking the same language

Published: April 02, 2014 11:15 AM

During a recent visit, a patient read from her notes taken during a conversation she had with a cardiologist. He had told her: “Your echocardiogram was unremarkable; the ejection fraction was 68 percent. There was no LVH. All of your laboratory tests were negative. I’ll send a note to your doctor.” With some embarrassment, she admitted that she had no idea what he was talking about.

There’s no excuse for such poor communication in this day and age when patients are being asked to take more responsibility for their own care. So I provided a translation: An echo­cardiogram is a moving image of the heart, and “unremarkable” meant that it looked the way it’s supposed to. The “ejection fraction” referred to the amount of blood the heart puts out with each beat (68 percent is normal). “No LVH” meant that the muscle of her heart’s left ventricle wasn’t abnormally thick. And “negative” lab results meant that the tests were normal. (A positive result would have meant there was a problem.)

Why doctors talk that way

Once upon a time, physicians believed that they should protect a patient’s delicate frame of mind by shielding her from the nature and severity of her illness. They accomplished this by using language that seemed deliberately designed to keep patients in the dark. It’s true that every profession has its own lingo (a legal contract or a paper on theoretical physics is hardly my idea of bedtime reading). But if a doctor fails to communicate effectively with a patient, that person’s life could be jeopardized.

During my training decades ago, I was steeped in jargon. As medical students, interns, and residents, we would actually compete to see who could best narrate a patient’s history and physical exam in the most obscure terms when presenting cases to the distinguished professors on hospital bedside rounds. That was partly to impress our peers, partly to “protect” patients, and partly to preserve their privacy on the open wards, which were commonplace at the time. Thus, a 58-year-old mother of two (whose own mother had had breast cancer), who was having drenching night sweats and intermittent fever, became a 58-year-old gravida 2, para 2 female with FHx of maternal mammary metaplasia who was having severe nocturnal diaphoresis accompanied by febrile episodes. Little wonder that after seven or more years of medical school, house-staff training, reading medical journals, and attending medical meetings, we gradually lose the ability to explain disease in everyday words.

Nowadays, with patients housed in the privacy of one- or two-bed hospital rooms, presentations are much more transparent. I also insist that my students ask patients to chime in if they don’t understand something. But as a profession, we clearly have a way to go.

7 steps to understanding your doctor

As the patient, it’s your right—and even your responsibility—to fully understand your diagnosis, your outlook, and the possible treatments in terms that are comprehensible. Here are a few tips to ensure that you and your doctor are speaking the same language.

  • Take someone with you, especially if the purpose of the visit is to discuss test results or treatments. A second pair of ears or, better yet, another mouth to ask questions, can be invaluable in such emotionally fraught situations.
  • Take notes or ask permission to record the conversation.
  • Don’t be intimidated. If there’s something you don’t under­stand, interrupt to ask for an explanation in plain English. (You are legally entitled to an interpreter if you don’t understand English.)
  • Never nod your head or give any other indication that you understand something if you really don’t.
  • Ask for references or online sources so you can read up on the diagnosis or treatment.
  • Repeat what you think you heard so that your doctor will know whether you’re both on the same page. That recap might be the most important tool you have to avoid miscommunication or misunderstanding.
  • Leave the door open for anything you may have forgotten by saying, “If I have any questions, I will call or use the online patient portal.”

Marvin Lipman, M.D.

Chief Medical Adviser and Medical Editor
Editor's Note:

This article also appeared in the April 2014 issue of Consumer Reports on Health.

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