During a recent visit, a patient of Marvin M. Lipman, Consumer Reports’ chief medical adviser, read from notes the patient had taken during a conversation with her 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.”
Lipman says that there’s no excuse for such poor communication in a time when patients are being asked to take more responsibility for their own care. So he 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.)
With some embarrassment, the patient admitted that she had no idea what he was talking about.
Once upon a time, physicians believed that they should protect a patient from the nature and severity of 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. But if a doctor fails to communicate effectively with a patient, that person’s life could be jeopardized.
Lipman says that during training decades ago, he was steeped in jargon.
As medical students, interns and residents, he and his colleagues 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 their peers, partly to “protect” patients and partly to preserve the patients’ 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, doctors can lose the ability to explain disease in everyday words.
Nowadays, with patients housed in one- or two-bed hospital rooms, presentations are much more transparent. Lipman also insists that his students ask patients to chime in if they don’t understand something. But as a profession, doctors clearly have a way to go.
As the patient, it’s your right — and even your responsibility — to fully understand your diagnosis, your outlook and the possible treatments. Lipman offers these tips to ensure that you and your doctor are speaking the same language:
●Bring 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 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 both of you are 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.”
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.